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missed periods
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An_249053 posted:
my last period started on Sept 3, it is now Nov 19 and I have not had another period though i've experienced some symptoms of pms. I took an at-home pregnancy test last week and it was negative. I'm debating how to proceed. I just had my annual exam last month and it was normal. do i need to schedule a doctor's appointment?
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genericnamehere responded:
should also add that my cycle is fairly regular and usually 5-6 weeks
 
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Jane Harrison Hohner, RN, RNP responded:
Dear genericnamehere (love your screen name!): If your cycles are every 35-42 days apart, a 42 day cycle is a ways out of the usual range of every 21-35 days. Your are now about day 77. Thus you definitely did the correct thing in doing a pregnancy test first.

If the pregnancy test is negative then the next most common cause of a missed period is not having ovulated that cycle. 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 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 can be MANY causes for not ovulating: thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with boyfriends/girlfriends, exams, money), increased body weight, anorexia, rotating shifts at work, etc. You mentioned that your annual exam last month was normal, so a large ovarian cyst seems less likely.

When one has been three cycle lengths without a flow that is usually the time to see the GYN (unless you have pelvic pain suggestive of an ovarian cyst). In your specific case, three cycle lengths would be about 105 days. If it takes a while to get into your GYN you should make an appointment for mid-December now. If a flow arrives you can always cancel the appointment, but at least you will have one. If you develop pelvic pain you should be seen promptly.

Yours,
Jane


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