Skip to main content

Pregnancy Isn't the Only Cause of Absent Periods

  • Author:
  • Updated date:

REVIEWED BY
Dr. Mark Trolice, MD, Reproductive Endocrinology and Infertility Specialist, Associate Professor of Ob/Gyn, The IVF Center and UCF College of Medicine

absent-periods-not-pregnant

Pregnancy Test Negative After a Missed Period?

You missed your period, but your pregnancy test is negative. There are several possible causes for this that will be discussed later in the article. However, it is extremely important that you first ensure you really aren't pregnant.

Advances in biotechnology have improved the accuracy of home pregnancy tests. Home urine tests for hCG (human chorionic gonadotropin) are now used to confirm or refute blood tests for hCG because, in some women, the blood tests can cross-react with what's called heterophile antibodies (HA) to give a false positive."

However, false negatives in home pregnancy tests can still happen. There are several reasons for a false negative on a home pregnancy test, the most common being that women will take the test too early after a late period. To get accurate results, you should wait to take a pregnancy test two weeks after you miss your period.

If you have ruled out pregnancy, there are 12 other causes of an absent period you should consider.

Can You Miss a Period and Not Be Pregnant?

There are several causes of missed periods other than pregnancy. Amenorrhoea is the medical term for absent periods. There are two types of amenorrhoea:

1. Primary Amenorrhoea

The absence of first menstruation by age 15, or no period more than 3 months after breast development

2. Secondary Amenorrhoea

No period for three cycle intervals, or six months, in women who have been menstruating regularly.

I get a lot of questions from women who report pregnancy-like symptoms, such as a late period and nausea or loss of appetite, even though they are not pregnant. There are several possible reasons for this, ranging from lifestyle changes to drugs/medication and chronic illnesses.

Four most common causes of a missed period.

Four most common causes of a missed period.

12 Reasons for a Late Period With No Pregnancy

  1. PCOS (polycystic ovarian syndrome)
  2. Stress
  3. Excessive exercise
  4. Extreme weight loss or weight gain
  5. Medication and drugs
  6. Stopping birth control pills
  7. Pituitary growth
  8. Sheehan's syndrome
  9. Cushing's syndrome
  10. Premature ovarian failure (primary ovarian insufficiency)
  11. Thyroid dysfunction
  12. Asherman's syndrome

1. Polycystic Ovarian Syndrome (PCOS)

According to Dr. Mark Trolice, reproductive endocrinology and infertility specialist at Fertility CARE, "Polycystic ovarian syndrome is the most common hormonal disorder in women, affecting 6-10% of all reproductive-aged women." If you notice you have acne, unwanted body hair, headaches, pelvic pain, extreme fatigue, and no period but are not pregnant, you may have PCOS.

Symptoms of PCOS:

  • Erratic or missed periods
  • Acne
  • Weight gain
  • Fatigue
  • Excess facial/body hair
  • Difficulty conceiving
  • Pelvic pain
  • Headaches
  • Interrupted sleep

In a typical case of PCOS, the affected woman may find that her periods are unpredictable. She may sometimes go several months without one, or she may bleed every day to the point of anemia. The underlying cause of PCOS is usually an abnormal hormonal environment. In the majority of cases, a successful reduction of body weight to a normal body mass index (BMI) will lead to a resumption of regular periods and ovulation, or it at least may facilitate induction of ovulation with medications.

Scroll to Continue

Read More From Healthproadvice

Ovarian cysts are generally benign, but in some cases, they can cause immense pain, nausea, and late periods.

Ovarian cysts are generally benign, but in some cases, they can cause immense pain, nausea, and late periods.

Functional Ovarian Cysts

During ovulation, small, fluid-filled sacs can form on the ovaries. These are common in all women and are typically benign—you may not even notice the symptoms. However, if the cysts become too large, twist the ovary, or rupture, they can cause pain in the abdomen and lower back, sore breasts, nausea and vomiting, and delayed menses.

If you have a late period and nausea but are not pregnant, your doctor may check for ovarian cysts. They may order ultrasounds and hormone level tests to determine the severity and any underlying hormonal cause.

Ovarian cysts typically go away on their own after a few weeks and up to a few months. In some cases, your doctor may tell you to take birth control pills to reduce the risk of cyst formation by preventing ovulation. In severe cases, surgery is required to remove the cysts.

2. Stress

Mental or emotional stress or anxiety can cause absent periods. Death of a loved one, exams, marital difficulties, and stress at work can cause a woman to miss her periods—sometimes for several months at a stretch.

3. Excessive Exercise

Excessive or intense exercise can also affect menstruation. The female athlete triad—defined as an energy deficit (with or without an eating disorder), decreased bone density, and absent period—is common in young women who participate in competitive sports. Up to half of long-distance runners and around 4 out of 10 professional ballet dancers will experience secondary amenorrhoea.

Excessive exercise can lead to the shut down of the hypothalamus, the part of our brain that regulates our hormones through control of the pituitary gland. This is one of the ways that the body deals with the excessive energy expenditure that it is being put through. In the case of ballet dancers, the situation is worsened by the fact that they tend to maintain a restricted calorie intake.

Once the athlete reduces training duration, frequency, or intensity, or increases caloric intake, periods should resume. However, this is not guaranteed and depends on other factors like age and duration and severity of the caloric deficit.

Absent periods are a common occurrence among marathon and other long-distance athletes.

Absent periods are a common occurrence among marathon and other long-distance athletes.

4. Extreme Weight Loss or Weight Gain

Anorexia Nervosa

Anorexia nervosa is a serious psychiatric condition in which the patient is severely underweight and is almost always accompanied by absent periods. The mechanism behind this relationship is similar to how excessive exercise causes missed periods. A caloric deficit puts the body under metabolic stress that can affect the hypothalamus' ability to balance hormones.

Sudden loss of weight not associated with anorexia (e.g. through surgery) can also lead to missed periods, especially if the weight is lost rapidly over a short period of time.

Obesity

Obesity is a metabolic condition that increases systemic inflammation. Excessive weight gain alone does not affect menstruation, but it may indicate other health conditions, most commonly PCOS.

The excess adipose tissue and increased inflammation can also lead to changes in levels of estrogen and testosterone, resulting in hormone dysregulation that can delay menses. As little as 5-10% of weight loss may restore ovulation and menses.

5. Medication and Drugs

Drugs that can cause a missed period:

  • Anti-blood pressure medications like methyldopa
  • Antidepressants
  • Antipsychotics (phenothiazines like chlorpromazine, thioridazine, and prochlorperazine)—elevate levels of prolactin, resulting in suppression of estradiol and progesterone
  • Anti-epilepsy drugs
  • Chemotherapy

Metoclopramide (Maxolon, Reglan, or Pramin) is another drug that can result in the temporary cessation of periods. It is mainly used as an antiemetic (to control nausea and vomiting), making it unusual for it to be taken for a prolonged duration. In general, metoclopramide should not be used for more than 3 months at a time.

6. Stopping Birth Control Pills

Some women, after using birth control pills for a long time, will find that when they come off, their periods do not resume, at least not for a few months. This is known as post-pill amenorrhoea. This can also happen after using other forms of contraception, especially the injection Depo-Provera.

Periods should return within 1-3 months after discontinuing the pill. If menstruation does not return after 3 months, you should consult your doctor and go through the same evaluations as any other woman with amenorrhea. To confirm that you are not pregnant, your doctor may order a hormone profile blood test and a pelvic ultrasound.

The menstrual cycle and hormone balance are largely regulated by the hypothalamus and pituitary gland.

The menstrual cycle and hormone balance are largely regulated by the hypothalamus and pituitary gland.

7. Pituitary Growth

The pituitary is a tiny gland in the brain that is responsible for the production of a variety of vital hormones. One of these hormones, prolactin, stimulates milk production. Pituitary growth or adenoma causes overproduction of prolactin (hyperprolactinemia).

If you notice acne and missed periods, but you're not pregnant, you could have hyperprolactinemia.

Other symptoms include:

  • Hirsutism (excess body/facial hair growth)
  • Vaginal dryness
  • Galactorrhea (milky discharge from breasts but not pregnant or breastfeeding)

Typically, treatment involves medication to suppress prolactin production. Once prolactin levels are back to normal, regular menses should resume.

8. Sheehan's Syndrome

Sheehan's syndrome describes severe blood loss due to postpartum hemorrhaging (bleeding after childbirth). The loss of blood leads to poor oxygenation of the brain, in particular, the pituitary gland, resulting in low levels of pituitary hormones, including luteinizing hormone (LH) and follicle-stimulating hormone (FSH) that regulate the menstrual cycle.

Symptoms

  • No periods
  • Fatigue
  • Difficulty thinking
  • Cold even in warm weather
  • Weight gain
  • Low blood pressure
  • Low blood sugar

Treatment usually involves hormone replacement therapy to make up for the loss of pituitary hormone production.

9. Cushing's Syndrome

Cushing's syndrome is characterized by overproduction of ACTH by the adrenal glands or pituitary glands because of hormone-producing, non-cancerous tumors. This results in prolonged, elevated blood levels of cortisol, the stress hormone. Elevated levels of cortisol can also be caused by taking corticosteroids like prednisone.

Symptoms of Cushing's Syndrome:

  • High blood pressure
  • Weight gain in the upper body and face
  • Loss of bone density
  • Loss of muscle
  • Easily bruised skin
  • Facial hair (in women)

In women, Cushing's disease can also affect menstruation, causing periods to stop.

Treatments involve the patient stopping the use of cortisol-like medication or surgery to remove the tumors producing excess ACTH.

10. Premature Ovarian Failure

Premature ovarian failure is also called primary ovarian insufficiency or premature menopause. It is estimated that up to 1% of women go into menopause before the age of 40. It is not yet known why ovaries can stop functioning before menopause. Premature ovarian failure has been known to happen to girls in their late teens and early twenties.

Symptoms of Premature Ovarian Failure:

  • Absent period
  • Hot flashes
  • Night sweats
  • Irritability
  • Difficulty conceiving
  • Decreased libido

A hormone profile blood test is used to form a diagnosis. Note that once diagnosed, 50% of women can still experience sporadic ovulation, and 1-5% may still conceive. Premature ovarian failure is usually irreversible.

11. Thyroid Dysfunction

Although thyroid dysfunction isn't a direct cause of absent periods, because it controls metabolism and affects so many other organs, it could be the underlying cause. Either underactive or overactive thyroid disease can cause absent or erratic periods.

Underactive Thyroid

If you notice fatigue and late periods, but you are not pregnant, you may have an underactive thyroid.

Symptoms of an Underactive Thyroid:

  1. Fatigue
  2. Late period
  3. Cold even in warm weather
  4. Low mood
  5. Weight gain
  6. Dry, brittle hair and nails

Treatment involves a prescription of synthetic thyroid hormone, like levothyroxine, to supplement the body's natural production of thyroid hormone.

Overactive Thyroid

If you feel hyperactive, are sweating excessively, experiencing weight loss, and you have a late period, although it's not very common, you may have an overactive thyroid.

Symptoms of an Overactive Thyroid:

  • Restlessness or hyperactivity
  • Hair loss
  • Absent or erratic periods
  • Heart palpitations
  • Feeling warm and poor tolerability of heat
  • Sweatiness
  • Weight loss, even though there may be increased appetite

Graves' disease is the main cause of excessive thyroid hormone production. Treatment involves taking radioactive iodine or antithyroid medication.

12. Asherman's Syndrome

Asherman's syndrome is a rare condition characterized by the formation of scar tissue, or adhesions, in the uterus, usually after uterine surgery, for example, dilatation and curettage (D&C).

The build-up of scar tissues leads to sparse or absent periods and frequent miscarriages. If you recently had a D&C procedure and notice a missed period, Asherman's syndrome is the most likely cause. Most cases can be treated with surgery to remove the adhesions.

Final Thoughts

As you can see, pregnancy is not the only cause of an absent period. Affected women should know that there are many possible causes and that these conditions are generally easy to treat. However, it is very important that you rule out pregnancy first.

Clinicians should understand the importance of taking a thorough history of the patient. Some of the symptoms are ambiguous and can indicate other possible conditions. Therefore, it is important to understand all the factors that may be contributing to the patient's absent period.

References

Corrine K Welt, MD and Robert L Barbieri, MD. (2017). Epidemiology and causes of secondary amenorrhea. UpToDate.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Comments

Ugwu Blessings on June 15, 2020:

I missed my period for seven days now after taking a contraceptive (porstino 2) however, I have gone for a blood pregnancy test,but the result is negative, please what should do?

AudioGik on March 24, 2020:

this is interesting. Where do i get one

akanga1 (author) on December 16, 2019:

@Nthabiseng

Current pregnancy test kits are pretty reliable (even if not foolproof). The likelihood is therefore that you are not pregnant. This hub was created to try to help individuals assess the potential causes of their own absent period when pregnancy has been ruled out. I would, therefore, encourage you to go through the article carefully and see if any of the possible causes might apply to you.

I cannot really comment much about the 'strange' movements in the stomach you alluded to. Suffice to say that fetal movements are not perceptible before around 18 weeks of gestation. That means, even if you happen to be pregnant, it is far too early for you to feel baby movements.

If you think the pregnancy test kit you are using might be misleading, your logical recourse is to see a doctor who might arrange a blood test for the pregnancy hormone (beta-hCG). This is 100% reliable. Alternatively, you can have a pelvic ultrasound scan.

My best wishes

Nthabiseng on December 15, 2019:

I have tested negative and missed periods for the past two months, I have strange movements on my abdominal. My breast feel strange but no pregnancy signs or symptoms but I feel pregnant and don't know how to explain this. 39 years old and have been trying for a baby with my partner for the past year

mclegend on October 19, 2019:

very helpful

akanga1 (author) on September 27, 2019:

@Shreenidhi

Thank you for the compliment

Glad to hear you have found it useful

SHREENIDHI from Chennai, Tamilnadu, India on September 17, 2019:

Quite an informative article for all the young women and even ghe mothers too. Thanku for sharing these information

sefako on August 18, 2019:

I am 28years so i have no period month

Lima on June 17, 2019:

Thank you for quick response. The incident happened on September 2018 and after 4 months upon doctors suggestion, I tried to conceive. Because I had 3 regular menstural cycles and my health was perfect then. Totally its been 9months since the incident. So for the past 5months we are trying for a baby.

Your words are true, still the pain haunts me mentally. But im worried as i didn't get periods for more than 2 months now with negative hpt. Am confused whether am awaiting periods or pregnancy.

Lima on June 17, 2019:

Thank you for the quick reply. Your words are true, I couldn't bear the loss. The doubt regarding my cycle is that, I had regular periods before and after sexual life, and even after the stillbirth. After stillbirth too I had 3 regular menstural cycles. After that doctors examined me and upon their advise I tried to conceive. Certainly I'm confused by what is happening now. Am I healthy or is this something to worry about seriously?

akanga1 (author) on June 14, 2019:

@Lima

A stillbirth is incredibly traumatic. It can be difficult to overcome the psychological effects of such an event even if physically you feel relatively well. The psychological effects can also influence the pattern of your cycles. Of course, it is not possible for me to say whether that is what is happening with you but it is one of the possibilities to be considered. Five months is not a long time and the grief of the loss could be affecting your menstrual cycles.

With five negative urine pregnancy tests, the likelihood is that the results are correct i.e. you are not pregnant. You can get clarity either by doing a blood test to check levels of the pregnancy hormone (beta-hCG) or having a pelvic ultrasound scan. If those happen to confirm that you are not pregnant, you can discuss with your doctor the need for further tests to get to the bottom of the missed periods.

Best wishes

Lima on June 14, 2019:

I am married for 2 years now. We are sexually active for the past 5 months, since I experienced stillbirth when I was 6months pregnant. Now am confused by the dramatic change in my cycle. My cycles are always regular always and I never experienced missed periods unless I was pregnant. Coming to the query, my lmp was 13th April I missed by periods on 13th May and 12th June. Its more than two months now. Although hpt turns out negative, I don't have any symptom of periods coming. I feel nauseous and tight breasts that too on and off. But by that, I couldn't conclude that I'm pregnant as five hpt showed negative result. I'm really worried. What should I do? Is it possible for me being pregnant? Please help me with answers.

Ebot cindy on June 10, 2019:

Does a response come immediately or after like a day?

akanga1 (author) on June 10, 2019:

@Mhm

Yes, you might still be pregnant but, and it is a big but; this might simply be part of the current variable pattern of your cycles.

As you might know, the sensitivity of pregnancy test kits varies. With some, if you perform the test too early after conception, you could get a falsely negative result. On the other hand, the symptoms you described (breast engorgement) are pretty common towards the end of the cycle just before the onset of a period.

Overall, it is unclear whether you have conceived or not. If your period hasn't arrived in one week, I would suggest you repeat the test

Best wishes.

akanga1 (author) on June 10, 2019:

@Hai

I am slightly confused by the part of your statement which says "there was no period till now". Does that mean your period has now arrived or you still have to see a period since the end of January?

Another thing is if you are having other pregnancy symptoms (other than the missed period), you really ought to repeat the pregnancy test. Your test in March might have been a false negative. I would really take too much notice of what you perceive to be 'movements' in your abdomen as, even if you are indeed pregnant, true fetal movements can only be perceived after 18 weeks gestation and, for most, not until after 20 weeks.

What you need to do as a priority is to repeat that pregnancy test. If it is negative again, it will be appropriate to move on with tests to investigate other causes of missed periods.

Best wishes

akanga1 (author) on June 10, 2019:

@Lakeata

It would appear to me that this was simply a missed or delayed period. You have not given any details whether the 'period' you had on the 1st of June was any different from your norm. If the bleeding was particularly heavier than normal, it could suggest the possibility of having been pregnant and suffering from a very early miscarriage. However, the details you provided are too brief to confidently state whether that might have been the case

Mhm on June 08, 2019:

My husband and I have an almost 2 year old but would like to have a second. I breastfeed child for 14 months and my period didnt come back until after I had topped completely. Since my cycle stared again it had been short and less regular (18-24 days) than before I was pregnant (28-30 days). I used an OPK test this month and a got a positive result at 6 days. We had unprotect sex 24 hours after. Its now 28 days into my cycle and i haven't gotten my period and my breast feel enlarged, but i took a pregnancy test and it was negative. Could i still be pregnant?

Thanks.

Lakeata Williams on June 03, 2019:

Hey I'm ben having normal periods I didn't have one n may at all by on June 1 it came on wat could dat b

akanga1 (author) on May 28, 2019:

@Metothecore

This isn't as straightforward as it may appear. A prolonged phase of absent periods after coming off the pill is not particularly unusual. It is what is known as 'post-pill amenorrhoea'. This is more common after being on the pill for several years without a break. The advice is usually that if periods don't spontaneously resume after 4-6 months, investigations should be carried out. It is therefore right that you have sought medical help at this point.

Your doctor is right in advising you that taking a few days of a progestogen hormone preparation would bring about a 'period'. Duphaston is a progestogen. However, strictly speaking, what you get after taking a course of a progestogen is a 'withdrawal bleed' and not what can be described as a true period. It is also false to suggest that taking a progestogen would kick-start a period. That is misunderstanding how it works. Taking a progestogen such as Duphaston has an effect on the lining of the womb. It makes it undergo what is known as decidualisation. When you stop taking the progestogen, the decidualised lining breaks down and therefore you get a bleed. You can do this repeatedly and you will see a bleed but that does not mean your cycles have resumed. Far from it. Cycles are a function of the ovaries and the cyclical hormones produced there. Duphaston and similar progestogens do not influence ovaries. You are therefore getting false reassurance.

Advice should depend on what your current needs are. If you are not trying to conceive, it is perfectly OK to continue with the current strategy, getting regular progestogen-induced withdrawal bleeds. In fact, a 7-day course would achieve the same thing. You don't have to take them for 14 days. On the other hand, if you are trying to conceive, then appropriate tests as to the underlying cause of your absent periods should be carried out. Normally, if you are not having periods, it is safe to assume, you are unlikely to be ovulating. That may need to be addressed. It is possible you may have an underlying condition such as polycystic ovaries (PCOS) being responsible. Inducing ovulation in such conditions is a relatively simple affair.