Is it normal for young people to occasionally miss periods?

From the Guidelines

It is normal for young people to occasionally miss periods due to various factors such as hormonal changes, stress, and certain medical conditions. When considering the potential causes of missed periods in young individuals, it's essential to take into account the complex interplay of hormones that regulate the menstrual cycle, as well as external factors that may influence this process [@1@]. Some of the key factors that can contribute to irregular periods include:

• Hormonal changes, particularly during the first few years after menarche
• Stress, which can disrupt the balance of hormones in the body
• Significant weight changes, which can affect hormone production and menstrual regularity
• Excessive exercise, which can lead to hormonal imbalances and missed periods
• Poor nutrition, which can impact overall health and menstrual regularity
• Certain medical conditions, such as polycystic ovary syndrome (PCOS) or thyroid disorders, which can cause hormonal imbalances and irregular periods In the context of PCOS, which is a common cause of irregular periods in women, it is crucial to note that approximately 4-6% of women in the general population are affected by this condition [@1@]. PCOS is characterized by hyperandrogenic chronic anovulation, which can lead to irregular periods, hirsutism, and other symptoms. The pathogenesis of PCOS involves the acceleration of pulsatile gonadotropin-releasing hormone (GnRH) secretion, insulin resistance, hyperinsulinaemia, and downstream metabolic dysregulation [@1@]. Given the potential causes of missed periods in young individuals, it is generally recommended that if someone misses one or two periods but has no other concerning symptoms, it's usually not cause for immediate concern. However, if periods are consistently irregular, absent for three or more months (a condition called amenorrhea), or accompanied by severe pain, unusual bleeding, or other symptoms, it is advisable to consult a healthcare provider to rule out any underlying medical conditions [@1@].

From the Research

Menstrual Irregularity in Young People

• Menstrual irregularity is a common occurrence during adolescence, especially within the first 2-3 years after menarche 1.
• It is not uncommon for young people to occasionally miss periods, but prolonged amenorrhea is not normal and can be associated with significant medical morbidity 1.
• Factors such as age at menarche, body mass index (BMI), and presence of bleeding disorders can influence menstrual patterns and irregularities in adolescents 2, 3, 4, 5.

Age at Menarche and Menstrual Abnormalities

• Research suggests that age at menarche may not be independently associated with menstrual abnormalities such as oligomenorrhea, polymenorrhea, and menstrual cycle irregularity 4.
• However, other studies have found that early or late menarche may be related to menstrual dysfunction among young women, with irregular cycles and oligomenorrhea being more frequent in these groups 5.
• The prevalence of menstrual abnormalities may be influenced by gynecological age, with younger gynecological age being associated with a higher prevalence of oligomenorrhea and menstrual cycle irregularity 4.

Menstrual Patterns and Treatment

• Adolescents with bleeding disorders are at risk of heavy bleeding at and after menarche, and consultation with a pediatric gynecologist and/or hematologist prior to menarche may be helpful in outlining abnormal patterns of menstrual bleeding and discussing treatment options 3.
• Hormonal therapy is commonly used as initial treatment for heavy menstrual bleeding, but combination therapy (hormonal and non-hormonal) may be more effective for subsequent treatment 3.