Your period is late, but the test is negative: what to do?

A missed period, but the test does not show pregnancy is a situation familiar to many women. The fact is that the regularity of the menstrual cycle depends not only on conception. A regular menstrual cycle is the most important marker of the health of all organs responsible for reproductive function1. Stress, obesity or underweight, hormonal imbalances, climate change, and illness can lead to a picture where the pregnancy test is negative and there is no period. In this article, Women First project doctors talk about why there is no period and the test is negative.

How to distinguish a delay from the norm?

First, let's define what is considered a delay. The norm is a cycle lasting 21-35 days, for most women it is 28 days. Due to various factors, ovulation may occur a couple of days later than expected, resulting in a delay of 2 days. But this is not a cause for concern, this is a variant of the norm. And even a delay of menstruation for 4 days followed by its onset is also acceptable if it is not systemic in nature and occurs no more than 2-3 times a year. That is, a shift in menstruation up to 4 days from the expected start is not a delay. If the test does not show pregnancy, but there is a delay, and it lasts 5 days or more, you need to establish why this situation has arisen. If there is no menstruation for more than 5-7 days, you need to consult a doctor to undergo an examination and find the reasons.

Lack of menstruation can be divided into several types:

• Increasing the duration of the cycle with bleeding every 40-60 days. At the same time, the discharge is light, menstruation can last 1 day and end.
• Menstruation occurs once every 35-40 days, with normal duration.
• No periods for more than 6 months.

Against the background of a delay, symptoms similar to those of pregnancy may appear: drowsiness, breast tenderness, nausea. In any of these cases, you should consult a doctor to get diagnosed and find out why there are no periods and the test is negative.

Rule out pregnancy

If you don't have your period on time, you need to do a home test. It will help you understand what is happening - a slight deviation from the norm or pregnancy. If the test does not show pregnancy, but there is a delay, we recommend repeating the procedure after 2-3 days. This is due to the fact that the result could be a false negative. A false negative test is possible in the following cases:

• The test is defective. To reduce this likelihood, purchase several tests from different manufacturers.
• The gestation period is too short. Test systems determine pregnancy by the level of the hCG hormone, which is produced by the pituitary gland after conception and fixation of the egg. If the period is minimal, then the concentration of the hormone is not yet sufficient to interact with the test reagent. It turns out that according to the results of home diagnostics, hCG is negative, but there are no periods.
• The technology is broken. The maximum content of hCG in urine is in the morning. The study should be carried out the first time you urinate after waking up. At other times of the day there may be a false negative result. It is important not to drink too much the night before, so as not to reduce the concentration of urine due to the large volume of liquid. To collect urine when using an immersion strip test, you need a sterile container, such as a pharmacy biospecimen container.

If, when the test is carried out correctly, the result remains doubtful, there is a very pale second line, pain in the lower abdomen appears, the temperature has risen, or other symptoms are bothering you, then we recommend that you immediately contact the clinic.

In a clinical setting, pregnancy is accurately diagnosed through an ultrasound examination and a laboratory blood test for hCG - from a blood sample, it is possible to determine hCG concentrations corresponding to the smallest stages of pregnancy, when there are no periods, and a home test shows negative hCG.

Diagnostics using ultrasound will show not only the fact of pregnancy, but will also determine the location of the fertilized egg, the number of fetuses, gestational age and development parameters.

Before visiting a doctor, you can analyze indirect signs, even if the test does not show pregnancy, but there is a delay:

• Increased basal temperature (measured immediately after waking up in the rectum). Before ovulation, the thermometer readings are kept at 37.0-37.3 °C. These same values ​​remain throughout the second half of the cycle, decreasing before the onset of menstruation. If the temperature during your expected period is still above 37.0 °C, this may indicate pregnancy. If the values ​​are 36.4-36.6 °C, menstruation is about to begin.
• Engorgement, increased sensitivity, enlarged mammary glands. Sometimes pain may occur without clear localization.
• Mood swings, fatigue, lethargy or irritability.
• Change in color of the mucous membranes of the external genitalia and vagina. The tissues darken and acquire a bluish tint due to increased blood flow to the pelvis.
• Nagging pain in the lower abdomen. They can be caused by the attachment of the fertilized egg to the walls of the uterus.

Important:

these signs are not specific and can appear not only during pregnancy. Therefore, do not delay visiting the clinic.

Some women are concerned about the question: is it possible to get pregnant if you don’t have periods? Yes, non-occurrence of menstruation does not exclude the possibility of conception. Therefore, if pregnancy is not desired, continue to use protection.

The mechanism of contraceptive action of the intrauterine device

Intrauterine devices come in different types:

• inert;
• copper-containing;
• containing gold or silver;
• containing levonorgestrel - a synthetic gestagen.

Hormonal IUDs contain a container with hormones and have a principle of action similar to other hormonal contraceptives - suppression of ovulation, changes in peristalsis of the fallopian tubes. Intrauterine contraceptives change the structure of the endometrium, preventing the fertilized egg from implanting. Thanks to this effect, they can be inserted after sexual intercourse as emergency contraception.

Copper-containing coils cause aseptic inflammation in the uterine cavity. In the uterus, the number of leukocytes and macrophages increases, which destroy sperm.

Possible reasons for the delay

The reasons why there is no menstruation and the test is negative may be:

• Stressful shocks that disrupt the production of hormones that regulate the menstrual cycle. Research shows2 a connection between stress and irregular cycles. In addition, frequent stress increases the risk of early menopause2.
• Sudden weight fluctuations, high physical activity and low-calorie diet3. With high stress on the female body, the likelihood of developing premenstrual dysphoric disorder and cycle disorders increases4.
• Changes in climate and time zone can cause the absence of menstruation during the period of adaptation to new conditions.
• Hormonal disorders, diseases of the reproductive organs, inflammatory processes in the urinary tract, obesity.
• Recent genital surgery, abortion.
• Smoking more than 1 pack of cigarettes per day for five years or more2. Smoking is also a significant risk factor for early menopause.
• Perimenopause is the natural period before menopause when periods may be irregular and cycles may become longer.

Most often, with a negative test, there is no period due to hormonal changes. If the problem recurs repeatedly, then persistent menstrual irregularities are diagnosed. The causes of violations can be established only after a comprehensive examination, including examination, laboratory blood tests, ultrasound, and other procedures.

The sooner you seek help from specialists, the sooner you will be prescribed treatment. Don't forget to bring your past examination data to your doctor's appointment. Experts ask some women to show a menstrual calendar, which reflects the consistency, duration, and other features of the menstrual cycle5.

In recent years, women have begun to take the periodic absence of menstruation lightly and frivolously. They are not in a hurry to get an appointment; instead, they look for reasons for a missed period with a negative test on forums or listen to the advice of friends. This approach can lead to delayed treatment and disappointing prognosis, causing infertility and other complications. Many genital tumors develop asymptomatically, but they often disrupt the cycle due to hormonal imbalances that occur.

It is known that hormones affect a woman’s health, her beauty, mood, performance, and life expectancy. The longer menstrual function is maintained, the better the woman will feel. When the production of female sex hormones ceases, the risk of developing arthrosis (age-related joint deformation), arthritis (joint deformation independent of age), other joint pathologies, as well as cardiovascular diseases increases sharply.

Also, the cause of the disorder can be benign neoplasms that mechanically prevent the flow of menstrual blood. A polyp can block the cervix, preventing the blood and endometrium accumulated inside from flowing out. This is a serious situation that requires immediate medical attention. Therefore, do not procrastinate or put off solving problems until later.

Inflammatory diseases of the uterus

Inflammatory diseases of the uterus and ovaries lead to disruption of the production of hormones that are responsible for the processes of maturation of eggs, follicles, and endometrium. As a result, they are often the cause of delay. At the same time, the volume and nature of the discharge changes, pain appears in the lower abdomen, lower back, and other symptoms.

Often, inflammatory processes are the cause of infertility, tumors of the reproductive system, and mammary glands. Inflammatory diseases occur due to infection due to improper hygienic care of the genitals, unprotected sexual intercourse, traumatic damage to the uterus during childbirth, abortion, and curettage.

How to act

First of all, don't panic. If there are no disturbing symptoms, then repeat the study after 2-3 days. If the result is the same, consult your doctor.

Do not try to speed up the arrival of menstruation if you are late using folk remedies or self-prescribing medications. This can cause bleeding or the development of serious pathologies.

Only a doctor after an examination should determine how to provoke menstruation if there is a delay and how to do it. Tactics are chosen based on the cause of menstrual irregularities.

If you are not pregnant based on the results of home diagnostics, but do not have your period, then make an appointment with a gynecologist, do not risk yourself. Take care of yourself and be attentive to your health.

Womenfirst

• Amenorrhea: A Systematic Approach to Diagnosis and Management. David A Klein, Scott L Paradise, Rachel M Reeder. Am Fam Physician. 2019 Jul 1;100(1):39-48. PMID: 31259490.
• Factors associated with menstrual cycle irregularity and menopause. Jinju Bae, Susan Park, Jin-Won Kwon. BMC Women's Health. 2022 Feb 6;18(1):36. PMID: 29409520. PMCID: PMC5801702. DOI: 10.1186/s12905-018-0528-x
• Menstrual irregularities: what we know about diet therapy. Menstrual disorders: what we know about dietary-nutritional therapy. Elena Aguilar-Aguilar. Nutr Hosp. 2022 Jan 13;37(Spec No2):52-56. PMID: 32993311. DOI: 10.20960/nh.03358
• Menstrual Cycle Disorders in Professional Female Rhythmic Gymnasts. Mariola Czajkowska, Ryszard Plinta, Magdalena Rutkowska, Anna Brzęk, Violetta Skrzypulec-Plinta, Agnieszka Drosdzol-Cop. Int J Environ Res Public Health. 2022 Apr 25;16(8):1470. PMID: 31027248. PMCID: PMC6518119. DOI: 10.3390/ijerph16081470
• Where did your periods go? Evaluation and treatment of functional hypothalamic amenorrhea/Where Have the Periods Gone? The Evaluation and Management of Functional Hypothalamic Amenorrhea. Marie Eve Sophie Gibson, Nathalie Fleming, Caroline Zuijdwijk, Tania Dumont. J Clin Res Pediatr Endocrinol. 2022 Feb 6;12(Suppl 1):18-27. PMID: 32041389. PMCID: PMC7053439. DOI: 10.4274/jcrpe.galenos.2019.2019.S0178
• Find a needle in a haystack. Differential diagnosis of ovarian dysfunction: Information Bulletin / Yu.A. Koloda, O.A. Raevskaya, D.V. Yatsyshina; edited by V.E. Radzinsky. - M.: Editorial office of the magazine StatusPraesens, 2022. - 20 p. ISBN 978-5-907218-39-0

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If what symptoms appear should you immediately contact a gynecologist?

Delayed menstruation may be accompanied by the following symptoms:

• nausea or vomiting;
• dizziness;
• increase in the size of the mammary glands;
• white discharge from the genital tract;
• refusal to eat, change in taste preferences;
• drowsiness or insomnia.

These delayed symptoms indicate pregnancy. It is necessary to contact a gynecologist for examination as soon as possible.

If the delay is accompanied by severe pain in the lower abdomen, fever, chills, vomiting, you must call an ambulance. The cause of this condition may be an ectopic pregnancy or a missed miscarriage, in which case the patient should receive immediate medical attention.

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Abortion and contraception clinic in St. Petersburg - department of the medical gynecological association "Diana"

Make an appointment, tests or ultrasound via the contact form or by calling +8 (812) 62-962-77. We work seven days a week from 09:00 to 21:00.

We are located in the Krasnogvardeisky district, next to the Novocherkasskaya, Ploshchad Alexander Nevsky and Ladozhskaya metro stations.

The cost of a medical abortion in our clinic is 3,300 rubles. The price includes all pills, an examination by a gynecologist and an ultrasound to determine the timing of pregnancy.