My sister-in-law is only 31 years old and she has not had a period in over a year. She does go to the doctor, but she does not tell them. She had a tubal ligation a couple of years ago, and she seems to always be fighting the diet game. I am concerned because she has three little children.

--Lisa

You have touched on a frustrating problem for most doctors—patients not telling us about problems. We are not psychic and cannot help if we are not given information. Fear is the reason most people clam up and do not admit to having concerns.

Ignoring a problem will not make it go away, and it can make it worse. You should encourage your sister-in-law to tell her gynecologist that she has not had a period in over a year. There are many reasons a woman will become amenorrheic, or not have periods. Being either significantly over- or underweight can trigger hormone imbalances that lead to lack of periods. Thyroid disease or tumors of the pituitary gland can do the same thing.

It is important to try to find the cause of amenorrhea and treat it. Lack of periods on one's own (as opposed to during pregnancy, or while on birth control pills or DepoProvera) increases the risks of osteoporosis and uterine cancer. Tell your sister-in-law you are concerned about her health, and offer to go to the doctor with her.