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kdoug93 posted:
my cycle is a week and todays late it ever did that b4 last month it spotted for two day n went off my beast are tender im cramping feeling emotinal but still no cycle i took a urnie test n it came back not pregnant I really dont know what other reasons i can be feeling this way plzz help
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Jane Harrison Hohner, RN, RNP responded:
Dear kdoug: Your cycle is a week or so late, and the cycle last month was shorter and lighter---hope I am tracking you correctly. The most important thing is to rule out an undetected pregnancy as even very reliable methods such as tubal ligations can fail.

Once pregnancy is ruled out there are several POSSIBLE explanations for a "too-light," or absent flow, in a woman not using hormonal forms of birth control:

1. Lowered estrogen levels--this is more likely to be the case in a woman around the time of menopause.

2. Elevated prolactin levels---prolactin is produced from the pituitary gland. Levels can be elevated from a benign pituitary adenoma or from certain psychiatric medications.

3. Missed ovulations--with a missed ovulation the lining of the uterus does not shed all at once. This can result in a missed flow, a too-light flow (just part of the top layer is shed), or even prolonged/erratic flows.

Missed ovulations are the most common reason for a menstrual pattern like the one you have described. In terms of the breast tenderness, 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.

Is your pregnancy test giving you a "false negative' result when you are in fact very early pregnant? In this instance the false negative can arise from three problems. First of all check the box to be sure that the product has not expired or shows visible signs of damage. Second, check to see if the sensitivity of the test purchased is 20 international units of pregnancy hormone (HCG). If it is more than that, it could be less sensitive to low levels of HCG. In this instance might wish to wait until at least a week after the missed period so that HCG levels are high enough to trigger a "true positive". Third, and least common problem, would be 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.

To summarize, there are many conditions which can produce "pregnancy symptoms". If one continues to have such symptoms, despite a negative pregnancy test, it is best to see your GYN or local family planning clinic and get some additional testing.

Yours,
Jane


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