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    Missed periods
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    An_248583 posted:
    I'm 35 have 4 kids.My periods are regular same time every month.I have not had a period since 8/13/2012. I have pregnancy symptoms.Tender breasts,fatigue,enhanced smell,& nausea.I've had 1 barely there positive pregnancy test & 2 negative tests.Whats the chance I'm actually pregnant?
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    Jane Harrison Hohner, RN, RNP responded:
    Dear An: The difficulty is that single "barely there" positive pregnancy test. Unless it was a false positive reading (eg evaporation line, etc.) a true positive followed by two negatives MIGHT suggest a missed miscarriage. If there was an early pregnancy, which was then lost but has not yet produced bleeding, the pregnancy test would return as "not pregnant". This is a difficult diagnosis to make. The most conclusive way to confirm a miscarriage is to have sequential blood pregnancy tests which show dropping HCG levels in amounts which may be too low for a standard urine test to detect.

    Another possibility would be that you have not actually been pregnant, but instead have missed an ovulation in September and October. So what about the pregnancy symptoms? Some other causes of pregnancy type symptoms can include:

    Nausea and vomiting. Generally speaking the nausea and vomiting of pregnancy are presumed to start about four weeks from conception. Some other causes of nausea and vomiting are viral, or bacterial, infections in the bowel. Appendicitis, or problems with the gall bladder or pancreas, can provoke nausea. Neurologic conditions such as migraine headaches or increased intracranial pressure can induce nausea. Even severe emotional or physical stressors can make one queasy. Less common are the psychiatric causes including anorexia, bulimia, and anxiety disorders.

    Breast tenderness/sensitivity. Bilateral breast tenderness can be a very early sign of pregnancy, appearing as early as two weeks after conception. This is thought to be related to increasing levels of hormones such as estrogen. In a month without an ovulation, not only can a menstrual period be missed, but there can be breast tenderness as well. This is similar to the increased breast tenderness experienced by some women when first taking postmenopausal hormone therapy. There are many other causes of breast pain (eg infections, herpes zoster) but most often these occur on one breast —not both.


    Fatigue: While many women complain of fatigue in their premenstrual week, early pregnancy can produce profound tiredness. Fatigue in the first trimester has been attributed to the rapid rise in progesterone. One of the metabolites of natural progesterone uses the same brain binding sites as the "Valium-type" drugs. Fatigue is also one of the most common symptoms for a myriad of medical conditions as well. Infections, anemia, electrolyte imbalances, low thyroid, diabetes, MS, cortisol abnormalities, cancer, depression, stress, and a variety of medications have all been linked to the symptom of fatigue.

    Bottom line, with continuing pregnancy-type symptoms and continued missed cycles you really need to see a GYN or even your local family planning clinic. They can do a blood pregnancy test. If the blood test comes back as less than 5 units of hCG then the search for the cause of symptoms needs to be widened. If the missed flows are attributed to missed ovulations then you might be offered a brief course of synthetic or natural progesterone to "kick start" a flow.

    Yours,
    Jane


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