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What is one thing that every woman on the planet has but nobody wants to talk about? It's periods, period. Actually, women talk about their periods a lot, but they don't use that word "menstruation." They don't say, "My menses has come," or they might say, "My period has come." But all over the world, in many cultures, people use other words. One study looked and found more than 5,000 different slang or euphemistic expressions or phrases for their periods.

What's my favorite? My favorite is the French who use les anglais ont débarqué, and that means "the English have landed." Now, that's quite a phrase for having your period come, and it tells you a lot about what the French think about the British.

We as mammals have a process of building up the uterus lining so that we can grow our babies inside. We are the only mammal, as humans, that actually sheds the lining in such an obvious way. The animals that we share our DNA with, and that's the higher primates, chimpanzees, gorillas, they usually don't bleed all that much unless they have a problem or a cancer, whereas humans, compared to all other species on the planet, bleed a fair bit, and they bleed when they're shedding the lining and getting ready to start a new menstrual cycle when they're not pregnant.

Now, this has been going on for millennia that we have been humans. However, thousands of years ago, women rarely had their periods because they rarely ovulated. When women were starving or breastfeeding, which we were most of the time when we were hunter-gatherers, we didn't have much periods. So we didn't bleed very much. But over the last couple hundred years, since the Industrial Revolution, we are mostly well fed. We don't breastfeed for four years.

Many of you know, who have periods, that you can modify your periods and make them lighter by using some contraceptive methods that are quite healthy. We know that women who use birth control pills have periods that are about 80% or half of their periods when they're not on birth control pills. And some IUDs have very light periods or no periods at all. Women may choose these methods specifically for the way they modify their periods. So periods can be lighter and less painful by using contraceptive methods.

Okay. We're going to get ready for this week's medical mystery. And my producer, Chloé, is here in the studio and she's going to give me a person and some symptoms, and I'm going to try to figure it out.

Chloé: So this person just stopped having her period.

Dr. Jones: Okay. And she's how old?

Chloé: Late 20s.

Dr. Jones: Late 20s. First of all, has she gained or lost a lot of weight?

Chloé: So she hasn't had any weight loss. She hasn't been pregnant. She's, for the most part, had pretty normal periods.

Dr. Jones: Okay. How about exercise? Is she an endurance athlete or an elite athlete?

Chloé: She's not Olympian, but let's say she keeps active maybe a few, three hours a week of physical activity a week. Not much.

Dr. Jones: Okay. Not really very much. Okay. I'm not worried about that. All right. Now, has she had any surgery on her cervix or her uterus that might have caused a blockage or anything?

Chloé: No. No major surgeries.

Dr. Jones: Okay. Tell me about her past medical history. Has she had any serious medical illnesses?

Chloé: I'm going to say that she doesn't know because she doesn't talk to her family. So no medical history—no family medical history. No.

Dr. Jones: How about for herself, though? Her own medical history. Any severe medical illnesses in her past?

Chloé: So she had cancer when she was a teenager around maybe 14, 13 years old. She did get treatment. She did get cured, and her period did stop for a little bit after that, but it's back to normal, or it was until it stopped.

Dr. Jones: I have a very strong suspicion here, and here's how it goes. When periods stop, we think about outflow track, something having damaged the uterus or the cervix. That didn't happen to her.

We think about weight gain and weight loss or a lot of exercise. Elite athletes or endurance athletes can interrupt the process of getting ovulating, and she doesn't have that.

The biggest thing is she had chemotherapy for a cancer, which she's cured for, but we know that chemotherapy can damage the number of eggs that she has. And even though she got her periods back, she probably still didn't have that many eggs left. Now, she's run out.

I think she has premature ovarian failure. Her ovaries have run out of eggs, not at 50 when most women do, but early. What we're going to do is going to get a blood test. It's pretty simple. I'm going to get an FSH level, follicle-stimulating hormone. If it comes back elevated, meaning she doesn't have any eggs left, then we're going to talk about where do we go from here to help her with her estrogens and help her have a baby someday.

"Do I have enough pads for my next period?" "Where have I stashed them?" "Do I have them in my purse?" "Do I have them in the house?"

Women have a lot of periods, and there's a whole industry that's been built up around this. There are methods that women use to control their menstrual flow or manage it. So menstrual products are a huge billion-dollar industry, but why do we always show commercials for women having their periods or women in these tight white pants when that's our ultimate fear? I think that we should be more real that this is a perfectly natural phenomenon.

And can you afford them? That's the financial aspect. The fact that you have to buy these products, and they can be pretty difficult. Not having the equipment, not having the protection can be pretty frustrating. Financially, not being able to afford your products can be very difficult. And there have been some movements around the country to try to make products for women who are homeless. When we think about women not being able to afford food, they certainly won't be able to afford their menstrual products. So being able to afford menstrual products is an important thing.

Polly Wiessner is a professor in anthropology at the University of Utah and at Arizona State who spent some time in two very different cultures. She's going to help us unwind some issues about periods in other countries.

Dr. Jones: Now, Polly, it's important for us to think about how long you've been following these cultures. Some people go for a two-week little trip to try to see stuff, but you've been following these cultures you're going to be talking about for how long?

Prof. Wiessner: I've worked with the Kalahari Bushmen for over 40 years and with the Enga of highland Papua New Guinea for 30 years, so a lot of experience.

Dr. Jones: Right. So you've seen a lot.

Prof. Wiessner: Yeah. One could say that human beings, culturally, what they elaborate on the most is food, sex, and things related to body fluids. So you have an enormous amount of variation. But I'll talk about menstruation in the two societies where I work, which have really diametrically opposite views. But in most cases, with menstrual blood in many societies, it is assumed that men have to be careful about it.

So, in the Bushmen, there's a lot of ritual around a girl's first menstruation. Menstruation is supposed to show the transition to adulthood. It's supposed to promote health, fertility, and so on. When she's finished menstruating . . . and she has to go through all these taboos with food, with not touching the ground, not seeing the sun, which is scorching and drying. When she's finished, she gets a ritual bath and then her face is painted with red okra so she looks beautiful, and she's showered with gifts and beads.

And come out and really praised in all possible ways. But after that, there are very few beliefs about menstrual blood, except a woman who is menstruating cannot touch a man's hunting equipment or go near a hunter because it's believed to interfere with his hunting success.

Dr. Jones: How about the Enga? How about the people in New Guinea?

Prof. Wiessner: Oh, the Enga, it's just opposite. They believe that female menstrual blood contaminates men, and if men have contact with menstrual blood, or if men take food cooked by a menstruating woman, they will decline in strength, get weak, and their wits will be greatly diminished. And so that's why they have men's and women's houses.

In the women's houses, you have a room where men can go in the front and a place where women sleep at the back. When they menstruate, they have to retire and sit in the pig stalls, and then they go out at night or when they're not likely to see people.

However, as you know, women tend to menstruate at the same time, so I think sometimes they have a lot of fun together because they don't have to do much work in that time. They get some rest. Then when they come out, however, in some parts of Enga, the women, to dispose of their menstrual wastes, go to the forest and they do all sorts of rituals that will promote their husbands' prowess in warfare, hunting success, success in exchange. So they are able to use their menstrual blood to benefit men if they handle the aspect of staying away and contamination properly.

You see, the beliefs are very different, but they always have some beliefs of how menstrual blood can affect men and beliefs about menstrual blood promoting fertility, the health, everything, the beauty of women.

Most women would say they feel different before their period is coming. This may be very difficult emotionally because they may be angry. They may be frustrated because they have pain and they lose time from work. Maybe they're more irritable or they're not sleeping as well.

Adolescents who don't understand it, who can barely control their emotions anyway, may get particularly difficult during their period. And I've seen a number of patients who are developmentally delayed for whom having a period is frightening. Blood is frightening, and the emotional changes lead them to be uncontrollable in their family environment, and their parents may actually bring them to me to stop their periods.

Premenstrual syndrome is common, and it is troublesome for women and the people who live with them. Recognizing that you have this and you have a predictable emotional pattern in the week before your period is very important.

• Identify why you're feeling irritable or depressed
• Understand what helps you feel better
• Eat well
• Get exercise
• There are medications that can help with premenstrual dysphoric disorder, or PMDD

Another emotional response to the menses, to the period, is for people who try desperately to become pregnant, and the sign that the period is coming is a sign that they have not succeeded. Women who've been through an enormous input of time and effort and physical trouble by doing an IVF cycle, understanding that their in vitro fertilization process has not worked, because their period has come, can bring a profound sense of failure and depression.

For many women, even though their periods can be frustrating, no matter what their periods might be and what their social and cultural norms may be, their period is a reminder monthly that they are female, that they are fertile. And all around the world, having your period is a reminder of this incredible gift that we have to be able to have children.

Many women say, "This is part of what every woman does on the planet. It ties me to my mother and to my daughter." It's something we share. It's part of the biological rhythm of life. And it's a rather profound rhythm, this monthly lunar rhythm. So it makes us often feel like we're part of something much bigger, and isn't that the very core of spirituality?

But where do you find and keep your spiritual home when you live in a body you don't believe in? For women or men who are going to be trans men, the period is a reminder that this is a body they don't love. This is a future and a foundation that they don't share. So every woman is going to have a very unique and special relationship with her periods.

So the spiritual domain is a powerful one because, certainly, many faiths tell us how we should feel about our periods, but we should feel the way that we feel about our own bodies.

I don't want our listeners to think, men and women, that because women have periods that actually closes down their life and they bleed to death and things are awful, because, in fact, women do their whole lives bleeding. So there's a great song, "Anything you can do, I can do better," and anything you can do, I can do bleeding. Women carrying on their lives while they're doing this menstrual thing and you don't know.

So, ladies, let's think about three things that are good for you during your period.

1. When blood comes out, that bright red comes from iron. Iron is important supplement in your diet. Most women actually don't eat enough iron, and you can get iron through meat. If you're not a meat-eater, you can take it through leafy vegetables. And if you're having difficulty with both of those, then adding a supplement that has some iron can be useful to keep your iron up, particularly if you have heavy periods.

2. You should take care of yourself. This is a time that's very personal to you. If it means that you need some time out and you need a little quiet time, if you have really crampy periods, give yourself a break already and take some time for yourself. If that means going for a walk, it turns out that exercise makes period cramps not so bad. So go for a walk. Take some time for yourself.

3. You should celebrate yourself. Every woman on the planet has periods. It's not such a bad thing. It could be bad, but it's not necessarily a bad thing. Celebrate this as a sign of your femininity. It's a sign of potential fertility, even if you don't want children, and it is a sign of your overall physical health. It means that you're young. You're not an old lady. You're not a little kid. You're a real live woman and good on you.

Sad when it shows up
Happy when it stops or not
Red can rule our lives

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Interviewer: So your period came early or maybe it's late. Maybe there's too much, too little. It's just not normal, or is it?

Dr. Jones, so I don't think my period is normal. Let me explain...

Dr. Jones: Please explain.

Interviewer: So I'm 28, I know I'm not pregnant, I know I'm not at that point where it should just go away, but it came earlier than expected by two weeks. Is this normal?

Dr. Jones: Well, I'm glad you told me you're 28 because periods are irregular predictably at the beginning right after you start your periods and at the very end of menopause and you don't follow that. And of course there's some birth control methods and you said you're not pregnant, but you didn't tell me about the birth control method you're on. But some birth control methods make for irregular bleeding.

So what's abnormal menstruation? And that would be periods that occur less than 21 days or more than 35 days apart. If you miss your periods for more than three cycles, flow that's much heavier or lighter than usual, periods that last longer than seven days, periods that are accompanied by severe pain, cramping or nausea or bleeding or spotting that happens between your periods or with sex.

You said they came two weeks early. Now, that would be probably less than 21 days, so it means this period was abnormal. But you don't have to see a doctor for this unless it happens all the time or unless you're pregnant. So what do you have to see a doctor for?

If the period is so heavy that you're dizzy and you can't live your life, you might be anemic. You need to see a doctor. So crampy or painful that you can't live your life, you need to see a doctor. Persistent spotting between your periods or with sex could be an infection or could be cancer, you need to see a doctor. Too irregular, meaning close within 21 days or farther than 35 days, if you're trying to get pregnant because you're not going to get pregnant if your periods are too wacky, or if you have any kind of abnormal bleeding and there's a chance that you're pregnant, you need to know because there could be a problem. So one period two weeks early, you're not pregnant, you're only 28, let's see what happens next cycle.

Interviewer: Going through down your list, all of this stuff seems normal. Just happened that one time. Why did it happen that one time?

Dr. Jones: Well, the problem is we won't know why it happens just one time because next time it's going to be normal. So if it happens just one time, stress can happen. If you just didn't ovulate that cycle because you stayed up too late or you went on a big trip or you broke up with your boyfriend or you suddenly gained weight or you've been on a big diet and you've lost weight, all those things can interfere with your normal ovulation. If it happens once, no big deal. If it happens three times, that's a deal and we'll work it up.

updated: February 4, 2021
originally published: October 25, 2018

Dr. Jones: You or someone in your house has painful menstrual cramps. What can you do without going to the drugstore or seeing a professional? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health and this is The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Menstrual cramps seem to be a uniquely human problem, well female human problem. Of course, part of that is because only primates have a menstrual cycle. Other animals have other biology and don't have nearly as many cycles and even other primates, chimpanzees and gorillas, don't seem to bleed as much or suffer cramps as much as we do.

About two weeks after ovulation if we don't become pregnant, the hormones from the ovary that would have supported an early pregnancy, progesterone or pregnancy, starts to fall and the uterus makes another local hormone called prostaglandins that causes the uterus to cramp, the blood vessels to constrict, and push out the old uterine lining to make way for the new with a bunch of blood that doesn't really seem necessary.

So what can you do right now? A hot but not too hot water bottle on your lower abdomen can be soothing or on your back if you primarily feel the cramps in your back. This was used by our mothers and probably their mothers. It doesn't really heat up your uterus but thermally stimulating the skin can distract other nerve pathways involving pain. Using this principle, a new take on an old device called a transcutaneous nerve stimulator that's been used for chronic back pain, might be useful for period cramps. But we're talking about right here and right now in a hot water bottle or a hot towel and a plastic bag is available to everyone but remember not too hot. Many women get in a hot bath tub and find this is helpful.

Well, what else right now? Well, believe it or not, exercise helps period cramps. Get out and move. A vigorous walk or ride or jog actually decreases the perception of menstrual pain for many women. Of course, if you never do these things, doing them now could be more painful but it will distract you from your cramps. Women who exercise regularly have less perception of menstrual pain, so for right now get up and move and if that doesn't work for you, go get that hot water bottle.

For women who have menstrual periods regularly, there are some habits that may decrease your pain. Some studies have found that decreasing fat in the diet significantly decreasing fat and particularly animal fat can lead to less painful periods. It won't work for you today, but it could be helpful for your next period.

Now personally and scientifically, I wouldn't say that supplements, substances you get in a pill at the health food store, are natural, but some studies found that fish oil decreased the intensity of menstrual cramps. It takes a lot of fish oil, about five pills a day.

A Danish study found that fish oil in combination with vitamin B12 worked better than other oils or placebo. Interestingly the women in the study were women who were chosen because they had bad period cramps. These women had low levels of omega-3 fatty acids in their diet compared to other Danish women. So all of the recommendation for decreasing period cramps is to decrease that in the diet, it may be all about the kinds of fat, less omega-6 from animal and dairy fats, which are associated with inflammation and prostaglandins and more omega-3s from nuts, fish, and seeds, which are anti-inflammatory.

Taking supplements may feel natural to some women but what's in the supplement may not be natural at all and they may contaminant, so be careful. The best choice may come down to dietary choices of low sugar and fat diets with seeds, nuts, and beans as the carbs and healthy oils and fish for the fat.

Of course the category of over-the-counter medicines called NSAIDs, non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen, all work to stop the production of prostaglandins, which cause the cramps. But we're talking about home remedies today.

Remember aspirin was originally isolated from willow bark and teas made from the bark of trees in the willow family have been used by many indigenous peoples to treat pain. Some herbal teas that claim to help period cramps may have some of these substances in them.

So these are some of things you try at home and a few options from the health food store and from the pharmacy section of your grocery store. But two things to consider, if your periods never used to be painful when you were younger and now are increasingly painful or heavy, it's important to see your clinician. Some diseases in the pelvis like endometriosis or fibroids in the uterus can grow and lead to increasingly painful periods.

In medicine we divide painful periods into two categories -- primary painful dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea refers to the menstrual cramps that started in early teen hood, the periods were always painful. The good news about primary dysmenorrhea is it gets better as women get older or maybe we just cope with it better.

Secondary dysmenorrhea means you didn't use to have cramps when you were younger and now you do. Secondary dysmenorrhea if it interferes with your daily activity, warrants a visit to your gynecologist.

Lastly if your painful periods interfere with your life and your home remedies and over the counter remedies aren't working, we as gynecologists have some options that are very helpful. Give us a call and thanks for joining us on The Scope.

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Announcer: Questions every woman wonders about her health, body, and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking with women's expert Kirtly Parker Jones. She's the expert on all things woman. Here is the scenario, Dr. Jones, it is that time of the month and I know menstrual cramps are normal. I know that. But for whatever reason, it just feels more painful this time compared to any other time. Or so it seems like. I know I won't die for menstrual cramps, but it feels pretty darn close. Am I normal?

Dr. Jones: Okay. First of all, let's talk about how common period cramps are and that is about 16 percent to 90 percent of women have cramps. So that's a big range, depends on which study you do. Of those people, about 2 percent to 29 percent of them have severe dysmenorrhea, meaning severe pain, enough that it disrupts their life.

Well, why would one period be different than the other? Well, it could be the amount of exercise you had. It could have been how much sleep you had. It could have been your pain tolerance. Maybe your hormones were a little bit different. Maybe you made two eggs that month so you made a little more estrogen that month. So not all months are exactly the same with respect to cramps. So what happens with the really bad ones? Well, you're not going to die, but there are people . . .

Interviewer: That's the good news.

Dr. Jones: . . . particularly and you're such a young voice. I'm going to assume that you're a young person. Young people can have a number of symptoms that go along with the period cramps that can make it even worse. So the hormone that makes the uterus cramp, that pushes out that dead uterus lining so that it's all cleaned out, so you can start again, is called prostaglandins.

And it's vital to the health of the uterus that you make it, but it makes not only the blood vessels constrict, so the lining will come out, it makes the uterus cramp. But prostaglandins also can cause diarrhea and it can cause fainting. And when you're dizzy and you're feeling nauseated and throwing up, then everything hurts more. So sometimes it's enough that people actually throw up and pass out. Sometimes, they don't.

Now, if you told me that your periods were getting heavier and heavier or not heavier but more and more painful, I would begin to think that as each period got worse, there was something going on. So a woman who said, "I just had one of the worst periods of my life." I'd think, "Fine." If you said, "My periods are getting worse and worse," I'd think of two conditions:

1. One are fibroids in the uterus. So the uterus is kind of trying to contract around a little muscle ball.
2. And the other one is endometriosis. A condition where little bits of uterine glands are growing around the pelvis and that causes pain too.

So for women who are having really bad periods but they're getting worse and worse and worse, (a) we have very good therapy for periods, but (b) we may need to do a little investigation. If it's just the worst period of your life and it's only this one, it's probably not going to be so bad next time. And the good news is you're probably normal.

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updated: August 2, 2018
originally published: February 3, 2017

Dr. Jones: All of us who've had menstrual periods know that we feel a little different in our bodies in the days around the start of our periods. We have what is called catamenial symptoms, symptoms around the period, but sometimes something big happens. This is Dr. Kirtly Jones from of obstetrics and gynecology at University Health Care and we're talking about catamenial catastrophes today on The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women Health, with Dr. Kirtly Jones, on The Scope.

Dr. Jones: The hormonal events at the start of the period are a big deal. Estrogen and progesterone levels made by the cyst that created the egg for that month were high the week before the period. If no pregnancy happens, these hormones drop rather quickly and that signals the uterus to make prostaglandins, a chemical that causes the uterus and the blood vessels in the uterus to contract and that starts the period.

These are normal and natural events, but they may cause cramping and occasionally nausea and vomiting and diarrhea, sometimes even fainting. But for some women with other medical problems, the drop in hormones and the rise in prostaglandins can exacerbate other conditions. Asthma and seasonal allergies can get worse. Some skin conditions, including eczema and hives can get worse around the pre-menstrual time.

But I use the word catamenial catastrophe and I made up that term, for things that can really go wrong and here are a few. Catamenial migraine, now this is really pretty common. About 15% of women have migraine and many of those women have predictable migraine with their periods. Catamenial migraine may be triggered by the change in hormones, or it may be the prostaglandins. For some women, it's the only time they have migraine. Migraine is one of those headache conditions that tendsto get better after menopause. No more periods, but for migrainers, that's the name of someone with a migraine, the monthly migraine can be very disruptive.

Catamenial epilepsy, seizures that occur just before or on the first day of the period. This happens to women who usually already have a seizure disorder, but they predictively have seizures about the time of their period. There are some women whose seizures start in adolescence when their period started, and some people have all of their seizures controlled with medications, but just not the ones that happen when they have their period.

Catamenial pneumothorax, this is a biggie. A pneumothorax is when there's a hole in the surface lining of the lung that lets air out underneath the ribs. With each breath, the air is trapped, making the lung get squished smaller and smaller. We're not exactly sure why this happens, but it can be associated with endometriosis on the surface of the lung that bleeds when the period starts and makes a hole for the air to leak out. Compared to the first two catastrophes, this one is rare and it can really be a catastrophe, requiring medical intervention to get the air or blood that's compressing the lung. Rare means about one in 100,000 women per year and that's really pretty rare.

Catamenial anaphylaxis, now, anaphylaxis is an acute reaction that is usually allergic that can cause hives, itching, swollen airways and difficulty breathing, low blood pressure and fainting. Catamenial anaphylaxis is really rare and it isn't probably an allergic reaction, but it is a reaction to the prostaglandins made by the uterus, which is also made in the ordinary kind of anaphylaxis. This is so rare, it hasn't been studied much.

If you think you have a big problem associated with your periods, who should you see? Your doctor who's helping you with your migraine, seizures, pneumothorax or anaphylaxis should consult with an OBGYN, preferably a reproductive endocrinologist, omeone who specializes in women's hormones. Together, they can figure out if it's really consistently related to the periods. Often, women say, "Oh yes, it happens before my periods and during my periods and after my periods."

For women with a 28-day cycle, that means it happens all the time so that's not really period-related. In some cases, it's appropriate to stop the periods and there are several hormonal ways of doing this. The good news is that once the connection is made between the period and the catastrophe, there are a number of options available. It makes cramps and crabbiness seem not so bad, huh? It makes the menopause sound better and better every day.

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Dr. Kirtly Parker Jones: Period. The punctuation at the end of a sentence that the Australians call the full stop. An amount of time in a high school day. Third period. Lots of other meanings. But to women, it means their menstrual period, and it assumes some periodicity, regularity. But what if it isn't regular? Is that normal? Or is there a problem? This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care, and this is The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Kirtly Parker Jones: My mother's generation called it my friend or falling off the roof. I remember the first time that I was in clinic in Boston and a patient's chief complaint was that her friend didn't come. My question to her was "Was there a problem with her travel plans? Was the train cancelled?" The young woman looked at me as if I were really clueless, and I was. What she meant was that her period was late. So is this a problem? What should you do about it?

Menstrual periods are called regular when the time between them is between 24 to 35 days. Women who have a 26-day cycle one month and a 31-day cycle the next are still called regular. Early in our evolution as humans, women were either pregnant, breastfeeding, or starving, all of which made periods absent or irregular. Today's idea that periods should be regular has only been part of our biology since we were well fed and life wasn't so calorically risky. Before several hundred years ago, most women on the planet were often at the lower limits of caloric intake, and periods were usually irregular.

All women are irregular at the beginning and the end of reproductive life. At the beginning, about 11 to 13, it takes about six months to get the system going, and irregular is the norm. If a woman hasn't achieved some kind of regularity in three years, there may be a problem. At the end of reproductive life, the perimenopause, 92% of women are irregular as the system grinds to a halt-menopause. But in between, women who were regular and then become irregular might want to see their clinician after the pregnancy test is negative. If it's positive, they should certainly see their clinician.

Common life changes can change a menstrual cycle. Weight gain or loss of as little as 15 pounds can disrupt the system. If the weight gain or loss isn't extreme or end up with women at the extremes of thinness or fatness, periods often settle themselves out again if a woman was regular before. Emotional or physical stress can disrupt a menstrual cycle for a month or two. Of course, if the illness is severe and ongoing, the disruption may continue.

Some women choose to limit the number of periods they have by their contraceptive method they use. Some contraceptive methods are associated with no periods or very light periods, and this is fine as long as this is a contraceptive effect. Some women manipulate the use of their contraceptive pill or patch or ring so they can take them continuously without a period break of one week each month, and these women choose to have their period every three months or six months or not at all.

So if you were regular and now you're not and none of the previous things apply, what could be going on? All of your brain hormones, thyroid hormones, and ovarian hormones have to be in sync to have a regular period. So women who become irregular should have a medical history and physical exam and have a couple hormones checked, their thyroid hormone and another hormone from the pituitary called prolactin. If these hormones are abnormal, things are pretty easily fixed. Of course, there are less common hormone problems, but your clinician can evaluate you for these if there are some clues from the medical history or the physical.

Some women run out of eggs early-premature menopause-either because they have an underlying condition that we understand to cause this or for no good reason. If periods become very irregular in a woman's thirties for no good reason, stress, weight gain or loss, pregnancy, etcetera, all that stuff we've talked about before, then the doctor might check a hormone called FSH, follicle-stimulating hormone, and see if it's high, suggesting there might not be so many eggs to grow and create the menstrual cycle.

So your friend didn't come and your pregnancy test is negative. Give it a month or so. But if she still didn't come, give your doctor's office a call, and we'll check it out. This is Dr. Kirtly Jones, and thanks for joining us on The Scope.

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