Patient's question:
I have been having a "hot" constitution for five or six years. A few years ago, it came every three or two months, but now it hasn't appeared for half a year.Doctor's answer:
The uterus, ovaries, hypothalamus-pituitary axis, and other parts of the body can all cause menstrual irregularities such as reduced menstrual flow, menstrual cessation, or amenorrhea (no menstruation for more than three months). Some girls may not menstruate even after entering puberty, a condition known as primary amenorrhea. In most cases, menstruation resumes after a period of absence, which is referred to as secondary amenorrhea. The causes of amenorrhea are complex, and some are relatively common.When menstruation is delayed, two main reasons should be considered: pregnancy and menstrual disorders. Since your menstruation has been delayed for more than four months, it is recommended to visit a hospital for examination. For example, an ultrasound can provide a detailed understanding of the specific situation and identify the underlying cause.
The timing of menstruation after an abortion varies depending on the duration of pregnancy and individual constitution. Generally, menstruation may return in the second month after an early pregnancy abortion. However, in many cases, the hormonal changes caused by the abortion may delay ovulation, leading to a corresponding delay in menstruation. As a result, some women may not menstruate for one or several months after an abortion. If menstruation is delayed by more than 7–10 days, it is advisable to seek a detailed medical examination.
The menstrual cycle is typically 28–30 days long. A delay of 7 days or less is still considered normal, as cycle length varies from person to person. However, if the delay exceeds this range, women with a normally functioning menstrual cycle should be concerned. The following four conditions can cause menstrual delay:
1. Pregnancy
After a delay of 7 days, a "pregnancy test strip" can be used to test urine. A positive result suggests pregnancy, while a negative result indicates otherwise. However, pregnancy may also be accompanied by other symptoms such as nausea and breast tenderness. The definitive method is to undergo an ultrasound examination at a hospital.
2. Medication Side Effects
Long-term use of birth control pills can disrupt the endocrine system, leading to delayed menstruation. Additionally, doctors have observed that the new-generation gastrokinetic drug metoclopramide (also known as domperidone) may also cause this issue. Metoclopramide does not easily cross the blood-brain barrier, so it is believed to have no inhibitory effect on central dopamine receptors. When central dopamine receptors are inhibited, the amount of hypothalamic releasing factors entering the anterior pituitary lobe decreases, reducing the secretion of gonadotropins and corticotropin by the anterior pituitary, which can result in menstrual cessation and delayed ovulation.
3. Surgical Causes
For example, cervical adhesions caused by uterine cavity surgery may lead to blood stasis, resulting in delayed menstruation.
4. Other Factors
Psychological factors such as stress, environmental changes, and certain endocrine disorders can also cause menstrual delay.
Expert Tip: If menstruation is delayed only occasionally (1–2 times) without other accompanying symptoms, it does not fall under the category of menstrual disorders. A menstrual cycle interval of 35 days or more is referred to as menstrual oligomenorrhea, while cessation of menstruation for more than three cycles is termed amenorrhea. Since amenorrhea can lead to issues such as osteoporosis and endometrial hyperplasia due to the absence of ovulation, it must be taken seriously. Immediate medical examination is recommended.