What to Do About Missed Periods and Hormonal Imbalance

Experiencing delayed periods due to hormonal imbalance can be both confusing and concerning. Medically known as oligomenorrhea, a regular menstrual cycle typically occurs every 21 to 35 days. When cycles extend beyond this window—especially if your period is consistently late—it's essential to investigate the underlying causes. Early diagnosis and targeted treatment can help restore balance and prevent long-term complications.

Key Diagnostic Steps for Hormonal Evaluation

To identify the root cause of menstrual irregularities, healthcare providers often recommend a series of tests. These are ideally conducted on the second day of menstruation and may include:

• Hormone panel (six key hormones): This assesses levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estrogen, progesterone, and testosterone.
• Thyroid function tests: To detect hypothyroidism or hyperthyroidism, both of which can disrupt menstrual cycles.
• DHEA-S (Dehydroepiandrosterone sulfate): A marker for adrenal gland activity and androgen production.
• Liver and kidney function tests: To rule out systemic issues affecting hormone metabolism.

After menstruation ends, a pelvic ultrasound is often performed to examine the ovaries and uterus. This imaging helps diagnose conditions such as polycystic ovary syndrome (PCOS), elevated prolactin levels, or diminished ovarian reserve.

Common Causes and Evidence-Based Treatments

1. Polycystic Ovary Syndrome (PCOS)

PCOS is one of the leading causes of irregular periods in women of reproductive age. It's often associated with elevated androgen (male hormone) levels, acne, weight gain, and insulin resistance. Treatment typically involves oral contraceptives containing anti-androgen components like cyproterone acetate. These medications help regulate the menstrual cycle, reduce excess hair growth, and improve skin health.

In addition to medication, lifestyle modifications—including a balanced diet, regular exercise, and weight management—are crucial for long-term symptom control.

2. Hypothyroidism

An underactive thyroid gland can significantly slow down bodily functions, including the menstrual cycle. Women with hypothyroidism may experience fatigue, weight gain, cold intolerance, and infrequent periods.

The standard treatment involves daily supplementation with synthetic thyroid hormone (levothyroxine). Once thyroid levels normalize, menstrual regularity often improves within a few cycles.

3. Hyperprolactinemia

Elevated prolactin levels can suppress ovulation and delay menstruation. This condition may stem from pituitary tumors (such as microadenomas), certain medications, or chronic stress.

An MRI of the pituitary gland is usually recommended to evaluate for structural abnormalities. Depending on the findings, treatment options include dopamine agonists like bromocriptine or cabergoline. In rare cases where a large tumor is present, surgical intervention may be necessary.

4. Declining Ovarian Function

As women approach their late 30s or early 40s, ovarian function naturally declines—but some may experience this earlier, a condition known as premature ovarian insufficiency (POI). Symptoms include missed periods, hot flashes, and low estrogen levels.

Hormone replacement therapy (HRT), such as estradiol (e.g., Progynova) combined with a progestin like dydrogesterone, can help regulate cycles, protect bone health, and alleviate menopausal symptoms.

5. Anovulation (Lack of Ovulation)

Even without PCOS or thyroid issues, many women experience delayed periods due to anovulatory cycles—where no egg is released during the menstrual cycle. This is common in adolescents, perimenopausal women, or those under significant stress.

In such cases, doctors often prescribe cyclical progesterone therapy using medications like medroxyprogesterone or dydrogesterone. This induces a withdrawal bleed and helps establish a predictable cycle over time.

Lifestyle Modifications That Support Hormonal Health

Beyond medical treatments, daily habits play a vital role in maintaining hormonal balance:

• Maintain a consistent sleep schedule: Avoiding late nights supports cortisol regulation and overall endocrine function.
• Manage stress effectively: Chronic stress elevates cortisol, which can interfere with sex hormone production. Mindfulness, yoga, and breathing exercises are proven tools.
• Avoid cold and processed foods: While not directly linked in Western medicine, eating a nutrient-rich, anti-inflammatory diet supports metabolic and reproductive health.
• Limit exposure to endocrine disruptors: Avoid foods or supplements containing unknown hormones, such as non-organic meats or unregulated herbal products.
• Eat balanced meals at regular intervals: Stable blood sugar levels support insulin sensitivity, which in turn benefits hormonal equilibrium—especially in PCOS patients.

Ultimately, addressing delayed periods and hormonal imbalances requires a comprehensive, individualized approach. Consulting a qualified gynecologist or endocrinologist ensures accurate diagnosis and safe, effective treatment tailored to your unique physiology. With the right care, most women can regain regular cycles and improved well-being.