Why is my period late?

a paper calendar with a date circled
More episodes in the Sounds Like Health Podcast

A missed period can signal much more than pregnancy. An OB-GYN discusses six of the most common reasons your period may be late.

Episode Transcript

Mary Leigh Meyer:  From allergies to zinc deficiencies, hangry to hay fever, we provide easy to absorb information to improve your health. It Sounds Like Health on Texas A&M Health Talk. Howdy, everybody. My name is Mary Leigh Meyer.

Sam Craft:  I’m her co-host, Sam Craft.

Mary Leigh Meyer:  And we are here today with one of our favorite experts, Dr. Hector Chapa, from the Texas A&M College of Medicine. Welcome back.

Hector Chapa:  All right, guys, it’s another podcast day. I love it. And it’s rainy outside, which makes it a perfect day to be inside and talking about my favorite subject, which is what, what is it?

Mary Leigh Meyer:  What is it, Sam?

Sam Craft:  I mean, you’re a gynecologist, so I’m assuming it’s female related.

Hector Chapa:  Well, there you go. Anything women’s health care. I mean, that’s what I do. Right?

Sam Craft:  Yeah.

Mary Leigh Meyer:  Anything women’s health care, period.

Hector Chapa:  And ironically, we’re talking about periods. Boy, that was a segue.

Mary Leigh Meyer:  Oh. Look at that.

Hector Chapa:  Is that great or what?

Sam Craft:  Was that on purpose?

Mary Leigh Meyer:  Look at that.

Sam Craft:  That was pretty good.

Hector Chapa:  That wasn’t cheesy at all.

Mary Leigh Meyer:  This is not my first podcast, however much it may look like it.

Sam Craft:  There was that one time we just had to redo the intro again.

Mary Leigh Meyer:  I know. I panicked.

Sam Craft:  Okay.

Mary Leigh Meyer:  I panicked.

Sam Craft:  That’s in the past. We’ll move on.

Mary Leigh Meyer:  I haven’t eaten today to be honest. It’s a little rough.

Hector Chapa:  Bringing the period into the period discussion. I mean, it is the number one reason that females go to the gynecologist—outside of birth control—is issues with their period. So what exactly are we talking about today, then?

Mary Leigh Meyer:  Why are periods sometimes late?

Hector Chapa:  It’s really stressful, right? And oddly enough, we’ll get to that in a minute, but stress is one of the reasons. But we want to jump ahead.

Sam Craft:  It’s also very stressful for men too.

Hector Chapa:  Oh, yes, especially if you’re not expecting it to be late.

Sam Craft:  Yeah, no. Yes. That is very correct.

Hector Chapa:  Well, so here’s the thing. Because it really is a very common topic, and it’s a very common reason to visit the gynecologist.

Mary Leigh Meyer:  Absolutely. And it’s the most obvious from a day-to-day average healthy woman situation, that is the most obvious women’s health related thing that they’re thinking of, if that makes any sense at all.

Hector Chapa:  So, I’ll throw out this question. So, let’s do this. And Sam, use your best guess for it. Okay?

Sam Craft:  Go on.

Hector Chapa:  What is the typical—now be very general with this, right?—what is a typical, in quotes, in finger quotes, typical menstrual cycle? Every how many days do you think a typical woman has a cycle?

Sam Craft:  Three to four weeks?

Hector Chapa:  Anybody, Mary Leigh?

Mary Leigh Meyer:  I think I know the answer. Twenty-eight days.

Hector Chapa:  Well, and the answer is, both of you are right. So historically, we said it was once a month. Right? And that’s how you get the menstruation. Menstruation actually comes from the old kind of the Latin, the Greek, meaning tied to the moon, so lunar cycles. Menstruation, once a month. However, we now know that’s a pretty cheap way of breaking it down. Everybody’s so complex and so different. So Sam, what you said, every three weeks, it is possible to have a cycle every three weeks. That’s called frequent menstruation, but it is possible. And it’s okay if a cycle happens every 42 days. So there’s this big spread. Now there is, if you think of the old math, the old bell shaped curve, the big zone in the middle where most people are, it’s typically about 25 to 28 days. But some people have it a little bit longer and some a little less. But we’re talking about what happens when the period is late because it can be stressful. So all right, Mary Leigh, let’s get into that. And you know it, what is the number one reason why a cycle is late or missed?

Mary Leigh Meyer:  Well, it’s definitely pregnancy.

Sam Craft:  Yeah. That is a stressor of men.

Mary Leigh Meyer:  If your period’s late, then that’s what everybody associates with as the cause. Not many people think of—

Sam Craft:  It’s most common, I think.

Mary Leigh Meyer:  Yeah. Not many people think of the other small—

Sam Craft:  The other we’re going to talk about—

Hector Chapa:  Right. Right. If you’re listening to this on the non-medical side, we’re going to talk about six very common causes of issues with a cycle. All right, now specifically, when they don’t arrive—so there’s a whole other topic. Maybe that’s another podcast, for having too many periods, or periods too frequently. But we’re going to do the opposite end of that, which is the late or the missed. So, let’s get into the six most common issues. And they really are based on age. So, based on how old you are, gives you the more likelihood of what’s going on. All right? But let’s set out a couple of baselines, let’s set out the ground rules, and then we’ll play the game. So the ground rules are: What are the basic definitions? So here it is. So when your period is called late, that means that it’s about five days or so past your expected date.

Mary Leigh Meyer:  Five days.

Hector Chapa:  Five days. All right, so you’re writing down, you have an app because there’s an app for everything. Small window. So that doesn’t mean it’s—it’s just late. And five days, late. Right? Because every cycle, every month, calendar month is a little different, so give it a day, give it a two. So by five days after you expect it, now you’re valid, you’re on the books. You have a late cycle.

Mary Leigh Meyer:  That’s so interesting. You said that was a longer window than expected, but I would hit—

Hector Chapa:  Hit shorter.

Mary Leigh Meyer:  Yeah. I’d hit day four and I’d be—

Sam Craft:  Having a period five days seems like something that’s, “Oh, it’s five days.”

Mary Leigh Meyer:  That’s pretty much a week. And if the average cycle’s four, that’s—

Hector Chapa:  Well, but that’s a good point. And the reason it’s five is honestly, it’s several things. There’s so many reasons. We’re going to get into it, that we don’t want everybody to freak out that if you’re two days late, something’s off. I want everyone who’s listening to back off the ledge. Breathe. Hold on. Some months are longer than others. There’s a lot of factors we’re going to discuss. So we typically say five days and you’re considered late. Now when we say if your period is just missed, when you’ve missed your cycle, that’s when you’ve gone one to two weeks after your expected start date. Now your period, you just missed it.

Now obviously, you could be late, late, but at some point, you’ve got a missed cycle versus late. So I know it’s part semantics. It’s not that crystal clear, but we have to have some boundaries. So a late period for everybody who’s listening, we have to define that. Right? So a late period in general is five days in gynecology world, five days after you expected it. And it’s absent, it’s missed, which we’ll discuss possible reasons, when it’s one or two weeks.

Mary Leigh Meyer:  And some people just miss them. I’ve always heard some people are typically more irregular. And so it’s normal for them to periodically be late.

Hector Chapa:  We’re going to talk about it.

Sam Craft:  Asking a question for me. Can you just skip a period and everything be normal?

Hector Chapa:  Oh, no. Well, wait a minute. So for sure. You can skip it, and it be—I don’t want to say normal, but it could be acceptable.

Sam Craft:  Well, not the reasons we’re going to talk about.

Hector Chapa:  For sure.

Sam Craft:  Yeah, yeah.

Hector Chapa:  Well, some women, remember, some women only have a cycle every 45 days.

Sam Craft:  Oh, so technically—

Hector Chapa:  That’s their normal. That is why if you notice we didn’t say a period is late if you don’t have a period by the 50th day. It’s one to two weeks after your expected date, so it’s relative.

Sam Craft:  So 45 days could be every month and a half instead of every month.

Hector Chapa:  And that’d be totally normal.

Sam Craft:  Wow. Okay.

Hector Chapa:  If that is your cycle, if you can cycle, and you cycle every 35 to every, usually, 42. Forty-five is infrequent, but if that’s your regularity of your cycle, then you just have infrequent cycles. But as long as they’re regular and predictable, then that’s okay. You see how we’ve gotten away from the 28 because it was menstrual shaming, right? You have body shaming.

Sam Craft:  Everyone just assumes—

Hector Chapa:  Your period doesn’t come on 28 days.

Sam Craft:  That’s a month.

Hector Chapa:  I mean, what’s wrong with you? Everybody’s different, Sam. It’s okay. Everyone’s different.

Mary Leigh Meyer:  Sam’s still waiting on his.

Hector Chapa:  I bet he is.

Sam Craft:  I keep hoping.

Hector Chapa:  Sam’s very late.

Sam Craft:  I get moody. I get moody like I have one. I don’t know. I don’t know what happened.

Hector Chapa:  I’ve heard that. I’ve heard you get very moody. So these are great things to talk about because missed cycles are very stressful. And there are known reasons for it, and we’re going to get into that. But you guys are right, the number one reason why a period is late or then eventually missed is pregnancy. So this is why we say it’s age specific. Right? So in somebody who’s reproductive age, late adolescence, in their 20s and 30s, and they’re having intercourse, especially if they’re having intercourse without protection, we have to rule out pregnancy. That has to be the first thing. And you don’t have to go to a physician for that. I mean, any of the tests that are over the counter, self-bought, actually are very reliable.

And so, patients always ask, “Do I need the digital $25, or the $6 no brand?” The truth is they’re all equally—they’re all pretty good. They’re all equally as sensitive. It comes down to how much bells and whistles do you want, but the tests are reliable. And if you think you’re pregnant, here’s a first take-home message, the first clinical pearl: check for pregnancy because we don’t want to miss the most obvious. All right. What else do you think? Give us another reason for why a period is late or missed.

Mary Leigh Meyer:  I know it’s always PCOS. I always hear about, and as a woman, it sounds kind of scary.

Hector Chapa:  What’s PCOS?

Mary Leigh Meyer:  Isn’t it polycystic ovarian syndrome?

Hector Chapa:  Look at you. And just for you guys to know, that is not scripted. You know it, that’s great. You must be in something medicine.

Mary Leigh Meyer:  You know, you would think. I dabble every now and then.

Hector Chapa:  And you know what, you would think that patients wouldn’t really know those letters. They do.

Mary Leigh Meyer:  Well, and I know people with it, and I know how serious it can be and how much some women struggle with it. And so that is also what I associate with a late, quote, unquote, period.

Hector Chapa:  For sure. So, let’s give this some validity because patients do come in talking about, “I think I have PCOS,” or “I’ve learned,” “I’ve read,” even in women’s magazines. This is in Cosmo. But it is a very known thing. People know Zika virus, they know certain conditions, they know Crohn’s disease is something of the bowel. So you don’t have to be a physician, you can know the term awareness. But you’re absolutely right, Mary Leigh. So here we go. PCOS stands for polycystic ovarian syndrome. Now “syndrome” is the key word. When I trained, and that wasn’t that long ago, guys, I’m not old, I’m not.

Sam Craft:  You’re well aged like a fine wine.

Hector Chapa:  Oh, absolutely. A little tart and bitter, is that what you’re saying?

Sam Craft:  I was for sweet and dry, but you know.

Hector Chapa:  Okay. I’ll take it. It used to be PCOD, polycystic ovarian disease. Well, that sounded terrible.

Sam Craft:  That does sound terrible.

Hector Chapa:  Until they finally realized, wait a minute, this isn’t a disease at all. This is just a syndrome. It’s a constellation of endocrine-emitting hormone and metabolic issues that present, not just with the period, but other things as well. So PCOS can actually be tied to early onset of diabetes, to high cholesterol. It has metabolic implications. And here’s the catch. So, if you’re non-medical and you’re not pregnant, and you have late cycles, here’s how this relates to you. PCOS is the most common cause of hormone imbalance causing menstrual or period disarray in women who are 18 to 44. So you are right, so good for you.

Mary Leigh Meyer:  Thanks.

Hector Chapa:  You picked the number two out of the number one. So one is pregnancy. If you’re having sex with no protection, got to go get a pregnancy test. And I mean, wow. Is that mind blowing or what? That’s number one. Number two is, yes, PCOS. The good news is PCOS, completely manageable. It’s not a great diagnosis, but it does have to be treated. So how do you treat that? Well, if you’re not interested in pregnancy, then you can use some kind of hormonal control, so kind of birth control can help you with that problem. And even birth control can help with some of the metabolic issues. But if you are seeking pregnancy, having irregular periods isn’t the problem, it’s the sign of the problem.

And the problem is that your ovary isn’t releasing the little egg every month, so you’re not having ovulation. So if you have PCOS and you’re trying to get pregnant, there’s medication for that too. So, the take-home, what I want everyone to listen to is that if you’ve been told you have PCOS, yes, it’s important to know that. But it’s treatable, both to prevent pregnancy and to help you with pregnancy. It just depends on where you are in your life and in your desires.

Mary Leigh Meyer:  And what actually is PCOS?

Hector Chapa:  It literally is descriptive of the condition. So “poly” means many, “cystic” means a bunch of little eggs on the ovary, ovarian syndrome. So it means because the egg isn’t getting the hormone signal correctly to release the egg, to ovulate, they just kind of stay there on the ovarian surface. So while you can do an ultrasound and see the many cysts on the ovary, you don’t necessarily have to have that. That’s one of the most common findings, but because it’s a clinical syndrome, there’s other ways to diagnose it. And labs can be helpful, but it’s really just based on history. So PCOS, so look, we said we were going to cover six. We’ve got two down.

Sam Craft:  Well, you said that was number two. To me, I think the average everyday male like myself would probably think that number two after pregnancy would be stress because I think that’s the one that we see the most. Growing up with a sister and a mother in the household, we understood all those matters, but stress always seemed to be… Now having a wife, I know that sometimes stress is a big factor.

Mary Leigh Meyer:  And it impacts the body in crazy ways.

Sam Craft:  It does.

Mary Leigh Meyer:  In ways you don’t expect.

Hector Chapa:  For the audience to know, these guys sitting across from me have hit number one, number two and number three on the list by order of frequency. Not planned, by the way. How great are these guys, huh?

Sam Craft:  We try.

Hector Chapa:  Well, there you go.

Sam Craft:  We try.

Mary Leigh Meyer:  We are edubacated.

Hector Chapa:  It’s a talent, isn’t it?

Sam Craft:  SMRT.

Hector Chapa:  Well, you just took down a point.

Sam Craft:  Yeah.

Hector Chapa:  I just took you down a notch.

Sam Craft:  That’s not very—I thought we were doing really good.

Mary Leigh Meyer:  You know, Sam, you’re doing great.

Sam Craft:  I thought so.

Hector Chapa:  You are right.

Mary Leigh Meyer:  Don’t listen to the medical professional.

Hector Chapa:  What do I know? Pregnancy, PCOS and stress.

Mary Leigh Meyer:  PhD.

Hector Chapa:  No, not a PhD. It’s an MD. So why do you think? So Mary Leigh, talk to me about stress. What are we talking about? How does stress affect your period?

Mary Leigh Meyer:  Stress, well, stress affects the body in a lot of ways. And I know it has implications on more than just the lady parts too. Stress headaches, who would’ve thought?

Sam Craft:  The mind, just the overall health of your body, I think, you don’t realize.

Mary Leigh Meyer:  The mind-to-body connection.

Hector Chapa:  Oh, boy. Here we go. That’s another podcast. Let me tell you guys what they’ve hit on. And we’re going to get to it. But there is a whole new genre, that’s a word.

Sam Craft:  Yes.

Mary Leigh Meyer:  Genre, yes.

Hector Chapa:  Genre of medicine, which is the mind-body connection. This is real. Now traditionally, I trained at a very traditional medical school. We have a prescription for that, and it’s diseased focused. Well, we now know, Sam, is what you said, this is real. So our feelings, our stress level, obviously we know control the body. That’s the whole premise of the lie detector test. Right? Rapid heart rate, sweaty palms, changes in skin, electrical current. We know that your mind can really wig you out. So here’s what we’re talking about. Stress from a variety of reasons, which we live in a stressful world, guys. Let’s deal with it.

So work is stressful, interpersonal relationships are stressful, financial difficulties are stressful. Stress. There seems to be a certain thermostat where the connection in the female body, from the mind to the ovary to the uterus—that’s actually the medical terms for that is the hypothalamic pituitary ovarian uterine axis.

Mary Leigh Meyer:  Oh, of course.

Sam Craft:  What’d you just call me?

Hector Chapa:  I’m not doing it again.

Mary Leigh Meyer:  Of course.

Hector Chapa:  The hypothalamic pituitary ovarian uterine axis.

Sam Craft:  I feel like that’s part of a song.

Hector Chapa:  It’s a country song, actually.

Mary Leigh Meyer:  That was your son’s first word.

Sam Craft:  A, B, C. I feel like there’s a song to remember all those parts and the order that they go in.

Hector Chapa:  You keep thinking that, Sam.

Sam Craft:  I keep thinking medicine students have those kind of things. There’s no way I could remember all the organs and muscles in the body without some sort of system like that.

Hector Chapa:  A song?

Sam Craft:  Yes.

Mary Leigh Meyer:  There’s a song about the periodic table elements.

Sam Craft:  Yeah. I saw it. We saw it yesterday.

Hector Chapa:  We have derailed.

Sam Craft:  Sorry, everybody. We’ll go back to it. So as you were saying.

Hector Chapa:  As I was saying.

Sam Craft:  The live highway.

Hector Chapa:  Stress is the potholes on the live highway of the pituitary ovarian axis. There you go, Sam. Yes. So, stress. Here are the key words. You’ve got to remember two words and that’s it: cortisol, epinephrine. Cortisol, epinephrine.

Mary Leigh Meyer:  Those are words.

Hector Chapa:  Everybody knows those hormones. Right? Those are the stress hormones. Listen, it’s incredible, the complexity of our bodies, male or female, but specifically in this, I’m talking about the female. Everything has to be such in line. If you think about the domino effect, one domino goes down, the rest of the cascade will follow. It is such an intricate balance of cooperation that if one thing is thrown off, including stress, there is no question that stress can both bring your period too frequently, but more likely, it is a delayer. So for those of you that have gone to a university, a college, not uncommon that if you’re not on some kind of birth control where your cycle is being maintained, you’ll skip periods.

So guys, we know as full disclosure, of course, I’m one of the OB-GYN physicians for our university. I love it. But guess what, it’s very common for these relatively late adolescents, 18 to 20-year-olds, left home for the first time, trying to do great on their grades, taking care of themselves. I don’t know. My periods are just gone. And I’m not on any medications.

Mary Leigh Meyer:  And is it a chronic stress that does this? Or is it more of an acute stress?

Hector Chapa:  It is both. It is both. So the deeper issue there is beyond the effect on your cycle—which we want everyone to be healthy and strong, not just gynecologically, but overall—is that the effect of stress on the body in general. And so, Sam, you are right. There is something to, listen, mindfulness. That’s another great topic.

Sam Craft:  I mean, stress can cause a heart attack. Surely it can cause for your period to be late.

Hector Chapa:  Well, there you go. For sure, that’s a great point. Absolutely. And stress of course, linked to depression, linked to anxiety. By the way, we’ll get to those in just a minute and certain medications. And mindfulness, mind-body medicine, and the mindfulness movement, which I’ve got to be honest, as traditional, Westernized medicine, we thought, “You get over it. You can deal with that.” That’s a stiff upper lip mentality. That was wrong. We know that mindfulness matters, and I’m a full believer that there are things that we have to do to relax ourselves, to bring us together. That can actually, if stress is an issue, which it’s an issue at some point for all of us, but when there’s healthy ways to take care of it, and it’s not necessarily found in the pharmacy, we can do better. We’ve got to take care of ourselves better because mind-body connection is real.

Mary Leigh Meyer:  So, let me stereotype really quickly. I feel women, the stereotype of PMS in women in menstrual cycles, PMS stereotypically tends to—

Sam Craft:  Be very angry.

Mary Leigh Meyer:  Yeah, their emotions are unstable and they might not be able to manage their stress levels as much. What is the—I don’t even know what my question is. What is the connection between—

Hector Chapa:  We’ve got two different… Well, they’re kind of not connected.

Mary Leigh Meyer:  They aren’t?

Hector Chapa:  And here’s why. So PMS means premenstrual. In order to have PMS, you have to have ovulation. So if a woman is having regular ovulation, that typically means she’s having regular periods.

Mary Leigh Meyer:  I get it now.

Hector Chapa:  So, it’s the anti-topic of what we’re talking about. So in other words, the main reason of why you’re not having a period is that it comes down to it, but that’s the symptom. That’s what you see. But the cause underneath the veil, behind the veil, is that you’re not ovulating. Notice, do you ovulate when you’re pregnant? Well, that boat sailed. The ovulation has become a pregnancy, so you’re not ovulating. PCOS, we’ve already said it, you may need help getting pregnant because you’re not ovulating. How does stress affect this? Stress shuts off ovulation. So all of these have to do, the missed period is what you see. What’s behind it is that you’re not. That’s the root. Although, the root can have different causes.

Mary Leigh Meyer:  That makes perfect sense.

Hector Chapa:  So, you’re not having PMS because, by definition, if you’re having PMS, you’d be ovulating and your period wouldn’t be irregular. How about that?

Mary Leigh Meyer:  That makes perfect sense.

Hector Chapa:  We have covered three big topics. So we did pregnancy, PCOS, stress. And one kind of related to stress is what? Too much of this can put too much, not emotional stress, because we just kind of covered kind of emotional.

Mary Leigh Meyer:  So physical stress?

Hector Chapa:  So what is physical stress?

Sam Craft:  It’s ice cream, isn’t it?

Mary Leigh Meyer:  Well, I’ve heard marathon runners—

Hector Chapa:  Ice cream is never a stressor.

Sam Craft:  Well, no. Too much can cause stress.

Mary Leigh Meyer:  Chocolate cake.

Sam Craft:  Yeah, mm-hmm.

Hector Chapa:  Chocolate cake poisoning. It could be a thing.

Sam Craft:  Honestly, outside of pregnancy and stress, I’m running low on solutions here of why your period might be late. What kind of stress?

Mary Leigh Meyer:  I know marathon runners—

Hector Chapa:  You got it.

Mary Leigh Meyer:  Don’t have periods.

Hector Chapa:  That’s it. So let’s go right there, guys. So, if you’re in your car, non-medical, we’re trying to do this by topic, by name, pregnancy, PCOS, stress, meaning more emotional, psychological, but physical stress as well. Correct. And it’s not just marathon. Exercise. So severe forms of exercise. Isn’t that crazy? Listen, guys, too much of a good thing is bad.

Sam Craft:  Define severe.

Mary Leigh Meyer:  Which is exactly why I avoid exercising.

Hector Chapa:  I’m going to tell you what’s severe. And by the way, we’ve got to be very careful because I’ll be very clear what I’m saying. I am not anti-exercise. I am 100 percent for it.

Sam Craft:  Just reasons why.

Hector Chapa:  Well, because like everything else, you can overdo it. Guys, if you’re running and you’re like, “I’m almost to the store. I’m going to run out of time.” We’re going to get to the last two in a minute. We’re going to wrap it up. But physical stress, too much for example, too much exercise will shut off your period. That is actually called, if you’re interested in looking it up, the athlete triad. So, the athlete triad, usually in young adolescents or early adulthood, is low body mass, meaning they’re very thin. The marathon runner, if you will, low bone mass, so low BMI, low bone mass, and lack of periods. You can literally get so stressed out physically, even though you feel great because your endorphins are high. But your cycle is telling you, you’re overdoing it.

So excessive exercise can shut off your period, especially if it causes severe weight loss or weight restriction. So emotional stress, and then the physical stress called the athlete triad. And again, because we see a lot of the athletes at the university, incredible physical shape, no periods. And it’s because they’ve shut it off. And that also is not healthy because the cause of that is they actually are so metabolically altered that their estrogen levels fall, and now they’re at risk of other issues. So exercise is great. Take home message is great. But like everything else, balance, life balance. Stress is part of life. It must be in balance. You’ve got to be able to balance that out.

All right. We’re down to that last two. So, for sake of time, we’re going to run through these quickly. And we’ve kind of touched on one already, and that’s certain medications. So certain medications that are taken can throw off your cycle. And some are on purpose.

Sam Craft:  I was going to say, birth control is on purpose. Right?

Hector Chapa:  There you go. Absolutely. So a reason that cycles can be late can be, for example, some kinds of birth control. So for example, there’s a birth control that’s an implant that is actually placed in the arm. It’s wonderful. Takes three, lasts for three years, phenomenal, almost as good or as good as getting your tubes tied, but reversible, but reversible, so very, very dependable. But one of its side effects, which is actually a benefit, is that it will eventually reduce or eliminate cycles. So for women who have heavy periods, this is one of the treatments. So sometimes outside of the initial goal, which is contraception (birth control) it can affect your cycle, and that’s all right.

So here’s a big takeaway that may be a shocker for some. Not having a period is absolutely okay if you have driven it away. So if you’re using medicine to say, “I’m in charge of my cycles, and I don’t want to have a cycle this month,” you can skip your cycle. That’s perfectly okay. But if your body has decided to skip a cycle by itself, because it’s not been directed by you, then that’s different, and that’s a topic of our conversation.

Mary Leigh Meyer:  That makes sense. I know growing up, I had a few friends who went on birth control because their cramps were so severe, and they had other period complications. Birth control wasn’t used for birth control.

Hector Chapa:  For sure. And we have women that are not sexually active, or have never been, that are virginal, that are on birth control because they can’t do their daily activities. That’s terrible. And it’s hard for us as a male to relate to that unless you’ve seen these women. They’re distraught. “I want to go to class, I can’t, I can’t go to class.” It’s terrible. So for sure, you don’t have to have a cycle if you choose to drive it away. That’s called hormonal suppression.

And we’re down to the last one because I think Sam’s quarters are going to run out of the meter, so we’ve got to speed it up here.

Mary Leigh Meyer:  He’s pretty stingy with his quarters.

Hector Chapa:  I know, man. Geez.

Sam Craft:  Who carries quarters? Unless you’re going to fight.

Hector Chapa:  Do they still make quarters?

Sam Craft:  No, okay.

Mary Leigh Meyer:  Sam wouldn’t know.

Sam Craft:  Carry a roll of quarters around just in case you need them every once in a while. Toll roads.

Mary Leigh Meyer:  Laundry mats.

Sam Craft:  Brass knuckles. That’s how it works.

Hector Chapa:  No one’s taking quarters at the toll, man.

Sam Craft:  I have a toll tag. I’m good. I’m telling you, I keep a roll of quarters for a reason. It’s not toll tags.

Hector Chapa:  You do that. Do they expire? Do you have quarters that expire? They’re good. They don’t expire.

Sam Craft:  I think they’re made in the ’70s.

Mary Leigh Meyer:  You should put all your expired quarters on my desk.

Hector Chapa:  That’s a new research topic. Let’s do that.

Mary Leigh Meyer:  I think so.

Hector Chapa:  Maybe a podcast topic.

Mary Leigh Meyer:  Okay. I’ll just put a little bowl out.

Hector Chapa:  And we’re back to number six. The last reason for our delayed cycle, so let’s do a wrap up, guys. Remember, pregnancy, PCOS, stress, excessive exercise and the athlete triad. Certain medications can throw off your cycle. And then the last, we said at the beginning, we’re back to your bookend, is it depends on your age. So if you are above a certain age, which is still young, trust me, anything above 45, typically you have to rule out perimenopause. So perimenopause is a big cause of what’s called skips and delays. That is on the transition to the menopause. So menopause by definition is a lack of a cycle for 12 consecutive months, so a year.

Mary Leigh Meyer:  Consecutive months.

Hector Chapa:  Consecutive. So listen, my last cycle was 13 months ago. I am 48, and I’ve got some hot flashes. They’re all the clinical syndrome, the clinical picture of menopause. And remember, that is natural.

Sam Craft:  You do not look 48, by the way.

Hector Chapa:  Well, nor does it look like I’ve had periods. So, nonetheless.

Mary Leigh Meyer:  Especially in the last 13 months.

Sam Craft:  Yeah, no. Really. Yeah.

Hector Chapa:  I’m not going to go over my age. Nonetheless, so perimenopause is a natural part. So here it is. No one’s cycles will last forever. They are timed. The ovarian reserve is limited. So, the average age of menopause in the U.S., because it’s geographically driven, is 51. So some women—

Sam Craft:  Why’s it geographically driven?

Hector Chapa:  Because it’s based on diet, BMI, life stressors, genetics.

Mary Leigh Meyer:  That’s interesting.

Hector Chapa:  So it is different.

Sam Craft:  So the overall average is 55.

Hector Chapa:  No one’s going to enter menopause at 60 worldwide, but it can be off, for example, 53 to 52.

Mary Leigh Meyer:  It’s the bell curve.

Hector Chapa:  Correct.

Mary Leigh Meyer:  Nature’s bell curve.

Sam Craft:  What’s the youngest you’ve ever heard of someone having menopause?

Hector Chapa:  Anything over 40 is actually fair game.

Sam Craft:  Wow.

Hector Chapa:  Now it’s early, but it’s not abnormal. Now there is a term if a woman goes through menopause under the age of 40. That is called POF or POI, premature ovarian failure or premature ovarian insufficiency.

Sam Craft:  That sounds terrifying.

Hector Chapa:  That’s too early. It happens. That’s a whole other issue. So anything in the fourth decade—40s to 50s—while early and outside of the bell curve, you just hit it early. But it’s not pathologically abnormal. The typical is 45 years of age to about 52. But the median has actually shifted to about 51.

Mary Leigh Meyer:  So, if you’re in that timeframe, and your periods are irregular, then maybe talk with your provider about perimenopause.

Hector Chapa:  Absolutely, because it happens. Now it doesn’t happen frequently. But women will think, “Oh, I’m going through the change,” which is a whole other topic because the change isn’t a day, it’s a process. And I can’t conceive anymore, so they stop taking birth control, and they get pregnant at 47. And as an OB-GYN, pregnancies at 47, despite what you see on the news and these rare, isolated—

Sam Craft:  I just saw a lady that had—

Hector Chapa:  I know. We’re not going to go there.

Sam Craft:  60 years old, I think.

Hector Chapa:  Correct. They’re very dangerous for chromosomal reasons for the child, and for medical complications for the mothers. Much higher rate of preeclampsia, which is high blood pressure in pregnancy, diabetes, preterm labor, and we’ll go down the list. So, you do still need to protect yourself unless it’s been a full year and you’re in that age of life. Now we can probably say we can back that off because your chance of resuming ovulation after a year of nothing is almost zero.

Mary Leigh Meyer:  So, after a full year of no period, do you still have a chance of becoming pregnant?

Hector Chapa:  If you’re in that age—

Mary Leigh Meyer:  I mean, it’s going to be small, microscopically small.

Hector Chapa:  So, let’s say—and you’re age appropriate, everything is possible, but it’s very… While everything is possible, it’s not probable. So that’s why we’d actually stop. You can stop taking birth control if you’re 51 and it’s been 12 to 18 months of no cycle. You’re pretty much not going to conceive at that time, and you don’t need birth control. And I think menopause, it’s a great topic. That’s a whole other issue.

Mary Leigh Meyer:  We did a menopause podcast a few months ago.

Hector Chapa:  Oh, well, there you go.

Mary Leigh Meyer:  We had Dr. Dormire from College of Nursing.

Hector Chapa:  For sure. Well, excellent. Excellent. So again, that gives us our wrap of pregnancy, PCOS.

Mary Leigh Meyer:  Our wrap.

Hector Chapa:  Stress. That’s a wrap. Excess exercise, perimenopause, and medication.

Mary Leigh Meyer:  That’s a pretty good list. I think that covers a pretty big range of—

Hector Chapa:  Of options.

Mary Leigh Meyer:  Yeah.

Hector Chapa:  Right, so the take home is look, everybody’s different. If you’re not 28 days, like your mom probably told you, and your grandma told you, you had to be every 28. Actually, a study came out that only about 10 percent to 15 percent of women are 28 days.

Sam Craft:  I think that’s really good information, though.

Hector Chapa:  Very small.

Sam Craft:  The average everyday person I think is just a once a month thing. It could be totally different.

Hector Chapa:  It could be 24 days. It could be 35. The upper end was still considered “acceptable.” I hate the word normal because it makes it seem abnormal. Acceptable is 42 up to 45 days.

Sam Craft:  Wow.

Hector Chapa:  As long as that’s your system, it’s predictable and there’s no other issues or symptoms, it’s okay. But remember, if contraception is desired, then talk to your provider. If you think that PCOS is a likely issue, if you’re heard those terms, maybe somebody in your family has it, because there are familial ties to this, you do need to get checked because they are also tied to those metabolic issues like diabetes, high blood pressure and cholesterol.

Mary Leigh Meyer:  And I think this is a good point to say if you have any questions about your period, if it’s coming too late usually, or too early, that you can ask. And if you’ve any doubt at all, ask your provider because like you just said, that there are other health complications that could be associated with it.

Hector Chapa:  Open communication, for sure.

Mary Leigh Meyer:  Yeah. Open up that dialogue.

Hector Chapa:  Absolutely. And if you have a family physician, they’re just as comfortable talking about it. And maybe if you want to speak to a gynecologist, find a gynecologist. But the important thing that you talk to somebody, know your system, know your body. And now at this availability, where everyone’s got at least some way to connect with somebody, do yourself a favor for your health, and take care of yourself both mentally, physically, and in terms of your reproductive health.

Mary Leigh Meyer:  One little question before we wrap up. What about those women who don’t necessarily know their cycle yet? What about the people who are first starting to get their period, who are trying to figure out, maybe have never tracked it, maybe don’t have that period experience?

Hector Chapa:  Absolutely. So that term, first cycle, is called menarche. So menarche is when a young woman—

Mary Leigh Meyer:  Menarche?

Hector Chapa:  Menarche.

Mary Leigh Meyer:  Menarche.

Hector Chapa:  Menarche, menstruation. Menarche. So “arche” is the beginning. “Men” is short for menses. So the beginning of menstruation. So here it is, guys.

Mary Leigh Meyer:  It sounds like men anarchy.

Hector Chapa:  Oh, boy. That’s a movie, I think.

Sam Craft:  That’s a good way to describe a period. I’m just going to say it.

Mary Leigh Meyer:  Can you just acknowledge this word you just said, Dr. Chapa?

Hector Chapa:  It’s not men anarchy.

Sam Craft:  Let me just break that off.

Mary Leigh Meyer:  But it’s menarche.

Hector Chapa:  Menarche.

Mary Leigh Meyer:  Okay.

Hector Chapa:  So the initiation of puberty is pubarche. The initiation of menses is menarche. The average age of when a young girl starts to have a period is about the age of 12, about the age of 12. Any young girl that starts having a period under the age of 8 is called precocious. That’s too early. That requires evaluation. But here’s the take home, as you said. In the first year, up to two years, after a young girl begins to have her period, they’re not like clockwork. Now that can happen. That’s not the usual. It’s okay. So, if you’re a mother of a young preadolescent girl, and she’s about to get her cycle, or has gotten her cycle, and 10 is fine, 11 is fine. I’m talking about the average. By the way, if you don’t get your period by the age of 16, that requires evaluation. That’s too late. That’s called amenorrhea, primary amenorrhea.

So at the first start of your cycle, it may not be every month. And if it is, and that’s great. But it’s all right if there’s initially some irregularity as the body tries to figure that out. And it can take 12 months to 18 months. The longest is two years. Now if you’re irregular and it’s been two years since you had a cycle, that’s kind of your system. You’re kind of irregular. But my point is give yourself time. So don’t go, “I had a period two months ago and it never came back.” It’s all right.

Mary Leigh Meyer:  So, don’t jump to PCOS.

Hector Chapa:  Correct. That’s a great take home. So you guys, did you all get that? If you have a young girl who is age appropriate, 10, 11, 12, and had a first cycle, and then there’s nothing else, one, have that open communication with your child. Make sure there’s nothing else going on. Right? Make sure nothing else is going on. And then reassure them, excluding things like Sam said, I mean, it’s the real world, guys. I’ve delivered many a 12-year-olds. I mean, let’s just be real. Okay. It’s out there. But excluding that, let them know that their cycle can take a while to regulate. There are free apps on the Android store, in the app store, the iPhone, whatever, that you can track. You can track it on a regular paper calendar. It is absolutely critical that every menstruating woman write down their cycle. It’s just part of good body awareness to know how their cycle is. Very, very important.

Mary Leigh Meyer:  Okay. Well, I think we are about over time. Any last closing thoughts from you, Dr. Chapa?

Hector Chapa:  No. Guys, I really do care about this. I think it’s so important. I have two daughters, and we’ve had this conversation with them. Listen, the old days of, “We don’t discuss these things, and they’re taboo,” that’s just ridiculous. This is about health and it’s about their well-being. Have an open communication. And I just thank you guys for the chance to do this.

Mary Leigh Meyer:  Oh, of course. We love having you on the show.

Hector Chapa:  All right. Well, we’ll see what we come up with next.

Mary Leigh Meyer:  Okay. Well thank you, everybody, for listening. This has been another episode of Sounds Like Health.

Tim Schnettler:  Thank you for joining us on Texas A&M Health Talk, a production of the Texas A&M University Health Science Center. Visit us on the web at vitalrecord.tamhsc.edu, where you’ll find answers to all of your health questions. Until next time, stay healthy.