Delayed Menstruation: Causes and Concerns for Women

Menstruation has not occurred?

From June 10 to 14, I had my menstrual period.
During this time, I had sexual intercourse with my boyfriend several times.
On June 26, I experienced bleeding and went to see a doctor, who diagnosed it as ovulatory bleeding.
My next expected period was from July 11 to 15, but it did not come, and I did not feel any cramping.
However, I noticed that my nipples started to itch around some day in July, though I am not sure if it is related to my menstrual cycle.

On July 16, after having intercourse with my boyfriend, I began to experience severe pain in my uterus, which radiated to my anal sphincter and caused abdominal pain, along with a sensation of wanting to vomit and have diarrhea.
That night, I took a pregnancy test, which showed one line.
However, I had doubts the next morning and went to see a doctor, who also advised me to take a pregnancy test.
The test confirmed that I was not pregnant.
An ultrasound revealed some pain in my right ovary, and the doctor noted that my endometrium was thickened.
The doctor also mentioned the presence of a cyst or follicle on my right ovary, but said it would resolve naturally with menstruation.

The doctor prescribed a five-day course of medication to induce menstruation.
After finishing the medication, I still did not get my period the next day, but I started to experience cramping in my abdomen, which came and went.
There was some white discharge, but no menstruation.
The doctor advised me to wait seven days after finishing the medication to see if my period would start, and if it did not, I should return for a follow-up.

I only had sexual intercourse on July 16, and no other days in July.
I had a surgery for endometrial issues on December 31 last year, but everything was normal before this month.
I am unsure what is happening this month.
I previously had hyperthyroidism, and I am wondering if it could be related to my thyroid condition, as I have not had a follow-up appointment this year.

Zu, 20~29 year old female. Ask Date: 2017/07/23

Dr. Huang Jianzhong reply Obstetrics and Gynecology

From June 10 to June 14, I had my menstrual period.
During this time, I had sexual intercourse with my boyfriend several times.
On June 26, I experienced bleeding and went to see a doctor, who diagnosed it as ovulatory bleeding.
My next expected period was from July 11 to July 15, but it did not come, and I did not have any cramping sensations.
However, I remember that starting from an unknown day in July, my nipples began to itch, though I am not sure if this is related to my menstrual cycle.

On July 16, after having sexual intercourse with my boyfriend, I started experiencing severe pain in my uterus, which radiated to my anal sphincter and caused abdominal pain, along with a sensation of wanting to vomit and have diarrhea.
That night, I took a pregnancy test, which showed one line.
However, the next morning, I had doubts and went to see a doctor, who also advised me to take a pregnancy test.
The test confirmed that I was not pregnant.
An ultrasound revealed some pain in my right ovary, and the doctor noted that my endometrium was thickened.
The doctor also mentioned the presence of a cyst or follicle on my right ovary, but said it would resolve naturally with menstruation.

The doctor prescribed a five-day course of medication to induce menstruation.
After completing the medication, I still did not get my period, but I started experiencing cramping in my abdomen, which came and went.
There was also a little white discharge.
The doctor advised me to wait seven days after finishing the medication to see if my period would come; if it did not, I was to return for a follow-up.
The only sexual intercourse I had in July was on July 16.

I had surgery for endometrial issues on December 31 last year, but my cycles had been normal until this month.
I am unsure what is happening this month.
I previously had hyperthyroidism, and I am wondering if it could be related to my thyroid condition, as I have not had a follow-up this year.

In summary, my expected menstrual period did not occur, and the doctor prescribed a five-day course of medication to induce menstruation.
I should expect my period to come within three to seven days after finishing the medication.
The absence of menstruation this month may not be related to my previous hyperthyroidism.

Reply Date: 2017/07/23

More Info

Delayed menstruation can be a source of concern for many women, especially when accompanied by unusual symptoms or changes in the menstrual cycle. In your case, several factors could be contributing to the delay in your period, and understanding these can help alleviate some of your worries.

Firstly, it's important to recognize that menstrual cycles can be influenced by a variety of factors, including hormonal fluctuations, stress, lifestyle changes, and underlying medical conditions. Given that you have a history of thyroid issues, specifically hyperthyroidism, this could certainly play a role in your menstrual irregularities. Thyroid hormones are crucial in regulating the menstrual cycle, and any imbalance can lead to delayed or missed periods. If you haven't had a follow-up appointment for your thyroid condition this year, it would be wise to schedule one to ensure your hormone levels are stable.

Additionally, the occurrence of ovulation bleeding you experienced on June 26 could indicate that your body is still undergoing normal reproductive processes, but the timing may be off. Ovulation bleeding is typically light and can occur when the ovary releases an egg, which may confuse the timing of your menstrual cycle. The absence of your period following this event could be due to a variety of reasons, including stress or changes in your physical health.

Stress is another significant factor that can lead to menstrual irregularities. Emotional and physical stress can disrupt the hypothalamus, the part of the brain that regulates hormones related to the menstrual cycle. If you've been experiencing increased stress, whether from personal relationships, work, or other life changes, this could be a contributing factor to your delayed menstruation.

Regarding the symptoms you described, such as breast tenderness and abdominal pain, these can also be associated with hormonal changes in your body. The itching you mentioned could be related to hormonal fluctuations or even skin sensitivity, which can sometimes occur in conjunction with menstrual changes.

You mentioned that you took a pregnancy test that returned negative, which is a good initial step in ruling out pregnancy as a cause of your delayed menstruation. However, if your symptoms persist or worsen, or if you continue to miss your periods, it would be advisable to consult with a healthcare provider. They may recommend further testing, such as blood tests to check hormone levels, including thyroid hormones, and possibly an ultrasound to assess any structural issues with your reproductive organs.

In summary, while delayed menstruation can be concerning, it is often influenced by a combination of factors, including hormonal imbalances, stress, and lifestyle changes. Given your medical history and the symptoms you've described, it would be prudent to follow up with your healthcare provider for a comprehensive evaluation. They can help determine the underlying cause of your delayed menstruation and recommend appropriate treatment options to help regulate your cycle and address any other concerns you may have.

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