Delayed Menstruation: Symptoms, Causes, and Next Steps

Delayed menstruation?

Hello Doctor, my last menstrual period started on March 3 and lasted for 6 days.
My cycle is approximately 37 to 38 days, but it has now been 51 days and I still haven't gotten my period.
(The mobile app estimated it would arrive around April 6.) During this time, I had sexual intercourse twice on March 11 and March 19.
On March 11, three days after my period ended, there was unprotected intercourse for about 30 seconds, but it was external ejaculation.
On March 19, we used a condom and there was external ejaculation throughout.
I saw a gynecologist on April 14, and an ultrasound confirmed that I had ovulated.
The doctor advised me to wait ten days, and if my period still hadn't come, to return for medication to induce menstruation.
However, this past week, I have experienced noticeable symptoms such as lower back pain, breast tenderness, bloating, and a feeling of heaviness in my lower abdomen.
Does this mean my period is coming soon? Should I take a pregnancy test? (Since the doctor performed an ultrasound, I didn't take a home pregnancy test.) If my period doesn't come, should I take medication to induce menstruation? Thank you for your guidance, Doctor!

Ashley, 20~29 year old female. Ask Date: 2023/04/22

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you can take a pregnancy test to check; it should be unlikely.
If you are not pregnant, you can take medication to induce menstruation.
Wishing you good health.

Reply Date: 2023/04/22

More Info

Understanding delayed menstruation can be a complex issue, especially for individuals with irregular cycles or those who have recently experienced changes in their reproductive health. In your case, you mentioned that your menstrual cycle typically lasts around 37 to 38 days, but you have now surpassed 51 days without menstruation. This delay can be concerning, especially after having had unprotected sexual intercourse, even if it was brief.

First, let's discuss the symptoms you are experiencing. The symptoms of lower back pain, breast tenderness, bloating, and a feeling of heaviness in the pelvic area can indeed be indicative of an approaching menstrual period. These symptoms are often associated with premenstrual syndrome (PMS) and can occur as your body prepares for menstruation. However, they can also be signs of other conditions, including pregnancy.

Given that you had two instances of sexual activity during your cycle, it is prudent to consider the possibility of pregnancy, even if you used protection during one of those instances. The fact that you experienced a delay in your period, combined with the symptoms you described, warrants a pregnancy test for peace of mind. Home pregnancy tests are generally reliable and can provide you with quick results. If the test is positive, it is essential to follow up with your healthcare provider for further evaluation and guidance.

Regarding the ultrasound you had on April 14, which indicated that you had ovulated, it is important to note that ovulation typically occurs about 14 days before your next period. If you ovulated around that time, you would expect your period to start approximately two weeks later. Since you are now significantly past that point, it is understandable to feel anxious about your menstrual health.

If your period does not arrive within the next week, and you have confirmed that you are not pregnant, your doctor may consider prescribing medication to induce menstruation. This is often done to help regulate the menstrual cycle and alleviate any discomfort associated with prolonged delays. However, it is crucial to have a thorough discussion with your healthcare provider about the potential causes of your delayed menstruation before starting any medication.

In summary, here are the steps you should consider taking:
1. Take a Home Pregnancy Test: This will help determine if pregnancy is a possibility, given your recent sexual activity.

2. Monitor Symptoms: Keep track of any additional symptoms you may experience, as these can provide valuable information to your healthcare provider.

3. Follow Up with Your Doctor: If your period does not arrive soon, or if the pregnancy test is negative, return to your healthcare provider for further evaluation. They may recommend additional tests or treatments based on your individual health history and current symptoms.

4. Consider Lifestyle Factors: Stress, significant weight changes, and other lifestyle factors can also impact your menstrual cycle. Reflecting on any recent changes in your life may provide insight into your current situation.

In conclusion, while the symptoms you are experiencing may suggest that your period is on its way, it is essential to rule out pregnancy and consult with your healthcare provider if your period does not arrive soon. Taking proactive steps will help you manage your menstrual health effectively.

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