Menstrual Delays: Causes, Treatments, and Concerns

Menstrual issues

It has been since October 19, 2021, the first day of my last menstrual period, and as of now, January 7, 2022, my period has not arrived.
However, on December 30, 2021, I visited a doctor who performed an ultrasound and a pregnancy test, confirming that I am not pregnant.
The doctor prescribed Norethisterone (5 mg) and Estradiol for me, stating that I should expect my menstrual cycle to start within 3 to 5 days.
I began taking the medication on January 1, 2022, but my period still has not come.
I have been experiencing abdominal pain and discomfort, similar to the sensations I feel before my period.
Before seeing the doctor, I noticed breast tenderness starting in early December, which has since become more pronounced and painful to the touch.

I would like to know if my period will come after taking these two medications and how long it might take.
This is the first time I have experienced such a long delay in my menstrual cycle, and I am unsure if it is due to my work-related late nights or having frequent sexual intercourse with my partner, which may have caused my period to be delayed for almost three months.
The precautions for Norethisterone indicate that it should only be used if there is no pregnancy, and since I have had an ultrasound and a pregnancy test, I am somewhat confused about my body’s condition.

Chen, 20~29 year old female. Ask Date: 2022/01/07

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
For pregnancy concerns, please take a home pregnancy test or visit a gynecologist for evaluation four weeks after your most recent sexual intercourse.
2.
The menstrual cycle can be influenced by various psychological and physiological factors.
If your period is more than two months late, it is advisable to consult a gynecologist for evaluation.
3.
The menstrual cycle is affected by various psychological and physiological factors.
A normal menstrual cycle ranges from 21 to 42 days, and the duration of menstruation varies by age, typically lasting about 3 to 10 days.
If your cycle consistently falls outside this normal range, it is recommended to seek evaluation from a gynecologist at a major hospital.

Reply Date: 2022/01/07

More Info

Understanding menstrual delays can be complex, as they can stem from various causes, including hormonal imbalances, stress, lifestyle factors, and underlying health conditions. In your case, it appears that you have already taken some important steps by consulting a doctor, undergoing an ultrasound, and taking pregnancy tests to rule out pregnancy as a cause for your missed period.

Norethisterone is a synthetic form of progesterone, often prescribed to help regulate menstrual cycles. Estradiol is a form of estrogen, which is also important for menstrual regulation. Your doctor likely prescribed these medications to help induce a period, especially since you have not had one since October 2021. It is common for doctors to prescribe these hormones when a patient experiences amenorrhea (the absence of menstruation) for an extended period, particularly when pregnancy has been ruled out.

You mentioned that you started taking Norethisterone on January 1, 2022, and that your doctor indicated you should expect your period within 3-5 days after starting the medication. However, it is important to note that individual responses to hormonal treatments can vary. While many women may experience a withdrawal bleed (similar to a period) after stopping Norethisterone, some may take longer to respond, and factors such as stress, lifestyle, and overall health can influence this.

The abdominal pain and breast tenderness you are experiencing could be related to hormonal fluctuations, which are common when taking medications like Norethisterone and Estradiol. These symptoms may mimic premenstrual syndrome (PMS) and can be uncomfortable. If the pain is severe or persists, it is essential to communicate this with your healthcare provider, as they may need to reassess your treatment plan.

Regarding your concerns about lifestyle factors, such as working late hours and frequent sexual activity, these can indeed impact your menstrual cycle. Stress and changes in routine can lead to hormonal imbalances, which may delay menstruation. It is crucial to maintain a balanced lifestyle, including adequate sleep, a healthy diet, and stress management techniques, to support your menstrual health.

If you do not experience a period after completing the course of Norethisterone, it is advisable to follow up with your doctor. They may want to explore further investigations to determine the underlying cause of your amenorrhea. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or other hormonal imbalances may require specific treatments.

In summary, while Norethisterone and Estradiol can help induce a period, individual responses can vary. It is essential to monitor your symptoms and maintain open communication with your healthcare provider. If your period does not return after completing the medication or if you have any concerning symptoms, do not hesitate to seek further medical advice. Your health and well-being are paramount, and addressing any underlying issues is crucial for restoring your menstrual cycle.

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