Delayed Periods, Negative Pregnancy Tests, and Uterine Thickening

Delayed menstruation, one line on the pregnancy test, thickened endometrium?

Hello Dr.
Lu: My last menstrual period was on September 29, and my cycle is usually around 30 days, which has been very regular since I was young.
This month, my period should have started on October 29.
On the night of October 28, I suddenly felt very tired and wanted to sleep, thinking it was a sign that my period was coming.
I also felt a pulling sensation in my lower abdomen, but my period still did not arrive.
On Sunday, I started to wonder if I might be pregnant, but my partner always practices withdrawal, so I'm not sure.
We had intercourse on October 4, 11, 17, 18, 25, and 31.
I have been experiencing discomfort in my lower abdomen, nausea after eating, and a bit of diarrhea.
On November 3, I took a home pregnancy test, which showed one line.
I went to see a doctor tonight, and the hospital pregnancy test also came back negative, but the doctor mentioned that it doesn't necessarily mean I'm not pregnant.
After hearing my description, the doctor performed an ultrasound and said that my uterine lining is thick.
If my period does not come within the next ten days, I should return to see the doctor for another test, as it could indicate a possible pregnancy.
The doctor did not prescribe any medication or induce my period, allowing me to see if my menstrual cycle will start in the next ten days.
The doctor was very kind.
I just want to ask you, Dr.
Lu, what does it mean for the uterine lining to be thick? Why could it indicate a possibility of pregnancy if my period does not come within ten days?

Xiao Ya, 20~29 year old female. Ask Date: 2015/11/05

Dr. Lü Lizheng reply Obstetrics and Gynecology

1.
In the center of the uterus, there is a layer of tissue known as the endometrium.
The embryo implants itself in the endometrium; if the embryo does not implant, the endometrium will shed and be expelled through the vagina, which is what we observe as menstruation.

2.
Therefore, there are two possible reasons for endometrial thickening.
One possibility is hormonal imbalance, which stimulates the endometrium to continue growing without shedding, resulting in endometrial hyperplasia, and menstruation may be temporarily absent.
The other possibility is pregnancy, where the embryo produces hormones to support the growth of the endometrium, leading to endometrial thickening.
3.
The physician's implication is that it is still uncertain.
It is possible that there is indeed no pregnancy, and a pregnancy test taken ten days later may still show negative results.
Alternatively, the embryo may have just implanted, and testing too early may yield a negative result; waiting ten days for the embryo to develop further may provide a positive result.
4.
Withdrawal is not an effective method of contraception; it is recommended to use condoms or take oral contraceptives.
Sincerely, Dr.
Li-Cheng Lu, Taoyuan Hospital.

Reply Date: 2015/11/05

More Info

Understanding delayed periods, negative pregnancy tests, and uterine thickening can be quite complex, especially when considering various physiological factors and individual circumstances. In your case, it appears that you have a regular menstrual cycle, typically around 30 days, with your last period starting on September 29. Given that your period was expected on October 29 and did not arrive, it is understandable that you are concerned about the possibility of pregnancy.

Firstly, let's address the concept of uterine thickening. The endometrium, or uterine lining, thickens in preparation for a potential pregnancy. This thickening is primarily driven by hormonal changes, particularly estrogen. If fertilization does not occur, the lining is shed during menstruation. In your case, the ultrasound indicated that your uterine lining is thick, which can be a sign of hormonal activity, possibly indicating that your body is preparing for a menstrual cycle or a potential pregnancy.

Regarding your negative pregnancy tests, it is important to note that home pregnancy tests can sometimes yield false negatives, especially if taken too early. The hormone human chorionic gonadotropin (hCG) is produced after a fertilized egg implants in the uterus, and it may take some time for hCG levels to rise to a detectable level. Since you mentioned that you had unprotected intercourse on several occasions, albeit with external ejaculation, there is still a possibility of pregnancy, albeit a lower one.
The symptoms you described—abdominal discomfort, fatigue, and a feeling of nausea—can be associated with both early pregnancy and premenstrual syndrome (PMS). Stress, lifestyle changes, and hormonal fluctuations can also contribute to these symptoms and may lead to a delayed period. Given that you have been experiencing these symptoms, it is wise to monitor your condition closely.

Your doctor’s recommendation to wait ten days before re-evaluating is a common approach. If your period does not arrive within that timeframe, it would be prudent to take another pregnancy test or consult with your healthcare provider for further evaluation. This could include blood tests to measure hCG levels, which are more sensitive than urine tests and can provide a clearer picture of whether you are pregnant.

In summary, uterine thickening can indicate hormonal activity and potential pregnancy, but it is not definitive on its own. The negative pregnancy tests do not rule out pregnancy, especially if taken early. Your symptoms could be related to either hormonal changes or early pregnancy. It is essential to follow up with your healthcare provider as advised, and keep track of any changes in your symptoms or menstrual cycle. If you experience severe pain, heavy bleeding, or other concerning symptoms, seek medical attention promptly.

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