Menstrual Delays: Signs, Symptoms, and Concerns

My period hasn't arrived yet..?

Hello doctor, I have some questions to discuss with you.
On July 11, I had intercourse with my girlfriend and took emergency contraception within 12 hours.
Her period was delayed by 4 days and arrived on August 6.
During the fertile window on August 17, we used a condom and there was no breakage, but there was some white discharge from her vagina, which you mentioned was likely her secretions, and you said there was no risk of pregnancy.
She expects her period to come on August 23.
However, she has been experiencing breast pain and frequent dull pain below the navel, with occasional sharp pains.
Even though her period is two days late, it still hasn't arrived.
She drank cold beverages on August 17 and has had a slight cold since then.
Are these symptoms premenstrual signs? I recall you mentioning that early signs of pregnancy can appear after 2-3 months.
Additionally, she has been experiencing shoulder pain recently.
Could this be related to her menstrual cycle? (She is trying to relax and cope by sleeping it off.) She has always been very regular with her periods, except for last month when she took the contraceptive pill.
How many days of delay are considered normal? I read online that some women experience delays of nearly two weeks due to stress and anxiety.
She has been feeling like her period is about to come, and she has experienced almost all the typical premenstrual symptoms.
Does this indicate that her period is approaching? She mentioned that she doesn't experience these symptoms when her period is absent, and she has also had a decreased appetite lately.
Thank you very much for your help!

Niming, 10~19 year old female. Ask Date: 2018/08/24

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On July 11, I had intercourse with my girlfriend and took emergency contraception within 12 hours.
My period was delayed by 4 days and finally arrived on August 6.
During the fertile window, we used a condom and there was no breakage, but there was white fluid present in her vaginal area, which you mentioned was her discharge.
She said she wouldn't get pregnant and expects her period on August 23.
However, she has been experiencing breast pain, frequent dull pain below the navel, and occasional sharp pain.
Even after two days of her expected period, it still hasn't arrived.
On August 17, she drank a cold beverage and has had a slight cold since then.
Are these symptoms indicative of premenstrual signs? I heard you mention that pregnancy symptoms can appear after 2-3 months.
She has also been experiencing shoulder pain.
Are these signs of an impending period? (She is trying to relax and cope by sleeping it off.) She has always been very regular, except for last month when she took the contraceptive pill.
How many days of delay are considered normal? I read online that some women can be delayed for almost two weeks due to stress and anxiety.
She has been feeling like her period is coming, and she has experienced almost all premenstrual symptoms.
Does this mean her period is on the way? She mentioned that without her period, she wouldn't have these symptoms, and she hasn't had much of an appetite lately.
What is the issue...?

Reply Date: 2018/08/24

More Info

Understanding menstrual delays can be a complex issue, as various factors can influence a woman's menstrual cycle. Based on the information you've provided, let's break down the signs, symptoms, and concerns regarding your girlfriend's situation.

Signs and Symptoms of Menstrual Delays
1. Menstrual Cycle Variability: A typical menstrual cycle ranges from 21 to 35 days, with an average of 28 days. However, it's important to note that cycles can vary due to numerous factors, including stress, hormonal changes, illness, and lifestyle factors. A delay of a few days can be normal, especially if your girlfriend has a history of regular cycles.

2. Pregnancy Concerns: You mentioned that your girlfriend took emergency contraception (the morning-after pill) shortly after unprotected intercourse. This medication is designed to prevent pregnancy and is most effective when taken as soon as possible after unprotected sex. However, it can also cause temporary changes in the menstrual cycle, including delays. Since she experienced a delay of four days after taking the pill, this could be a side effect of the medication rather than an indication of pregnancy.

3. Physical Symptoms: The symptoms your girlfriend is experiencing, such as chest pain, lower abdominal discomfort, and shoulder pain, could be related to premenstrual syndrome (PMS) or other factors. PMS can cause a variety of physical and emotional symptoms, including breast tenderness, bloating, mood swings, and cramps. The fact that she has a history of regular cycles and is now experiencing these symptoms may suggest that her period is approaching.

4. Stress and Lifestyle Factors: Stress is a significant factor that can affect menstrual cycles. If your girlfriend is feeling anxious or stressed about the possibility of pregnancy or other life circumstances, this could contribute to her delayed period. Additionally, lifestyle factors such as diet, exercise, and illness (like the cold you mentioned) can also impact menstrual regularity.

Concerns and Recommendations
1. Timing of Menstrual Delays: While a delay of a few days can be normal, if her period is more than a week late, it would be advisable for her to take a home pregnancy test for peace of mind. Pregnancy tests are most accurate when taken after a missed period.

2. Consulting a Healthcare Provider: If her period does not arrive soon or if she continues to experience discomfort, it would be wise for her to consult a healthcare provider. They can perform a thorough evaluation, including a physical examination and possibly blood tests, to rule out any underlying issues.

3. Understanding Symptoms: The symptoms she is experiencing, such as chest pain and abdominal discomfort, should not be ignored. While they may be related to PMS or stress, it’s essential to ensure that they are not indicative of a more serious condition. If the pain is severe or persistent, seeking medical attention is crucial.

4. Emotional Support: Encourage your girlfriend to talk about her feelings and concerns. Sometimes, just having someone to listen can alleviate anxiety. Stress management techniques, such as mindfulness, yoga, or gentle exercise, can also be beneficial.

Conclusion
In summary, menstrual delays can be influenced by various factors, including hormonal changes, stress, and the use of emergency contraception. While a delay of a few days can be normal, it’s essential to monitor the situation closely. If her period does not arrive soon or if she experiences significant discomfort, consulting a healthcare provider is recommended. Open communication and emotional support can also help her navigate this stressful time.

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