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Late period, why?
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whitney91 posted:
I've recently had abnormal bleeding a week after my period, and now I'm 5 days late to start. When I had the abnormal bleeding I took a pregnancy test and it was negative. I'm really worried and my boyfriend keeps asking me what I think is wrong with me, and the only answer I can give him is I'm not sure. What can the late period be from?
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Jane Harrison Hohner, RN, RNP responded:
Dear whitney: If you are using some type of hormonal birth control (eg pill/patch/ring/Mirena IUD) then the most likely answer would be erratic bleeding patterns or breakthrough bleeding due to the hormones in your contraceptive. Even though using reliable contraception, you did the right thing in checking a pregnancy test first.

If you are not using hormonal birth control, here are a couple of other, possible explanations. You mentioned that the bleeding began about cycle day 14 (cycle day 1 being the first day of your last period). If this specific timing is correct, the most likely cause would be bleeding with ovulation. Right before ovulation there is a brief spike of estrogen. When this level drops back down to normal, the sharp decline can destabilize the lining of the uterus leading to spotting/bleeding. Some women have this sign of ovulation every month; others only rarely. Fortunately the amount is usually scant and brief in duration.

Some other possible causes of erratic spotting can include a new chlamydia infection (unlikely if you are both monogamous). polyps of the lining of the uterus (way more common in midlife women), or missed/erratic ovulations (usually there will be a history of missed/irregular periods).

Given your missed period ovulation problems seem the most likely culprit. As you may know, 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. In a normal cycle, progesterone production increases following ovulation. 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/late period. Alternatively the lining can begin to shed under its own weight producing prolonged bleeding.

If your erratic bleeding persists, or you develop other symptoms (eg pelvic pain from an infection or ovarian cyst) see your GYN or local family planning clinic. Hopefully, since it never happened before, this is an isolated episode.

Yours,
Jane


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