Missed periods while on the pill
February 3, 2022 2:18 PM   Subscribe

I'm in my mid-40s and have missed two periods in a row while on the pill. My general health hasn't changed and neither has my weight nor diet. I'm stressed out lately, but, you know, I've been stressed out for the last two years, so. I'm not pregnant. My ob/gyn office said to call back if I miss three in a row. Could this be perimenopause?
posted by trillian to Health & Fitness (21 answers total)
Mid-40s? It absolutely could.
posted by Too-Ticky at 2:29 PM on February 3, 2022 [5 favorites]

I'm in my mid-50s now, but from my experience, basically anything that happens to you physically, emotionally, or psychologically in your 40s could be peri-menopause.

I wasn't on the pill, but my periods got very irregular, and increasingly bloody, until eventually I had an endometrial ablation. I have no idea how the pill might interact with the underlying hormonal changes and chaos you might be experiencing, but, to repeat what Too-Ticky said: It sure could be peri-menopause.

Welcome to this stage of your life. And good luck.
posted by Well I never at 2:33 PM on February 3, 2022 [2 favorites]

Response by poster: I should have added that I've had a lot of fatigue in the last couple of years (e.g., falling asleep in the afternoon regularly -- I did an Ask about it) and my doctors haven't had great explanations (after bloodwork they said was normal, they said "I dunno, Lyme test?" and "I dunno, sleep study?"). I don't think being this tired is pandemic-stress-related. I'm wondering if it could be have been the beginnings of perimenopause too.
posted by trillian at 2:38 PM on February 3, 2022 [2 favorites]

Best answer: I hesitate to comment because I don't know anything about how the pill interacts with perimenopause, but I've done a fair amount of reading around perimenopause symptoms recently for both work and personal reasons and the standard age for actual menopause (the final period) is 45-55 so you're bang on age for perimenopause. It's only considered early menopause if your last period is before the age of 45, I believe, I at least in the UK.

And yes, huge, baffling tiredness with no obvious cause, and doctors who inexplicably don't think to suggest perimenopause as the cause, both seem to be pretty standard perimenopausal experiences. See also: The arrival of new depression/anxiety which also don't have an obvious cause and which doctors also somehow don't think to link to perimenopause, despite it being clear possible cause to anyone who's spent a few hours reading about perimenopause.
posted by penguin pie at 2:42 PM on February 3, 2022 [9 favorites]

Anecdote, but I missed two periods on a pill for no discernible reason in my 20s and my obgyn wasn’t concerned; I liked having my period so I switched to a different brand pill and it came back.
posted by chaiyai at 3:16 PM on February 3, 2022

Best answer: Any chance this started after receiving a 2nd or 3rd covid shot?
posted by jessica fletcher did it at 3:18 PM on February 3, 2022 [5 favorites]

Response by poster: Any chance this started after receiving a 2nd or 3rd covid shot?

Ooh, good question -- my booster was in November, so maybe it's related!
posted by trillian at 3:29 PM on February 3, 2022

Best answer: Yeah, I'd say the vax could definitely be a factor - I'm 47, regularish cycle until my 2nd jab, when it went a bit haywire for a couple of months. Now sort of back to normal, even after my booster, but I'm taking it as round one of the new fun game of "Is it perimenopause or something else?"
posted by penguin pie at 3:35 PM on February 3, 2022 [2 favorites]

So for my underlying health condition (Cerebral Palsy), I am at risk for early-aging/doctors not quite sure how CP and aging impact each other because it is still primarily seen/researched as a paediatric condition, despite the fact that it does not magically disappear on your 18th birthday. As I’m among the first generation of people with CP to be integrated into society rather than immediately sent to institutions and shut away/never seen from again (sobering fact: I’m under 40! It wasn’t that long ago) so as a result doctors (specialists and GPs) don’t always quite have answers to my medical questions.

Anyways I tell you this backstory because for 10 years (in my 20’s/30’s) I did not have a period while I was on the pill. I’ve been on it since my early 20s for sexual health, but found it made my previously heavy periods much more manageable. My (male) GP wasn’t alarmed/concerned about my “missing” periods for a decade and continued to Rx me the pill (Alesse). It wasn’t until I went to see a (unrelated, not a ob/gyn but female) specialist Dr and she took my medical/prescription history that someone (who wasn’t me) was alarmed at this and wondered if I had entered in perimenopause early, or if it was the pill. She didn’t know if once going off the pill after being on it for so long would bring back my monthly period or what the implications would be but thought it might be worth a shot. I agreed happily, and under her supervision I stopped taking the pill. After a month and a half, my period started again, after 10 years. It now is happily on a cycle each month for me.

Long story short: hopefully this doesn’t happen to you but be aware of implicit/explicit bias by your healthcare providers and maybe look for seemingly undervalued/less obvious connections that you or others have missed in your care. I firmly believe had I continued to have a female GP (which I did before I moved and got a male GP) I might have solved the issue of my missing periods earlier than my current male GP status. Obviously, we’ll never know for sure if my male GP was biased/unconcerned because “disabled people don’t/can’t have sex” stigma, or if it’s because I am female (with a visible disability) and females concerns are often dismissed by healthcare practitioners, etc. but I thought I should put it out there even though it’s not a direct answer to your question.
posted by carabiner at 3:58 PM on February 3, 2022 [3 favorites]

Best answer: I know at least three women who started perimenopause in their early forties, FWIW.
posted by aspersioncast at 4:02 PM on February 3, 2022

Best answer: In case reading about perimenopause might be a comfort, I am really glad that Jen Gunter wrote The Menopause Manifesto. It's full of so much great information, including how to understand what is and isn't medically known about peri/menopause. It also includes lots of refreshingly undisguised raging about medical bias and general gendered nonsense in the world. Highly recommended!
posted by Hellgirl at 4:37 PM on February 3, 2022 [8 favorites]

Have you been checked for fibroids? They can cause irregular periods and because they are fed by your blood can cause some anemia, which might explain your fatigue.
posted by brookeb at 4:43 PM on February 3, 2022 [1 favorite]

Best answer: FWIW, I think the covid vax messed with my period. Most recently I got my booster while I was actively bleeding and it…ground to a halt on the days where I was sleeping off the post vax symptoms. Four days after the booster it started back up again.

When I got both initial doses I was not actively bleeding but had uncharacteristic cramps after the first shot when that time of the month rolled around and a really heavy period after the second. Also 40s.

Also, how’s your iron levels? I thought I had gone into perimenopause in late 2020 but it turned out to be anemia and stress.
posted by floweredfish at 5:38 PM on February 3, 2022 [2 favorites]

Best answer: Just want to echo penguin pie's advice about health care providers not considering peri menopause as a cause even when you fit all the criteria, so be aware of that and ask about it. Especially the mental health angle, for me it's meant pretty bad anxiety and depression.
Thanks for asking this question as the answers are useful to me as well!
posted by Zumbador at 7:39 PM on February 3, 2022 [2 favorites]

The covid vaccine made my periods go awry too. I’m in my late 30s and have always been kind of irregular but I had like three to four months after each shot and booster of bizarre menstruation, like really spaced out and/or super spotty and/or woosh all out in like a day and a half and it has been pretty much a mess all this past year. Now, a few months out from my booster, it appears to finally be normalizing back to my previous irregular but not entirely unpredictable ways. I know ages ago somewhere reputable was doing a study on the vaccine and menstruation cycles but who knows where that went.

I had some other issues in mid 2020 that made my doctors think I could be having a remarkably early perimenopause but it turns out I needed anxiety medication to wrangle whatever the heck my body was doing in protest, so when my cycle went wonky I thought, maybe they were right in the first place and actually it is all perimenopause?? But no, it seems a few months after each shot I settle back into some kind of normal so I’m willing to believe that it messes with some people’s hormones or response to them or whatever. Since you’re already augmenting your hormones via birth control pills it follows that it could all be interconnected. Since I’m just some random internet layabout with an occasionally bleeding vagina, and it seems that you have access to healthcare professionals, I encourage you to bring this up to them next appointment. And I also encourage you to use barriers if you’re having sex with anyone who could get you pregnant!
posted by Mizu at 9:25 PM on February 3, 2022

Not sure what pill you are on, but I've been taking Lo Loestrin for about a year (?) and my periods have stopped completely (they got lighter for a few months and then went away around month 5 I think). Apparently this is very normal for this particular med. I'm 38.

I assume your doctor would have mentioned that when you expressed concern, but might be worth looking into before worrying yourself that it's something more serious!
posted by a.steele at 2:57 PM on February 4, 2022

Response by poster: Also, how’s your iron levels? I thought I had gone into perimenopause in late 2020 but it turned out to be anemia and stress.

Interesting that you should ask that, because in my last Ask, I mentioned that my ferritin was at the low end of normal and my doctors just brushed it off. I got some great advice/info from MeFites though!
posted by trillian at 3:18 PM on February 4, 2022

It probably is; you should get bloodwork (including hormone levels) done.
posted by Ostara at 10:52 PM on February 5, 2022

My understanding is that the periodic bleeding you have while on the pill is not a period, it’s “withdrawal bleeding” that occurs based on the hormones or lack of hormones in the pill, not anything you are naturally generating (not sure if this is true of all pills, but certainly the standard combined pills). So peri menopause shouldn’t affect it that much.
posted by Dolukhanova at 9:09 AM on February 6, 2022

Response by poster: I'll keep this updated a bit in case it helps other people. I happened to have a physical scheduled yesterday, so I asked my doctor about it. She said to call my ob/gyn. I asked if it could have been the COVID vaccine, and she said that the vaccine usually gives you heavier or irregular periods instead. She also gave me the typical info that you can miss periods because of stress or exercising too much. I told her that my ob/gyn had said to call after missing three in a row and she said that's the usual advice. Somehow I didn't even think to ask about perimenopause as a possibility, probably because I felt really rushed during the appt. in general. So, now just waiting to see if I'll miss #3.
posted by trillian at 5:25 AM on February 10, 2022

Response by poster: OK, final update, because why not. Period is back, so in my non-medical opinion, it was probably the booster that did it.
posted by trillian at 3:35 PM on March 8, 2022 [1 favorite]

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