Late period? Here are potential reasons beyond pregnancy | Omaha

Question:

I’m supposed to get my period and I haven’t been this late before. Could I be pregnant? What are symptoms of early pregnancy? When should I see a doctor?

Answered by OB-GYN Karen Carlson, MD:

There are many reasons why a woman’s period can be late, ranging from common hormonal imbalances to stress to pregnancy. Additionally, it is quite common to have late cycles both right after a teen begins having periods and when a woman is about to end or near menopause. A menstrual cycle is considered normal if it ranges between 21 and 35 days. Many women have times during their reproductive years when they have late or irregular periods. In fact, this is the most common reason that women seek care from a gynecologist. Stress, low or high body weight, excessive exercise, use of birth control, chronic diseases, early menopause, and other hormonal problems are just some examples that may cause periods to be late. Let’s take a look at some of these in more detail. 

When we feel stressed, our body produces stress hormones from the adrenal gland. These hormones can inhibit the production of sex hormones from the ovary, which are essential to maintain regular menstrual cycles. Additionally, too much exercise, for example with long and frequent running sessions or intense weightlifting, can also decrease estrogen levels and make periods late or sometimes stop altogether. Many forms of birth control, including pills, patches, NuvaRing, progesterone IUDs, shots and arm implants, especially near the beginning of use, can make periods irregular or late. 

More concerning causes of late periods include chronic diseases and hormonal problems. Diabetes, thyroid disease, polycystic ovarian syndrome, celiac disease and pituitary tumors are common diseases and hormonal problems that can cause irregular or late menses (blood and other matter discharged from the uterus at menstruation). When periods are late, many women will have some mild symptoms similar to early pregnancy, including mild uterine cramping. The breasts may feel heavier and fuller or be tender to the touch. Nausea, constipation, mood swings, dizziness and fatigue may be experienced. These symptoms are caused by increasing levels of the hormone progesterone, and they occur in both early pregnancy and the premenstrual portion of the cycle. Because of this similarity, when a period is late for other reasons, a woman may still have some early symptoms of pregnancy, due to the higher levels of progesterone. It is reasonable to take a home urine pregnancy test with a late period to differentiate. 

Many women have a time in their reproductive years when their periods are late or irregular. It is time to call a doctor if you have a positive pregnancy test, if the abnormal bleeding pattern continues for three consecutive months, or if there is no menstrual bleeding for three months in a row.

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Why Do I Have Period Symptoms But No Period? Reasons for Cramps and Pain Without Menstruating

September 28, 2021

17 October 2022

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Published

29 September 2021

Fact Checked

Medically reviewed by Dr. Anna Targonskaya, Obstetrician and gynecologist

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Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. To learn what we do to deliver the best health and lifestyle insights to you, check out our content review principles.

If you have period symptoms but no period, you might be wondering what’s going on. In this article, we’re going to explore reasons for having period symptoms without menstruating.

Period pains but no period: Could I be pregnant?

You’ve used Flo’s online period calculator and know when you’re due. All the  signs of PMS arrive but then… there’s no sign of your period. So, what’s going on? 

Period symptoms but no period might actually be a sign of pregnancy. This is because when the embryo implants into the uterine lining, cramping may occur. Following this, breast tenderness, headaches, fatigue, and more symptoms occur as the body begins going through various changes to carry the fetus. If you suspect this might be what you’re experiencing, watch for these signs of pregnancy.

A pregnancy test can detect pregnancy as early as 10 days after conception. But there are things that can make a positive urine home pregnancy test inaccurate, and here are some of them:

• Not following test instructions or misinterpreting the results
• Medications (aspirin, carbamazepine, and methadone)
• Blood or protein in the urine

It is also possible for a negative home urine test to be wrong:

• Taking a test too early or checking results too quickly
• Diluted urine (for a more accurate result, it is recommended to do the test in the morning when the concentration of hCG is highest)
• The “hook effect,” which is something that happens when there are so many hCG molecules in the urine that they prevent the test from working properly. They are simply washed off the test, so the result will be negative.

However, the absence of menstruation doesn’t necessarily mean you’re pregnant. There are lots of things that can cause period symptoms like cramps without actually having periods. 

Causes of period symptoms without menstruating

Premenstrual symptoms are common. In fact, about 90 percent of women state they experience cramps, bloating, headaches, fatigue, moodiness, tender breasts, and difficulty sleeping before their periods. So it makes sense for you to assume you’re about to get your period when you have these symptoms. But what if you experience moodiness, breast tenderness, bloating, or cramps, but no period? Is it simply a delayed period, or is it something else?

Rigorous training

This is most common for female athletes. According to studies, the risk of developing menstrual irregularities is three times higher for people who are involved in competitive sports. This is especially true among long-distance runners. A 2010 study of 87 women found that frequent, intense workouts affect the menstrual cycle. Around 50 percent of the participants who did intense training had menstrual cycle issues: 30 percent of them had a period delay, and 11 out of 17 long-distance runners didn’t get periods at all, a condition called amenorrhea.

Another study of 187 Norwegian long-distance runners found that almost a quarter of them had menstrual disturbances (from minor ones to amenorrhea).

Low weight

Low body weight and body mass index (BMI) can also cause a missed period with some symptoms.

Menstrual irregularities and amenorrhea are both associated with eating disorders. Studies have shown that people with a low body weight — less than 85 percent of what’s considered a healthy BMI for them — are four times more likely to have menstrual problems.

According to one study, a sharp decrease in weight, especially in combination with stress, can lead to impaired ovulation and menstrual dysfunctions.

Stress

Even though stress is unfortunately common, it can have a major impact on health, wellness, and the menstrual cycle. A 2010 study of over 1,600 working women found that stress at work and in the family was associated with menstrual problems in around 60 percent of participants. And a 2015 study of 100 medical students aged 18 to 23 and a study on Taiwanese nurses found that high stress levels are associated with irregular menstrual periods.

Medications

There are certain medications that can also cause period symptoms, but no period. For instance, these medications affect hormone levels that can affect the menstrual cycle:

• Hormonal contraceptives
• Hormonal medication for endometriosis treatment (leuprolide)

Hormonal birth control, such as the pill or injection, contains synthetic hormones that help regulate your cycle and prevent pregnancy. If you’ve recently started taking a new form of birth control, it might take your body some time to adjust. Usually, this adjustment period lasts from a few weeks to several months. During this time, it’s common to skip a period, experience irregular periods, and have period symptoms without menstruation. Additionally, when you’re coming off birth control, you may experience similar effects.

And here are some drugs that can disrupt the menstrual cycle as a side effect:

• Recreational drugs
• Psychotropic medications (such as antidepressants)
• Blood pressure regulators (such as methyldopa)
• Anti-nausea medicine (such as metoclopramide)

Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a disorder associated with hormonal imbalances. PCOS can cause the body to produce more of male androgen hormones, which can cause various issues. One of them is difficulty regulating the menstrual cycle, resulting in skipped, irregular, or late periods.

If you suspect you might have PCOS (common symptoms include excess body hair, male pattern baldness, irregular periods, and acne), it’s important to see a health care provider for consultation.

Thyroid conditions

The thyroid gland regulates many metabolic and hormonal functions, including body temperature, heart rate, menstrual cycle, and more. But nutritional deficiencies, stress, autoimmune diseases, and other things can disrupt how the gland functions. There are two different conditions that might trigger menstrual disturbances: underactive and overactive thyroid. 

Takeaway

It’s important to remember that having period symptoms but no period doesn’t necessarily mean you’re pregnant. There are a variety of reasons you might miss a period or experience a delayed period. Taking a home pregnancy test about five days after you were expecting your period can help you figure out what’s going on, as can listening to your body and the clues it’s giving you. From there, you can do what’s best for you, your health, and your life.

References

Winer, Sharon A, and Andrea J Rapkin. “Premenstrual disorders: prevalence, etiology and impact.” The Journal of reproductive medicine vol. 51,4 Suppl (2006): 339-47.

Hillard, Paula Adams. “Menstrual suppression: current perspectives.” International journal of women’s health vol. 6 631-7. 23 Jun. 2014, doi:10.2147/IJWH.S46680

“Pcos Research.” Center for Reproductive Health, Accessed Sept. 2021, crh.ucsf.edu/pcos-research. 

Betz, Danielle and Kathleen Fane. “Human Chorionic Gonadotropin.” NCBI, StatPearls Publishing LLC, 11 August 2021, https://www.ncbi.nlm.nih.gov/books/NBK532950/ 

“Home pregnancy tests: Can you trust the results?” Mayo Clinic, Mayo Foundation for Medical Education and Research (MFMER), 24 February 2021, https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/home-pregnancy-tests/art-20047940 

De Souza, M J et al. “High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures.” Human reproduction (Oxford, England) vol. 25,2 (2010): 491-503. doi:10.1093/humrep/dep411

Meczekalski, B et al. “Functional hypothalamic amenorrhea and its influence on women’s health.” Journal of endocrinological investigation vol. 37,11 (2014): 1049-56. doi:10.1007/s40618-014-0169-3

Nagma, Shahida et al. “To evaluate the effect of perceived stress on menstrual function.” Journal of clinical and diagnostic research : JCDR vol. 9,3 (2015): QC01-3. doi:10.7860/JCDR/2015/6906.5611

Zhou, Mei et al. “Work and family stress is associated with menstrual disorders but not with fibrocystic changes: cross-sectional findings in Chinese working women.” Journal of occupational health vol. 52,6 (2010): 361-6. doi:10.1539/joh.l10057

Winkler, Laura Al-Dakhiel et al. “Body composition and menstrual status in adults with a history of anorexia nervosa-at what fat percentage is the menstrual cycle restored?.” The International journal of eating disorders vol. 50,4 (2017): 370-377. doi:10.1002/eat.22600

“Delaying your period with hormonal birth control.” Mayo Clinic, Mayo Foundation for Medical Education and Research (MFMER), 31 January 2020, https://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/womens-health/art-20044044 

DeSapri, Kristi. “Amenorrhea Clinical Presentation.” Medscape, WebMD LLC, 14 October 2019, https://emedicine.medscape.com/article/252928-clinical#b1 

Fourman, Lindsay T, and Pouneh K Fazeli. “Neuroendocrine causes of amenorrhea–an update.” The Journal of clinical endocrinology and metabolism vol. 100,3 (2015): 812-24. doi:10.1210/jc.2014-3344

Huhmann, Kimberly. “Menses Requires Energy: A Review of How Disordered Eating, Excessive Exercise, and High Stress Lead to Menstrual Irregularities.” Clinical therapeutics vol. 42,3 (2020): 401-407. doi:10.1016/j.clinthera.2020.01.016

“Leuprolide Injection.” MedlinePlus, U.S. National Library of Medicine, 15 July 2020, https://medlineplus.gov/druginfo/meds/a685040.html 

Ajmani, Nangia Sangita et al. “Role of Thyroid Dysfunction in Patients with Menstrual Disorders in Tertiary Care Center of Walled City of Delhi.” Journal of obstetrics and gynaecology of India vol. 66,2 (2016): 115-9. doi:10.1007/s13224-014-0650-0

Koyyada, Arun, and Prabhakar Orsu. “Role of hypothyroidism and associated pathways in pregnancy and infertility: Clinical insights.” Tzu chi medical journal vol. 32,4 312-317. 10 Apr. 2020, doi:10.4103/tcmj. tcmj_255_19

“Current evaluation of amenorrhea.” Fertility and Sterility, vol.90, no.3, 2008, pp. 219-225. American Society for Reproductive Medicine, https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/current_evaluation_of_amenorrhea.pdf 

Falsetti, L et al. “Weight loss and menstrual cycle: clinical and endocrinological evaluation.” Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology vol. 6,1 (1992): 49-56. doi:10.3109/09513599209081006

History of updates

Current version
(17 October 2022)

Medically reviewed by Dr. Anna Targonskaya, Obstetrician and gynecologist

Published
(28 September 2021)

PMS symptoms – 10 signs of early menstruation

PMS symptoms, known as premenstrual syndrome, appear 5-14 days before the onset of menstruation. Here are 10 main signs that a woman experiences during this period. Most of them you can handle at home. But if the manifestations are too active and affect your life, interfere with you, be sure to discuss this with your gynecologist.

More than 90 percent of women experience PMS symptoms to some degree. Usually they pass in the first two days after the onset of menstruation. We publish the 10 most common signs of approaching menstruation.

PMS symptoms

Abdominal cramps

This medical condition is called dysmenorrhea. Cramping may begin on the eve of your period and continue into the first few days of your cycle. The degree of soreness varies from mild to severe, and some even need time off to survive the pain. Cramping is usually felt in the lower abdomen. But soreness can radiate to the lower back and upper thighs.

Pain caused by contraction of the uterus. They help shed the lining of the uterus (endometrium) when pregnancy does not occur. These contractions are triggered by prostaglandins, which regulate ovulation.

There are diseases that cause severe pain during PMS. These include:

• endometriosis
• cervical stenosis
• adenomyosis
• pelvic inflammatory disease
• myoma

If you have a history of any of these conditions, you are diagnosed with secondary dysmenorrhea.

Pimples

Approximately half of women note the appearance of pimples among the symptoms of PMS about a week before the onset of menstruation. They usually appear on the chin and jawline, but can appear anywhere else.

This is due to natural hormonal changes associated with the reproductive cycle. If pregnancy does not occur at ovulation, estrogen and progesterone levels decrease, and androgen levels, such as testosterone, increase slightly. Androgens are responsible for the production of subcutaneous fat produced by the sebaceous glands. If there is an excess of fat, acne appears. They usually go away by the end of your period, when estrogen and progesterone levels begin to rise.

Breast augmentation

In the middle of your cycle after ovulation, progesterone levels begin to rise, which causes your breasts to increase in size and swell. The symptom of PMS is expressed in different ways. Someone has a slight increase, and someone notes the heaviness of the breast, the appearance of lumps and discomfort. If you belong to the second type, you need to contact a mammologist for advice and treatment.

Fatigue

As your period approaches, your body switches from preparing for pregnancy to preparing for your period. Hormonal levels plummet, causing the PMS symptom of fatigue. Many are sad, nothing can cheer them up. Women during this period often experience problems with sleep, do not rest at night, and because of this, daytime fatigue increases.

Bloating

As you prepare for your period, your body’s levels of the hormones estrogen and progesterone change, causing your body to retain more water and salt than normal. In this case, you often see an increase in weight up to 2 kg. Symptoms disappear on the first day of the onset of menstruation.

Gut Problems

Because we are so dependent on changing hormones, our gut is no exception. Prostaglandins that cause uterine contractions can also cause contractions in the intestines. You may notice frequent urination and additionally experience the following PMS symptoms:

• diarrhea
• nausea
• increased gas formation
• constipation

Headache can be a symptom of PMS

In our body pain is caused by serotonin. Estrogen, which rises during PMS, increases serotonin levels. It is this interaction that causes headaches and migraines.

Moreover, pain can occur both before, during and after menstruation. Clinical studies show that migraine is 1.8 times more common one to two days before the onset of menstruation and 2.5 times more common in the first days of menstruation than on other days of the month.

Mood swings

For many, the emotional symptoms of PMS cause more discomfort than the physical symptoms. Women may experience:

• mood swings
• depression
• irritability
• anxiety

All the fluctuations of the same hormones are to blame.

Low back pain

Contraction of the uterus under the influence of the release of prostaglandins may also cause contractions of the muscles of the lower back. Women may experience pain and a pulling aching sensation in the lower back.

Sleep problems

PMS symptoms such as bloating, headache, tearfulness and depression can make it difficult to fall asleep and generally affect your sleep. Also, sleep is affected by body temperature, which rises by about half a degree and lasts until the onset of menstruation. Healthy sleep occurs at a lower temperature.

Treatment of symptoms of PMS

Depending on the severity, various therapeutic assistance is prescribed for a woman to relieve symptoms. The help of a doctor is usually required by severe migraines, indigestion, endometriosis, severe pelvic pain.

In some cases, the gynecologist will prescribe birth control pills to regulate hormone levels. They prevent natural ovulation by providing a constant stable level of hormones for three weeks.

You can relieve PMS symptoms at home:

• reduce your salt intake
• take painkillers
• use dry heat on the abdomen to relieve spasm
• Eat small meals during this period to maintain stable blood sugar levels
• take calcium

Be healthy! And remember that with any problems you can always contact us.

How to tell PMS from pregnancy, signs and symptoms of both PMS and pregnancy

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How to distinguish PMS from pregnancy, signs and symptoms of both PMS and pregnancy

Contents

• Symptoms of PMS and early pregnancy
• Diagnosis
• Medical advice

Every woman planning to conceive wants to know how to distinguish take PMS off pregnancy. Unfortunately, there are no clear specific signs for these two conditions. An unequivocal answer can only be obtained when conducting specific tests (for example, determining the level of hCG in the body).

SYMPTOMS OF PMS AND EARLY PREGNANCY

Signs of PMS and early pregnancy are practically the same. In both states, a woman may be disturbed by typical manifestations. If she previously had no problems before and during menstruation, then any “new symptom” can be regarded by her as a desired conception. However, we should not forget that PMS can also manifest itself in this way. Many patients who experience physical and emotional discomfort during and before menstruation for several years know “their” symptoms very well. Therefore, when such manifestations change, a woman immediately begins to think that “something is wrong.” However, one cannot completely rely on “one’s own instinct” in this situation.

PMS or pregnancy? How to distinguish – the table will help:

90 150 Mainly localized in the outer quadrants and nipples

It should be understood that the body of each woman is individual and the onset of pregnancy may differ from typical standards. Sometimes the absence of “habitual” signs of PMS will indicate an imminent delay. ^2.3

DIAGNOSIS

Accurately answer the question: “PMS or pregnancy?” – can test. You can determine the level of hCG (human chorionic gonadotropin) in the urine yourself. There are very sensitive tests that allow three days before the expected menstruation (subject to a stable cycle) to detect the fact of a successful conception.

Also, a woman can go to a gynecologist and donate blood for hCG. An examination by a doctor will help not only to establish pregnancy, but also to identify diseases of the reproductive system, if any. ⁴

DOCTOR’S ADVICE

Early detection of pregnancy can be difficult if a woman does not keep a menstrual calendar. Therefore, gynecologists advise every month to mark the beginning of “critical days”. Since the symptoms of PMS and early pregnancy are very similar, doctors recommend that all patients who suffer from cyclic illness undergo full treatment at the stage of preconception preparation. If, during therapy, undesirable signs cease to occur, it will be easier for a woman to recognize the first manifestations of life emerging in the body. Moreover, the treatment of premenstrual syndrome will prepare the female body for bearing the fetus. After all, it includes a healthy lifestyle, proper nutrition, an adequate daily routine, the intake of herbal remedies with a high content of vitamins, macro- and microelements. One such drug is Time Factor®. It is a non-hormonal complex of vitamins, minerals and plant extracts and can be used for PMS and various disorders of the monthly cycle. ¹

References:

1. Esina E.V., Svidinskaya E.A. Possibilities of using the vitamin-mineral complex Time-Factor® for the correction of menstrual disorders and the reduction of manifestations of premenstrual syndrome // BC. 2005. No 14, pp. 825–829.
2. Yakovleva E.B., Babenko O.M., Pilipenko O.N. Premenstrual syndrome // Emergency Medicine. 2014. No 3 (58). pp.