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 Is My Period Late? Reasons, Causes, and What To Know

If you’re not pregnant, your period may be late due to a great deal of stress or low body weight. Certain conditions, including polycystic ovary syndrome (PCOS), diabetes, and others, can also affect your menstrual cycle.

Worried about a late period but know you’re not pregnant? Missed or late periods happen for many reasons other than pregnancy. Common causes can range from hormonal imbalances to serious medical conditions.

Research shows that the prevalence of irregular menstrual cycles is 5-35.6% depending on your age, your occupation, and where you live.

There are also two times when it’s typical for your period to be irregular: when it first begins and when the menopause transition starts. As your body goes through the transition, your cycle can become irregular.

In this article, we discuss eight reasons your period may be late besides pregnancy.

Most people who haven’t reached menopause usually have a period approximately every 28 days. However, a healthy menstrual cycle can range from every 21-40 days.

If your period doesn’t fall within these ranges, it could be because of one of the following reasons.

1. Stress

Chronic stress can throw off your hormones, change your daily routine, and even affect the part of your brain responsible for regulating your period: your hypothalamus. Over time, stress can lead to illness or sudden weight gain or loss, all of which can impact your cycle.

If you think stress might be throwing off your period, try practicing relaxation techniques and making lifestyle changes.

Chronic stress can also affect other health conditions you’re living with, so addressing it yourself or with the help of a medical professional is an important part of taking care of your overall well-being.

2. Low body weight

People who have eating disorders, such as anorexia nervosa or bulimia, may experience irregularities in their cycle. Losing too much weight can cause irregular periods and may even stop your cycle altogether. This is because not having enough body fat can pause ovulation.

Getting treatment for your eating disorder and getting to the point where your body fat is optimal again can return your cycle back to its original length.

People who participate in extreme exercises, such as marathons, may also experience cycle irregularities as well.

3. Obesity

In the same way that living with a low body weight can cause hormonal changes, living with a high body weight can also cause irregularities.

Obesity can cause the body to produce an overabundance of estrogen, which is a key reproductive hormone. Too much estrogen can cause irregularities in your cycle and may even stop your periods altogether.

If your doctor has determined that obesity is a factor in your late or missed periods, they may advise you to lose weight through lifestyle changes, such as focusing on nutrient-dense foods and exercising.

4. Polycystic ovary syndrome (PCOS)

PCOS is a condition that causes your body to produce more of the male hormone androgen. Cysts form on the ovaries as a result of this hormone imbalance. This can make ovulation irregular or stop it altogether.

Other hormones, such as insulin, may also become unbalanced. This is due to insulin resistance, which is often associated with PCOS.

Treatment for PCOS focuses on relieving symptoms. Your doctor may prescribe birth control or another medication to help regulate your cycle.

5. Birth control

You may experience a change in your cycle when you go on or off birth control. Birth control pills contain the hormones estrogen and progestin, which prevent your ovaries from releasing eggs.

It can take up to 3 months for your cycle to become consistent again after you stop taking the pill.

Other types of contraceptives that are implanted or injected can cause missed periods as well.

6. Chronic diseases

Chronic diseases, such as diabetes and celiac disease, can also affect your menstrual cycle. Changes in blood sugar are linked to hormonal changes, so even though it’s rare, unmanaged diabetes could cause your period to be irregular.

Celiac disease causes inflammation that can lead to damage in your small intestine, which may prevent your body from absorbing key nutrients. This can cause irregular or missed periods.

Other chronic conditions that may lead to cycle irregularities include:

• Cushing syndrome
• congenital adrenal hyperplasia
• Asherman’s syndrome

7.

Primary ovarian insufficiency (POI)

Most vagina owners begin menopause between the ages of 45-55. Those who develop symptoms around age 40 or earlier may be experiencing primary ovarian insufficiency (POI) or early natural menopause.

About 1% of women before the age of 40 experience POI. While this condition can arise from the surgical removal of the ovaries, other causes include genetic disorders and autoimmune conditions.

If you’re experiencing missed periods and you’re 40 years old or younger, contact your doctor to talk about POI testing and treatment.

8. Thyroid issues

An overactive or underactive thyroid gland could also be the cause of late or missed periods.

The thyroid regulates your body’s metabolism, so hormone levels can be affected as well. Thyroid issues can usually be treated with medication. After treatment, your period will likely return to your normal cycle.

If your period is late and you think you might be pregnant, you can take a pregnancy test. Most home tests are pretty accurate, but if you think your result may be wrong, you can see your doctor for a blood or urine test.

Certain pregnancy symptoms during the first six weeks after conception can also suggest that you might be pregnant. If you haven’t received your period within six weeks, it’s not likely that the cause is related to natural variations in your menstrual cycle.

If your periods seem irregular, or you’ve missed a period but know you’re not pregnant, it’s a good idea to talk with your doctor ASAP, as there are many reasons and conditions that could be causing the issue.

Your doctor can properly diagnose the reason for your late or missed period and discuss your treatment options. If you can, keep a record of changes in your cycle as well as other health changes. This will help them make a diagnosis.

If you have the following symptoms, contact a doctor immediately, or call 911:

• unusually heavy bleeding
• fever
• severe pain
• nausea and vomiting
• bleeding that lasts longer than 7 days
• bleeding after you’ve entered menopause and have not had periods for at least a year

Just as every person is different, every menstrual cycle is different. While 28 days is the generalized cycle length, cycles can range from 28-40 days.

Occasional cycle irregularities can happen for a variety of reasons, from chronic stress to weight loss or weight gain, to stopping or starting birth control.

If you’ve noticed that your cycle has been irregular lately, or you’ve missed a period and know for a fact you’re not pregnant, it’s a good idea to talk with your doctor right away. The quicker they can make a diagnosis, the quicker you can work on regulating your cycle again.

Read this article in Spanish.

Mental disorders of late age

Mental disorders of late age are diseases that occur in presenile (presenile, involutional) and senile age. Since there are large differences in the definition of the concept of “late age”, in psychiatry, the involutionary period is usually understood as the age from 45 to 55 years, and patients older than 60 years are referred to the old age (V. M. Bleikher, I. V. Kruk “Explanatory Dictionary psychiatric terms”, 1995), which is at odds with the WHO classification, according to which patients from 60 to 74 years old are considered elderly, and persons from 75 to 90 years old are classified as old age.

The increase in life expectancy has led to a change in the age structure of the population, manifested in an increase in the proportion of elderly and senile patients and, accordingly, elderly patients who manifest certain somatic disorders, as well as severe mental disorders.

Gerontological mental disorders:

Mental disorders of late age are usually divided into diseases of “organic” origin, which arise on the basis of a certain destructive process and lead to dementia (dementia), and “functional” (reversible and, as a rule, not leading to gross dementia) disorders.

The treatment of affective (manifested by such disorders as depression or manic states) and delusional (manifested mainly by delirium) senile psychoses does not differ from the psychopharmacotherapy of similar conditions in other mental illnesses. At the European Medical Center, we use combined treatment with antipsychotics and antidepressants – depending on the patient’s condition, treatment can be started with the use of antipsychotics and, upon reaching a decrease in the patient’s anxiety-delusional arousal, it is possible to add antidepressant drugs.

If a patient with affective and affective-delusional senile (senile) psychosis is insensitive to psychotropic drugs, it is possible to prescribe the so-called electroconvulsive therapy (ECT), if there are no contraindications. Since ECT is ineffective in delusional forms of senile psychosis, treatment with antipsychotics is used.

Psychopharmacological treatment of mental disorders of late age is carried out in a multidisciplinary hospital of the European Medical Center, where patients are provided with comprehensive support and treatment – a complete physical examination is carried out, round-the-clock monitoring of the patient’s condition during therapy is provided and complications are prevented.

Parkinson’s disease is a degenerative-atrophic disease of the brain that manifests itself at a later age and is often accompanied by mental disorders. The most effective treatment for movement disorders currently used to treat Parkinson’s disease is L-DOPA, but the drug has side effects (approximately 50% of patients may experience mental disorders such as confusion, psychomotor agitation with anxiety, agitation, drowsiness, increased depression ). The appointment of L-DOPA follows after a thorough assessment of the mental state of the patient and treatment begins with small doses, which are gradually increased. If psychotic disorders occur, along with a gradual decrease in doses of antiparkinsonian drugs (up to temporary cancellation) and detoxification therapy, it is possible to prescribe small doses of psychotropic drugs.

Alzheimer’s disease – an atrophic brain disease that manifests itself mainly in presenile age, which leads to dementia and is accompanied by disorders of higher nervous activity. The prognosis of this disease is unfavorable, and today there are no proven effective methods of its treatment. In the later stages of the process, patients, as a rule, need to be hospitalized in psychiatric hospitals or placed in neuropsychiatric boarding schools.

Senile dementia is the most characteristic mental illness of senile age with a progressive breakdown of mental activity, culminating in most cases in total dementia (decrease in all intellectual functions). Some foreign psychiatrists consider senile dementia, a kind of completion of the physiological process of aging of the brain, inevitable in old age. With physiological aging, there is also a decrease in the level of mental activity, reminiscent of the initial symptoms of senile dementia. Proper care and symptomatic therapy are important for the fate of such patients – at the initial stage of the disease, patients are recommended to be left in their usual home environment (if their condition allows). Transfer to an unusual (including hospital) environment can cause an aggravation of the course of the disease. Patients are hospitalized only for special indications (helplessness, lack of care, danger to themselves and others).

There are no convincing data indicating the effectiveness of the treatment of senile dementia with nootropic drugs, and therefore such therapy can be recommended only in the initial stages of the disease, as well as in the combination of senile dementia with cerebral atherosclerosis. Psychotropic drugs in very small doses are indicated only when the patient is very agitated, persistent insomnia or psychotic disorders.

Complications after childbirth – causes and consequences

1. Increased allocations
2. Retention of part of the placenta in the uterine cavity
3. Changes in the blood coagulation system
4. Disorder of uterine muscle contraction
5. Inflammatory process in the vagina or uterus
6. Vaginal candidiasis (thrush)
7. Postpartum endometritis
8. Laktostasis and mastitis
9. Postpartum pyelonephritis
10. Venous thrombosis
11. Discomfort in the area of ​​postoperative sutures
12. Urinary incontinence, feces, uterine prolapse
13. Hemorrhoids

After giving birth, a woman often thinks that all worries and anxieties are behind her. But, alas, sometimes the first, happiest days or weeks of the life together of mother and baby can be overshadowed by various complications. In what cases are postpartum changes normal, and when should you see a doctor?

Labor ends after the third stage of labor, that is, after the birth of the placenta. Following this, the uterus immediately significantly decreases in size, becomes spherical, its cavity is filled with blood clots; the bottom of the uterus at this moment is located approximately in the middle between the womb and the navel. The early postpartum period lasts for 2 hours and during this time the woman is in the maternity ward. Then comes the late postpartum period. This period lasts 6-8 weeks. During this time, there is a reverse development (involution) of all organs and systems that have undergone changes due to pregnancy and childbirth. The exception is the mammary glands, whose function reaches its peak precisely in the postpartum period. The most pronounced involutional changes occur in the genital organs, especially in the uterus. The rate of involutional changes is most pronounced in the first 8-12 days. The uterus and cervix are significantly reduced in size. After the birth of the placenta, a large wound surface remains in the uterus, which takes about 4-6 weeks to heal. During this period, the placental site in the uterus bleeds, spotting – lochia – in the first days is bloody in nature, gradually their color changes from red to reddish-brown, brownish, by the 4th week the discharge almost stops and soon disappear completely. In women who have undergone a cesarean section, everything happens more slowly, because, due to the presence of a suture on the uterus, it contracts worse. Their total amount of spotting during the postpartum period is 500-1500 ml.

What complications can occur after childbirth

You should consult a gynecologist in the following cases:

Increased amount of discharge

discharge does not stop for a long time, large blood clots appeared. When bleeding occurs, you need to contact an obstetrician-gynecologist, preferably at the maternity hospital where the birth took place. If the bleeding is very heavy (several pads are required within an hour), you do not need to go to the hospital yourself, you need to call an ambulance.

Retention of part of the placenta in the uterine cavity

The most common cause of late postpartum hemorrhage (that is, those that occur later than 2 hours after birth) is the retention of a part of the placenta in the uterine cavity. The diagnosis in this case is confirmed by ultrasound. To remove the remnants of the placenta, the walls of the uterus are scraped under general intravenous anesthesia with mandatory subsequent antibiotic therapy to prevent infectious complications.

Changes in the blood coagulation system

In rare cases, the causes of bleeding may be changes in the blood coagulation system of a hereditary or acquired nature, blood diseases. In these cases, complex drug therapy is required.

Violation of the contraction of the muscles of the uterus

Possible development of bleeding associated with a violation of the contraction of the muscles of the uterus. This is the so-called hypotonic bleeding. In the subsequent period, the hypotonic state of the uterus can be caused by its overstretching due to polyhydramnios, multiple pregnancies, large fetuses, and underdevelopment of the uterus. A decrease in the contractility of the uterus is also caused by changes in its very wall (fibroids, the consequences of inflammatory processes, frequent abortions). These bleeding most often occur in the first hours after childbirth and require active treatment with medications, and in severe cases, surgery.
A sharp, unexpected cessation of spotting should also alert the woman and requires urgent medical attention. In this case, the outflow of blood from the uterus may be disturbed, that is, lochia accumulate in the cavity and the so-called lochiometer develops. Blood clots are a good breeding ground for bacteria, so if the lochiometer is not treated in time, bacteria enter the uterine cavity and endometritis develops – inflammation of the uterine mucosa. After a caesarean section, a lochiometer occurs more often than after a vaginal delivery. Treatment consists in prescribing drugs that reduce the uterus, while using antispasmodics to relax the cervix and restore the outflow of lochia. In some cases, it is necessary to resort to vacuum aspiration of the contents of the uterus under general intravenous anesthesia and mandatory follow-up antibiotic therapy.

Learn more about the services:

• Ultrasound of the pelvic organs

Inflammatory process in the vagina or uterus

The discharge has acquired an unpleasant odor. This may indicate the development of an inflammatory process in the vagina or in the uterus. In the postpartum period, there was a significant increase in the composition of most groups of bacteria, including bacteroids, Escherichia coli, streptococci, staphylococci. Potentially, all of these species can be the cause of postpartum infectious diseases. A common problem for women after childbirth is the development of bacterial vaginosis. Bacterial vaginosis is a pathology of the vaginal ecosystem caused by the increased growth of predominantly anaerobic bacteria (that is, those that grow in an oxygen-free environment) that actively proliferate in the postpartum period in the woman’s vagina and can be pathogens in postpartum endometritis or suppuration of the sutures of the vagina and cervix. Diagnosis of bacterial vaginosis is based on measuring the acidity of the vagina and detecting in a smear on the flora specific for this disease “key cells” (these are cells of the vaginal mucosa covered with anaerobic bacteria). Treatment of bacterial vaginosis in the postpartum period is carried out with local preparations.

Vaginal candidiasis (thrush)

The appearance of curdled discharge, itching, burning in the genital area, redness indicates the development of vaginal candidiasis (thrush). The risk of this complication increases with antibiotics. Diagnosis is based on the detection of a large number of yeast-like fungi in a smear on the flora. For treatment, local preparations are used in the form of vaginal suppositories or tablets.

Postpartum endometritis

Purulent discharge, lower abdominal pain, fever. These symptoms may indicate the development of a serious complication – postpartum endometritis (inflammation of the inner lining of the uterus). Most often, endometritis occurs in patients after cesarean section, manual examination of the postpartum uterus, manual separation of the placenta and removal of the placenta (if independent separation of the placenta is difficult due to a violation of the contractile function of the uterus), with a long anhydrous interval (more than 12 hours from the moment of amniotic fluid outflow to the birth of a baby), in women admitted to childbirth with inflammatory diseases of the genital tract (for example, against the background of sexually transmitted infections), in patients with a large number of abortions in the past. The classic form of endometritis occurs on days 1-5. Body temperature rises to 38-39degrees, heart rate increases to 80-100 beats per minute. They note depression of the general condition, chills, dryness and hyperemia of the skin, soreness of the body of the uterus, purulent discharge with a smell. The erased form appears on the 5-7th day, develops sluggishly. The temperature does not exceed 38 degrees, there is no chill. Endometritis after caesarean section always proceeds in a severe form.

An ultrasound examination of the uterus and a complete blood count, which reveal signs of inflammation, help the doctor make a diagnosis. Treatment of endometritis should be started as early as possible. It is carried out in a hospital. Assign bed rest, with acute endometritis cold on the lower abdomen. Postpartum endomeritis is necessarily treated with antibiotics, along with them, agents that reduce the uterus are used. Currently, in many clinics and maternity hospitals, the uterine cavity is washed with cooled solutions of antiseptics. In severe cases, an intravenous infusion of saline solutions is required to improve blood circulation, relieve symptoms of intoxication.

In case of untimely treatment, there is a very high risk of spreading the inflammatory process to the entire uterus, small pelvis, the development of sepsis (the appearance of infectious agents in the blood), up to the death of the patient.

Laktostasis and mastitis

In the postpartum period, there may be pain in the mammary glands, a feeling of fullness, an increase in body temperature. When these symptoms appear, you should definitely consult a doctor – an obstetrician-gynecologist in a antenatal clinic or a surgeon.

Possible causes of pain in the mammary glands and the accompanying fever are lactostasis and mastitis.

Laktostasis (stagnation of milk in the gland), due to blockage of the excretory ducts. Most often, this condition develops when the baby is not properly attached to the chest, violation of the feeding regimen. Laktostasis often affects primiparous women. With the stagnation of milk, the mammary gland increases in volume, its dense enlarged lobules are determined. Body temperature can rise to 38-40 degrees. There is no redness of the skin and swelling of the gland tissue, which usually appear with inflammation. After decanting the mammary gland with lactostasis, the pain disappears, painless lobules with clear contours are small in size, and the body temperature decreases. If lactostasis is not eliminated within 3-4 days, mastitis (inflammation of the mammary gland) occurs, since when milk stagnates, the number of microbial cells in the milk ducts increases dramatically, milk is a good breeding ground for various bacteria, which contributes to the rapid progression of inflammation. With the development of mastitis, the body temperature constantly remains high, accompanied by chills. Symptoms of intoxication appear (general weakness, fatigue, headache). The patient is disturbed first by a feeling of heaviness, and then by pain in the mammary gland, which is accompanied by stagnation of milk. The mammary gland increases in volume, areas of redness are noted on the skin. Pumping milk is painful and does not bring relief, after pumping, dense painful areas remain, and a high body temperature persists. In severe cases, pus impurities can be determined in milk.

To eliminate lactostasis, pumping, local anti-inflammatory ointments, and physiotherapy are used. Mastitis is treated with antibiotics. In some cases, lactation suppression and surgical treatment are required.

Postpartum pyelonephritis

Fever, pain in the back or side, painful urination. These symptoms may indicate the development of postpartum pyelonephritis, that is, inflammation of the kidneys. Critical periods for the development of postpartum pyelonephritis, doctors consider 4-6 and 12-14 days of the postpartum period. The development of the disease is associated with infection in the urinary tract from the genital tract. Most often, the disease develops in puerperas, in the urine of which a small amount of bacteria was found during pregnancy. An ultrasound examination of the kidneys and bladder and a urine test help the doctor make the diagnosis.

Treatment of pyelonephritis is mandatory with antibiotics.

Venous thrombosis

Pain in the legs, swelling, redness on the legs along the vein, increased pain when walking – these are symptoms of a serious pathology – venous thrombosis (formation of blood clots in the veins) and require an urgent visit to a surgeon or phlebologist. The most dangerous periods for the occurrence of thrombosis are considered 5-6 days after childbirth or cesarean section, less often thrombosis occurs 2-3 weeks after childbirth. The causes of thrombosis are changes in the blood coagulation system that occur during pregnancy and after childbirth. Physiologically, in the postpartum period, the activation of the coagulation system occurs. As the body tries to stop bleeding. At the same time, the tone of the vessels of the small pelvis and lower extremities is reduced, the veins have not yet had time to adapt to work in new conditions. These conditions trigger the mechanisms of thrombus formation. An important role in the development of postpartum venous thrombosis is also played by the hormonal background, which changes dramatically after the end of pregnancy.

The risk of developing venous thrombosis is especially high in women with various pathologies of the blood coagulation system, which are detected even before pregnancy or during childbearing. There is a high probability of thromboembolic complications and in the presence of diseases of the cardiovascular system, overweight. The risk of thrombosis also increases in women in the age group after 40 years, in the presence of varicose veins of the lower extremities. The risk of thrombus formation is increased in women who have undergone a caesarean section. An ultrasound examination of the veins, with Dopplerography, that is, an assessment of blood flow in the vessels, helps the doctor in making a diagnosis. For the treatment of venous thrombosis, medications are used, wearing compression stockings.

A severe complication of venous thrombosis is the separation of part of the thrombus and its movement along the vascular bed. In this case, blood clots, entering the vessels of the lung or brain, cause strokes (impaired cerebral circulation) or pulmonary embolism (blockage of the pulmonary arteries by a thrombus). This serious complication appears as a sharp cough, shortness of breath, pain in the chest, hemoptysis may begin – the appearance of blood streaks in the sputum when coughing. In severe cases, the work of the heart is disrupted and death can occur.

Unpleasant sensations in the area of ​​postoperative sutures

Discomfort in the area of ​​postoperative sutures after caesarean section or in the area of ​​sutures on the perineum. Normally, after suturing vaginal tears, there may be slight pain for 1-2 days, but they quickly pass. Pain in the postoperative wound after cesarean section may be disturbing for 2 weeks, gradually decreasing. Feeling of heaviness, fullness, pain in the area of ​​the postoperative wound may indicate the accumulation of hematoma (blood) in the area of ​​the sutures. This usually happens in the first three days after childbirth and requires surgical treatment – removal of accumulated blood. Pain, burning, bleeding of the sutures, the appearance of discharge with an unpleasant odor, swelling in the area of ​​the sutures, an increase in body temperature indicates the attachment of an infection and suppuration of the sutures. In these cases, you should also consult a doctor to treat the wound and decide on a further method of treatment.

Urinary incontinence, feces, uterine prolapse

Violation of the physiological functions of the pelvic organs of varying degrees (bladder, rectum), which may appear as in the postpartum period – urinary incontinence, feces, uterine prolapse. The problem of genital prolapse occurs when the pelvic floor muscles have lost the ability to contract so much that individual organs or parts of them do not fall into the projection of the supporting apparatus. The most common cause of pelvic organ prolapse is trauma to the pelvic floor muscles during childbirth.