A. The commonest cause of a missed period is pregnancy. While it isn’t likely, if there is any chance that you are pregnant, it’s worth getting a pregnancy test. Also ask for a test for
FSH that tells if you are approaching menopause if the level is high. Your pattern of bleeding isn’t unusual for perimenopause. An
estradiolEstradiol
Estradiol topical
Estradiol-levonorgestrel
Estradiol-medroxyprogesterone
Estradiol-norethindrone
Estradiol-norgestimate test is also good to check. People who don’t have a bleed after Provera usually have low
estrogenHormone replacement therapy levels and the addition of the progesterone doesn’t cause a period because the lack of estrogen didn’t build up their uterine lining enough to shed after the progesterone.
It is also possible that provera doesn’t work because a person isn’t ovulating. Common reasons are excessive exercise, stress and weight loss, or poor diet. Once again, it causes low estrogen levels to occur so provera can’t cause a bleed. Not having a period isn’t necessarily a sign of a bad problem; it is more a sign of hormonal imbalance. If provera alone doesn’t work, then you will likely need to take estrogen plus progesterone in the form of a birth control pill or perhaps another combination of estrogen and progesterone at a lower dosage. You can always stop it after 3 – 4 months and see if you start again. If weight related or stress related issues are likely, they need other kinds of attention. If it's perimenopause, you might just want to wait and do nothing.
Machelle M. Seibel, MD