Common Period Problems
Your top questions about irregular menstrual cycles answered
Late or Missing Periods
I am over two months late for a period, but the pregnancy tests are negative. Are the tests wrong?
Probably not. What you’re describing is a medical condition called secondary amenorrhea, meaning that you’ve developed a condition of having no periods after having had them regularly before. (Primary amenorrhea would mean never having ever had a period at all). Everyone’s entitled to an erratic cycle or two from time to time. Stress can cause this, but don’t be too quick to assume stress is always the cause. It is generally not worth pursuing an investigation with expensive testing until you’ve gone more than three months without a period.
If this happens, there are several things that should be investigated:
- The first thing to do is undergo a physical exam to see if there are any ovarian cysts (possible) or tumors (very unlikely). This exam can (and should) be backed up with an ultrasound, preferably a vaginal ultrasound.
- Blood work should be done, including the following: 1) thyroid stimulating hormone (TSH), to rule out thyroid problems; 2) follicle stimulating hormone (FSH), to rule out premature menopause (unlikely); 3) Prolactin, to rule out a pituitary tumor which can mimic a breast-feeding state that inhibits ovulation, and with it, menstruation. 4) Estrogen and progesterone levels, to see if you’re making the “right stuff” to cycle with periods.
- You could be given a “progesterone challenge”: If you’re making estrogen, then a round of progesterone (given, then withdrawn) should yield a period. If not, you may not be making estrogen. This will indicate possibly premature menopause. However, this can also be ascertained by doing estrogen, progesterone, and FSH levels. Mechanical problems should be ruled out after all of the above.
- Aschermann’s Syndrome, a condition involving scarring within the intrauterine cavity, can effectively seal the uterus or be so scarred that there’s no tissue remaining which builds up with each cycle, causing amenorrhea (no periods). Previous dilation and curettage (D&Cs) and abortions can cause this. This can be ruled out with a hysteroscopy (looking into the cervix with a lighted scope) or with a hysterosonogram (a vaginal ultrasound in which saline is swished up the cervix to expand the intrauterine cavity to show any scarring or obliteration).
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