Delayed Menstruation: Causes and When to Seek Help

Delayed menstruation?

Hello, doctor.
My girlfriend's last menstrual period started on June 19, and her period was expected to arrive on July 17 (she had a delay of 6 days in March, but her cycles in April and May were normal, occurring every 27-28 days).
However, it has now been a week past her expected period, and she still hasn't gotten it as of July 23.
We only had sexual intercourse twice during this cycle, both times on June 27, and we used condoms (once with external ejaculation and once without ejaculation).
My girlfriend has started exercising and following a diet for weight loss over the past month, and she also has a demanding job that causes her some stress.

1.
What is the likelihood of her being pregnant? Could this be related to her exercise and work stress?
2.
My girlfriend currently does not plan to get checked or take a pregnancy test.
If her period still does not come, how long should we wait before seeking medical evaluation?
Thank you for your response to these questions.

Sam, 30~39 year old female. Ask Date: 2020/07/23

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
For pregnancy concerns, please take a home pregnancy test or consult a gynecologist for evaluation four weeks after sexual intercourse.
2.
Abnormal bleeding and irregular menstrual cycles can have various underlying causes; it is recommended to seek evaluation from a gynecologist.

Reply Date: 2020/07/23

More Info

Understanding delayed menstruation can be a complex issue, as it can be influenced by various factors including hormonal changes, stress, lifestyle changes, and potential pregnancy. In your case, your girlfriend's last menstrual period was on June 19, and she is now a week late, which can understandably cause concern.

1. Pregnancy Risk: Given that you had two instances of sexual intercourse on June 27, and both were protected with condoms, the likelihood of pregnancy is relatively low, especially since one instance involved external ejaculation. However, it's important to note that no contraceptive method is 100% effective, and condoms can sometimes fail. The stress of potential pregnancy can also contribute to anxiety, which may further delay menstruation. Additionally, your girlfriend's recent lifestyle changes, including starting a fitness regimen and dietary adjustments, can also impact her menstrual cycle. Weight loss, especially if it is significant or rapid, can lead to hormonal imbalances that may cause delayed periods.

2. When to Seek Help: If your girlfriend's period does not arrive soon, it is advisable for her to take a home pregnancy test, as this is a straightforward way to rule out pregnancy. If she is hesitant to take a test, it may help to discuss the importance of understanding her body and health. If her period remains absent for more than a week after the expected date (around July 24), it would be wise for her to consult a healthcare provider. A healthcare professional can provide a more comprehensive evaluation, including checking for any underlying health issues that may be contributing to the delay, such as hormonal imbalances, polycystic ovary syndrome (PCOS), or other medical conditions.

In summary, while the chances of pregnancy seem low given the circumstances, the combination of stress, lifestyle changes, and potential anxiety can all play a role in menstrual irregularities. Encouraging your girlfriend to take a pregnancy test and seek medical advice if her period does not return can help alleviate concerns and ensure her health is monitored. It’s essential to approach this topic with sensitivity, as discussions about reproductive health can sometimes be stressful or uncomfortable.

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