Delayed Menstruation: Causes, Symptoms, and Solutions

Missed menstruation?

1.
My last menstrual period was from August 12 to August 16, with ovulation likely occurring between August 23 and 29.
I had unprotected intercourse on August 14, 15, and 19, avoiding the potentially fertile days.
I also had unprotected intercourse on September 2, 4, and 10.
The app indicates that my period should have started on the 11th, but it is now 9 days late.
I took pregnancy tests on September 12, 13, 14, 16, 17, and 18, all of which were negative.
On the 19th, I visited a gynecologist, who performed an ultrasound and a urine test, and informed me that I am not pregnant.
It appears that I did not ovulate, which is why my period has not arrived.
Is this situation possible? My cycles in previous months have been quite regular, around 29 to 31 days.
I have been experiencing some discharge these days; what are the chances of pregnancy in this case?
2.
What could cause anovulation leading to a missed period?
3.
After my visit to the gynecologist, the doctor prescribed Provera (medroxyprogesterone) for me, but I have been feeling nauseous after taking it.
Is this normal? Is there a way to alleviate this side effect?
4.
How long after taking Provera can I expect my period to arrive?
5.
Since I had intercourse the day before my expected period on September 10, when can I take a home urine test to confirm that I am not pregnant?

Miss Lin, 20~29 year old female. Ask Date: 2022/09/20

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
Ovulation typically occurs about 13 to 14 days before the onset of menstruation, but if the menstrual cycle is irregular, it becomes difficult to determine, and a pregnancy test is needed for confirmation; currently, the likelihood seems low.
2.
There are many potential causes, including irregular lifestyle, stress, or endocrine disorders.
3.
The side effects of progesterone include dizziness, edema, and nausea, which are normal; it may be considered to reduce the dosage.
4.
After discontinuing the medication, it takes about 3 to 5 days.
5.
Approximately 20 days later, around October 10th.

Reply Date: 2022/09/20

More Info

Understanding delayed menstruation can be complex, as it involves various physiological, hormonal, and lifestyle factors. Based on your situation, let's break down your questions and concerns.

1. Delayed Menstruation and Pregnancy Risk
You mentioned that your last menstrual period was from August 12 to August 16, with ovulation likely occurring between August 23 and August 29. Engaging in unprotected intercourse during this time can raise concerns about pregnancy. However, since you have taken multiple home pregnancy tests (HPT) on September 12, 13, 14, 16, and 17, all of which returned negative results, and a visit to the gynecologist confirmed no pregnancy, it is reasonable to conclude that you are not pregnant. The absence of menstruation could be attributed to anovulation (lack of ovulation), which can occur even in women with previously regular cycles.

2. Causes of Anovulation and Delayed Menstruation
Several factors can lead to anovulation and, consequently, delayed menstruation:
- Stress: High levels of stress can disrupt the hormonal balance necessary for ovulation.

- Weight Changes: Significant weight loss or gain can affect menstrual cycles.

- Hormonal Imbalances: Conditions such as polycystic ovary syndrome (PCOS) can lead to irregular cycles.

- Thyroid Issues: Both hyperthyroidism and hypothyroidism can impact menstrual regularity.

- Lifestyle Factors: Changes in exercise habits, diet, or sleep patterns can also influence ovulation.

3. Side Effects of Progesterone (Provera)
You mentioned that your doctor prescribed Provera (medroxyprogesterone) to help induce menstruation. It is not uncommon to experience side effects from hormonal medications, including nausea. If you are feeling nauseous after taking Provera, it is advisable to discuss this with your healthcare provider. They may suggest taking the medication with food or adjusting the dosage to minimize side effects.

4. Timing of Menstruation After Provera
Typically, after taking Provera, you can expect your period to start within 3 to 7 days after completing the course of medication. However, individual responses can vary, and some women may take longer to resume menstruation.

5. Timing for Home Pregnancy Tests
Regarding your concern about the timing of home pregnancy tests, it is generally recommended to wait at least one week after a missed period for the most accurate results. Since you had intercourse on September 10, testing at least one week later (around September 17) would provide a reliable indication of pregnancy. If you continue to experience delayed menstruation beyond this point and have negative tests, it may be worth consulting your doctor again for further evaluation.

Conclusion
In summary, while the absence of menstruation can be concerning, it is often due to factors such as stress, hormonal imbalances, or anovulation rather than pregnancy. If your symptoms persist or worsen, or if you have additional concerns about your menstrual health, it is crucial to maintain open communication with your healthcare provider. They can offer tailored advice and treatment options based on your individual health needs. Remember, your menstrual health is an important aspect of your overall well-being, and seeking help is a positive step towards understanding and managing your situation.

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