Why Is My Period Late After Negative Pregnancy Tests and Provera?

I went to the gynecology clinic for a check-up and confirmed that I am not pregnant. I took medication to induce menstruation, but my period still hasn't arrived?

Hello Doctor, my last menstrual period started on January 16.
I had sexual intercourse on January 21 and January 23.
My cycle is usually around 28 days, and my period was expected to arrive on February 13.
I took a pregnancy test on February 13, which showed only one line.
My period still hadn’t come by February 16.
On February 21, I went to the obstetrics and gynecology department for a urine test and a vaginal ultrasound, both of which did not indicate pregnancy.
The doctor prescribed me Provera for three days to induce my period and advised me to return if my period had not started by February 28.
During this time, I experienced breast tenderness, mild abdominal pain, and nausea.
After taking the medication, these symptoms persisted, along with increased fatigue, drowsiness, and slight lower back pain.
I took the last two pills of the medication yesterday morning, and as of tonight, my period still has not arrived.
I took emergency contraception (Plan B) at the end of December 2017, and I heard that taking birth control pills can affect the menstrual cycle, but my period was normal in January this year.
I would like to ask the doctor if, based on these tests, it can be confirmed that I am not pregnant.
If I am not pregnant, why is my period suddenly delayed for so many days?

Nimo, 20~29 year old female. Ask Date: 2018/02/25

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Last month's period started on January 16.
I had sexual intercourse on January 21 and January 23.
My cycle is usually around 28 days, and my period was expected to arrive on February 13.
I took a pregnancy test on February 13, which showed only one line.
My period still hadn't arrived by February 16, so on February 21, I went to the obstetrics and gynecology department for a urine test and a vaginal ultrasound, both of which did not indicate pregnancy.
The doctor prescribed me Provera for three days to induce menstruation and advised me to return if my period had not started by February 28.
During this period before taking the medication, I experienced breast tenderness, mild abdominal pain, and nausea.
After taking the medication, these symptoms persisted, along with increased fatigue, drowsiness, and mild lower back pain.
I took the last two pills of the medication yesterday morning, and as of tonight, my period still has not arrived.
I had taken emergency contraceptive pills in late December 2017, and I heard that taking contraceptive pills can affect the menstrual cycle, but my period in January of this year was normal.

1.
Can the doctor confirm that I am not pregnant based on these tests?
Answer: Yes, it can be confirmed that you are not pregnant.

2.
If I am not pregnant, why is my period suddenly delayed by so many days?
Answer: This could be due to hormonal imbalance.

Reply Date: 2018/02/25

More Info

When dealing with a late period after negative pregnancy tests and the use of Provera, there are several factors to consider. Based on your description, it appears that you have a regular menstrual cycle, typically around 28 days, and your last period started on January 16. You had sexual intercourse on January 21 and 23, which places you close to your ovulation window, as ovulation typically occurs about 14 days before your next expected period.

You mentioned that your period was expected on February 13, but it did not arrive. You took a pregnancy test on that day, which came back negative. Following this, you visited a gynecologist on February 21, where urine tests and a vaginal ultrasound also confirmed that you were not pregnant. The doctor prescribed Provera, a medication commonly used to induce menstruation, which you took for three days.

The symptoms you experienced, such as breast tenderness, mild abdominal pain, nausea, fatigue, and lower back pain, can be associated with hormonal fluctuations, stress, or other factors unrelated to pregnancy. It is important to note that Provera can sometimes take a few days to induce a menstrual period after the last dose, and it is not uncommon for some women to experience a delay even after taking this medication.

There are several potential reasons for your late period despite negative pregnancy tests and the use of Provera:
1. Hormonal Imbalance: Stress, changes in weight, or lifestyle factors (like sleep patterns and diet) can lead to hormonal imbalances that affect your menstrual cycle. You mentioned experiencing fatigue and sleepiness, which could be related to stress or other lifestyle changes.

2. Anovulation: Sometimes, women may not ovulate in a given cycle, leading to a missed period. This can happen due to various factors, including stress, illness, or significant changes in routine.

3. Provera Effects: While Provera is intended to induce menstruation, it can also cause side effects that mimic pregnancy symptoms. The hormonal changes from taking Provera can lead to symptoms such as breast tenderness and mood changes.

4. Underlying Health Issues: Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or other hormonal issues can also lead to irregularities in the menstrual cycle.

Given that you have taken the Provera and are still waiting for your period, it is advisable to follow up with your healthcare provider. They may recommend waiting a few more days to see if your period arrives, as it can sometimes take time after the last dose of Provera. If your period does not start within a week after completing the medication, further evaluation may be necessary to rule out any underlying conditions.

In summary, while the negative pregnancy tests and the use of Provera suggest that pregnancy is unlikely, the delay in your period could be attributed to hormonal imbalances, stress, or the effects of the medication itself. It is essential to maintain open communication with your healthcare provider to address any ongoing concerns and to ensure that you receive appropriate care tailored to your situation.

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