Is it your age, or the weight that has come off? Either could explain two periods in five months in your forties, after years of regular cycles: the time leading up to menopause, called perimenopause or the menopausal transition, usually begins in your 40s, though sometimes earlier, and losing a lot of weight suddenly makes absent periods more likely.
Do two periods in five months have a medical name?
A medical name may already fit your five months, depending on how long the longest gap between those two periods ran. When periods stop after a stretch of normal cycles, the name is secondary amenorrhea. Definitions differ: one counts three missed periods in a row, or no period for at least 6 months after menstruating normally, and the other counts only a stop of 6 months or longer.
For most women a menstrual cycle runs 21 to 35 days, so take your own usual length and count how many periods should have come during your longest gap. Three or more missed in a row meets the first definition, and six months with no period at all would meet both.
Booking an appointment does not depend on either definition. See your primary health care provider or a women's health care provider once you have missed more than one period, so the cause can be diagnosed and treated if needed. With two periods in five months and a cycle anywhere in that usual range, you have missed at least two. A name, when it fits, still leaves the cause to be found: amenorrhea is often a sign of another health problem, and it can happen for many reasons.
Can weight coming off change your periods if nothing about it was extreme?
It can. A plan someone else set and supervised can still have you eating very little, or exercising hard enough to burn more than you eat. Weight loss can be behind absent periods, and they are more likely if you lose a lot of weight suddenly, for example from strict or extreme diets or after gastric bypass surgery. They are also more likely if you have obesity, exercise too much and for long periods of time, have low body fat (less than 15% to 17%), or have severe anxiety or emotional distress. The weight you started from and the speed it came off at can each play a part.
Weight is also part of one named cause, hypothalamic amenorrhea, in which the hypothalamus, a gland in the brain that regulates body processes, slows or stops releasing the hormone that starts the menstrual cycle. Common characteristics of women who have it include:
- low body weight
- a low percentage of body fat
- a very low intake of calories or fat
- emotional stress
- strenuous exercise that burns more calories than are taken in through food
- some medical conditions or illnesses
If your plan has you eating very little or exercising that hard, tell your primary care or women's health provider what you eat on a typical day and how much you exercise. Where weight loss turns out to be the cause, a lack of periods may respond to a change in exercise routine, or to gaining or losing weight as needed, and that change is one to make with the provider who found the cause.
How a doctor tells perimenopause from a weight-related cause
Pregnancy is checked first: a physical exam and pelvic exam must be done to check for pregnancy, and a pregnancy test will be done. Pregnancy is the most common natural cause of secondary amenorrhea.
After that, it may be difficult for you and your doctor to tell whether you are in perimenopause. If you have symptoms such as hot flashes, irregular periods or trouble sleeping, your doctor may ask about your age, your symptoms and your family history to judge whether perimenopause is a likely cause. In some cases, for example if a woman's periods stopped at an early age, a doctor may suggest a blood test to check hormone levels.
Ask your mother or sisters, if you can, at what age their periods stopped. A family history of early or premature menopause can be one of the reasons menopause comes early, and menopause before 45 is called early menopause.
Age and weight are not the only candidates. Missed periods after normal cycles can result from various causes, among them a thyroid gland that is overactive or underactive, and polycystic ovary syndrome. Most women with polycystic ovary syndrome have absent periods or irregular ones (see Irregular periods are worth a PCOS check, even before weight care).
After the exam and the pregnancy test, blood tests may be done to check hormone levels, and other tests that may be performed include a CT or MRI scan of the head to look for tumors, a biopsy of the lining of the uterus, genetic testing and an ultrasound of the pelvis. Which of these later tests you have, if any, is the clinician's choice. Finding the cause matters because treatment depends on it. Where the cause is a condition that can be treated, normal monthly periods most often return once it is treated, while at menopause, periods stop permanently.
These details are yours alone to supply at the appointment:
- the start date of every period you can find from the past year, and how many days each one lasted
- how heavy each period was next to what is usual for you
- any bleeding or spotting between periods or after sex, with its date
- hot flashes, night sweats or trouble sleeping, and when they began
- how much weight has come off and over how many months, with a typical day's eating and your usual exercise
- the age your mother or sisters were when their periods stopped
What to do while the cause is still unknown
If you do not want to get pregnant, keep using birth control whatever the cause turns out to be. If it is perimenopause, keep using it for at least a full 12 months after your last period, because menopause cannot be confirmed until one year after the final period. You will only know you have reached menopause once you have gone a full year without a period or any spotting.
If you use birth control pills or hormone shots, the method itself can change your bleeding: women who take birth control pills or receive hormone shots may not have any monthly bleeding, and after they stop, their periods may not return for more than 6 months. Tell the provider you see about your periods which method you use, and when you started or stopped it. Any change of method is a decision to make with that provider.
Periods that are no longer regular, that are shorter or longer, or that bring more or less bleeding than usual can all be normal changes during perimenopause, and some bleeding still needs care. Go to an emergency department or call 911 or the local emergency number if you have bleeding that is very heavy, if you faint or pass out, or if you have dizziness or weakness that does not go away; each of those is an emergency on its own. Very heavy bleeding happening now is the emergency, heavy bleeding as a pattern across your periods is a reason to book an appointment, and if you cannot tell which you have, treat it as the emergency. For the signs in this table, contact the office of the provider you see about your periods:
| Sign | What to do |
|---|---|
| Bleeding or spotting between periods or after sex | Contact the office right away to have it checked |
| Bleeding or spotting again after a year with no period | Contact the office right away to have it checked |
| Heavy bleeding with your periods | Book an appointment |
| Periods that come very close together | Book an appointment |
| Periods that last more than a week | Book an appointment |
Keep track of how many pads or tampons you use, how often one is soaked through and how often you need to change it, so the amount of bleeding can be determined, and give the office those counts when you contact it.
Tell your NicoCares care team, if you have one, about the change in your periods as well; they answer in Spruce, the secure app they message you through. Spruce has no set time for an answer, so it is the wrong place for the emergency signs above or for a sign the table marks right away: take those to emergency care or to the provider's office first.
