Abdominal Pain and Missed Period: Could It Be Menopause or Pregnancy?

Abdominal pain and a missed menstrual period?

Hello, Doctor.
I would like to ask about my menstrual cycle.
My periods usually come every 28 days, and my last menstrual period started on July 8.
I had sexual intercourse with ejaculation on August 5, but I did not get my period in August.
I visited a gynecologist on August 16, and the doctor prescribed a 3-day course of medication to induce menstruation.
After finishing the medication, my period still did not come.
I returned for a follow-up on August 28, and the doctor prescribed Chlormadinone (for 21 days).
After completing that on September 17, I experienced some dull abdominal pain.
As of September 20, my period still has not arrived, and I had sexual intercourse again on September 19 (with external ejaculation).
Doctor, could this be menopause, or am I pregnant? I am 45 years old, so my chances of conception should be quite low, right? Thank you, Doctor.

Li, 40~49 year old female. Ask Date: 2023/09/20

Dr. Chen Zhiyu reply Obstetrics and Gynecology

There is still a possibility of natural conception before officially reaching menopause, although the likelihood is lower.
Please practice safe sex; it is recommended that you return for an evaluation.
Thank you.

Reply Date: 2023/09/20

More Info

When considering the symptoms of abdominal pain and a missed period, especially in a 45-year-old woman, it is essential to evaluate both the possibility of pregnancy and the onset of menopause. At this age, women are often approaching perimenopause, which can lead to irregular menstrual cycles and various symptoms, including abdominal discomfort. However, pregnancy is still a possibility, particularly if there has been unprotected sexual intercourse.

Given your last menstrual period was on July 8, and you had unprotected intercourse on August 5, it is crucial to understand that sperm can survive in the female reproductive tract for up to five days. This means that if ovulation occurred shortly after intercourse, conception could have taken place. The missed period in August, followed by the administration of medication to induce menstruation, suggests that your body may not have responded as expected. The use of hormonal medications like the ones prescribed (to induce menstruation) can sometimes lead to further irregularities in your cycle.

The abdominal pain you are experiencing could be attributed to several factors. It might be related to hormonal changes, potential pregnancy, or even gastrointestinal issues. If you are experiencing persistent or severe abdominal pain, it is advisable to seek medical attention. A healthcare provider can perform a pregnancy test to confirm or rule out pregnancy and may also conduct an ultrasound if necessary to assess any underlying issues.

Regarding menopause, it is important to note that perimenopause can begin in the 40s, leading to symptoms such as hot flashes, mood swings, and changes in menstrual patterns. However, the absence of menstruation does not automatically indicate that menopause has begun, especially if you have had regular cycles prior to this.
In your case, since you are 45 years old and have missed your period, it is essential to consider both possibilities seriously. The likelihood of pregnancy decreases with age, but it is not impossible. The best course of action would be to take a home pregnancy test or consult with your healthcare provider for a blood test, which can provide a more definitive answer regarding pregnancy.

If pregnancy is ruled out and you continue to experience abdominal pain or other symptoms, further evaluation may be necessary to explore other causes, such as ovarian cysts, fibroids, or gastrointestinal issues. It is also worth discussing your symptoms with your healthcare provider to determine if they are related to hormonal changes associated with perimenopause.

In summary, while the symptoms you are experiencing could be indicative of either pregnancy or the onset of menopause, it is crucial to seek medical advice for accurate diagnosis and appropriate management. Regular follow-ups with your healthcare provider can help monitor your symptoms and ensure that any necessary interventions are made promptly.

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