Missed Period After Birth Control: Possible Causes and Next Steps

After stopping the use of emergency contraception, if menstruation does not occur?

Hello Doctor, I have been diagnosed with polycystic ovary syndrome (PCOS) for about a year and a half.
My last natural menstrual period was a year and a half ago (during this time, I took Diane-35 or other medications to induce menstruation).
The last time I took Diane-35 was in September 2019, after which I did not take it again.
I had a natural menstrual period on December 21, followed by another on February 17.
Here are the details I would like to discuss with you:
On February 17, I had the first day of my period.
On February 19, I took the first pill of Diane-35.
On March 7, I attempted to have sexual intercourse with my boyfriend (it was our first time), but it was not successful (there was some penetration, about 2-3 cm).
On March 10, I took the last pill of Diane-35 (the 21st pill).
I took the pills consistently every day (there were a few times I forgot to take them at the same time, but I took them within 2 hours).
In the past, I usually get my period four days after stopping the medication, but today is the fifth day after stopping, and I still have not gotten my period.

I would like to ask you:
1.
Is it possible that I am pregnant?
2.
What could be the reasons for not getting my period after finishing the contraceptive pills?
3.
If I still do not get my period in two days, should I go to a gynecologist for an examination? Thank you!

Nìmíng, 20~29 year old female. Ask Date: 2020/03/15

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, the chances of pregnancy should be low.
Please wait another week, and if your period still hasn't arrived, it is advisable to see a gynecologist.
Wishing you good health.

Reply Date: 2020/03/15

More Info

It's understandable to have concerns about missed periods, especially after being on birth control and dealing with conditions like polycystic ovary syndrome (PCOS). Let's break down your situation and address your questions.

1. Is it possible to be pregnant?
Given that you had unprotected intercourse, albeit briefly, there is a possibility of pregnancy. Birth control pills like Diane (Diane-35) are designed to prevent ovulation, but they are not 100% effective, especially if there were any missed doses or if the pills were not taken consistently at the same time each day. The fact that you had a natural menstrual cycle before starting the pill is a positive sign, but it does not rule out the possibility of pregnancy. If you suspect you might be pregnant, taking a home pregnancy test after a missed period can provide clarity.

2. What could cause a missed period after stopping birth control?
Several factors could contribute to a missed period after stopping birth control pills:
- Hormonal Imbalance: After long-term use of birth control, your body may take some time to readjust and resume its natural hormonal cycle. This is particularly relevant for individuals with PCOS, as hormonal imbalances are common in this condition.

- Stress: Physical or emotional stress can impact your menstrual cycle, potentially delaying or preventing menstruation.

- Weight Changes: Significant weight loss or gain can also affect your cycle, especially in individuals with PCOS.

- Other Medical Conditions: Conditions such as thyroid disorders or other hormonal imbalances can also lead to missed periods.

3. Should you see a gynecologist if your period doesn't come in two days?
If your period does not arrive within a couple of days after stopping the pill, it would be wise to consult with a gynecologist. They can perform a pregnancy test and evaluate your hormonal levels to determine the underlying cause of your missed period. Additionally, they can provide guidance on managing PCOS and discuss potential treatment options if necessary.

In summary, while there is a possibility of pregnancy, various factors could explain your missed period. Monitoring your symptoms and seeking medical advice if your period does not arrive soon is a prudent step. Regular follow-ups with your healthcare provider can help manage PCOS and any related concerns effectively. Remember, it's essential to communicate openly with your doctor about your menstrual cycle and any changes you experience, as this information is crucial for your reproductive health.

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