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Late period, negative pregnancy tests, spotting
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lostangelumbra posted:
My last menstrual cycle started on March 1st. I have had irregular periods a lot over the last four years and keep really hoping I am pregnant, only to not be pregnant. I had a full check up a little over a year ago to make sure I wasn't having any issues, and though I had an irregular pap smear and ended up having two biopsies taken of abnormal cells, I get a clean bill of health. I was having minor afternoon nausea feelings for a couple weeks, but ended up with negative pregnancy tests. Each taken two weeks apart and the last one getting taken over a week ago. I have had some minor spotting, just little flecks of blood when going to the bathroom and fairly pink discharge after we have sex. Now I am starting to feel pressure in my abdomen and right side of my body. Nothing unmanageable and possibly the beginning signs of my period starting, but something doesn't feel right. My husband is out of work and I really can't afford to go to the Doctor's. But I am starting to get scared and I don't know what to do.
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Jane Harrison Hohner, RN, RNP responded:
Dear lostangelumbra: The most common reason for a menstrual pattern like you have described is not having an ovulation every month. In a normal cycle, estrogen is produced all month. Estrogen is responsible for building up the lining of your uterus so you have something to shed each month. The good news is that you have enough estrogen to make a lining that does shed sometimes.

In a normal cycle, progesterone production increases following ovulation and release of an egg.. Progesterone "stabilizes" the uterine lining in preparation for a possible implantation of a new pregnancy. If you are not pregnant that month the levels of estrogen and progesterone fall, triggering the release of the uterine lining—your period. So, if you do not ovulate, the estrogen build up of the lining continues, but without the usual ovulation associated progesterone. Thus, the hormone levels don't decline, and the lining stays up inside the uterus—your missed period.

If you have been several months without a period, a gynecologist may give you some progesterone in a pill form (eg Provera 10 mg for 5 days). Within 48-72 hours after stopping the progesterone your "progesterone blood level" will fall, triggering the release of the lining that has been building up. Many women report that these periods are very heavy-- as though several months of lining are shed.

There are MANY causes for not ovulating: thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (spouse out of work, reduced income, trying to conceive), increased body weight, anorexia, rotating shifts at work, etc. In your specific case you noted a history of irregular periods over the past four years, as well as the absent period since early March. This might suggest that your lack of conception is related to irregular/missed ovulations. The pink spotting after sex can indicate a too thick lining (two months worth) inside the uterus that is shedding small amounts.

OK, if you do not get your period, and you do not have health insurance, I would urge you to see your local family planning clinic. This may be your county health department or even a Planned Parenthood clinic. Both of these should have a sliding fee scale. They can repeat the pregnancy test, and do a pelvic exam to assess for right sided ovarian cyst. They can also give you some generic Provera to "kick start" a flow and shed all the built up lining.

Yours,
Jane


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