Late or Pregnant

Mary Jane Minkin, M.D. is a board-certified obstetrician/gynecologist in private practice in New Haven, Connecticut, and a Clinical Professor of Obstetrics and Gynecology at Yale University School of Medicine. She is a lead author and co-author of articles in numerous peer-reviewed journals, including Obstetrics and Gynecology and Journal of Reproductive Medicine, as well as co-author of A Woman’s guide to Sexual Health (Yale University Press, 2005). She is compensated for her participation in FIRST RESPONSE™ communications.

The saying goes that many women can “set their clocks” by their periods — every 28 days, at 10:00 AM, their period appears. But it’s important to note that that is the exception, not the rule. The truth is that some menstrual irregularity is the more common phenomenon. And if a period doesn’t show up, many women wonder what could be going on? Of course, the first explanation we think about is pregnancy, but there are many other possible explanations.

When women go through puberty and start having periods, they can be quite erratic. The explanation? Regular ovulation does not start right away because it takes a couple of years for the cycle to settle in.

What we need to understand is that cycle regularity is not controlled by our ovaries. The process of ripening up an egg from the ovary and causing it to be released at an exact time is actually regulated in our brains. In fact, the hypothalamus and the pituitary gland send messages to our ovaries to get them into action. So, it’s not surprising that many things can interrupt this process. If you are curious to understand when you are ovulating, First Response Ovulation Predictor kits can help you determine your optimal fertile days.

While cycle irregularity can be a cause of a woman being “late,” there are other explanations.

Stress can be a major explanation for an interruption in a woman’s cycle – and any type of stress can do it, including personal or work related stress, which can be among the most likely culprits. Stress can affect us in many ways, and trying to minimize it is always helpful. Talking with good friends, regularly exercising, and practicing relaxation techniques, such as yoga, are all beneficial. Some women will benefit from talking with a counselor. And if you are thinking about planning a pregnancy, minimizing stressors in advance is ideal.

Weight and exercise can influence the process of ovulation. Significant weight loss or gain can alter one’s cycles. The classic example is a woman training for a marathon; distance swimmers and ballet dancers are also often affected. It is important if you are seriously training to maintain good nutrition, particularly proteins and calcium rich foods.

Thyroid abnormalities can also impact one’s menstrual cycle. Although overactive thyroid is classically the culprit, underactivity can also interact with control of menses. Thyroid functions are very easily tested with simple blood work.

Certain medications can also impact one’s menstrual cycle. The classic medications are antidepressants and what are referred to as atypical antipsychotic medications. These medications can cause elevation of a pituitary gland hormone called prolactin, which can directly impact your cycle. Prolactin can also cause your breasts to secrete milk; so if you are experiencing late periods and noticing discharge from your breasts, do contact your health care provider.

At the other end of the reproductive spectrum, the transition to menopause, so called perimenopause, can present with late or skipped periods. The average age at menopause (the complete cessation of periods) is 51; however, 1% of women will go through menopause by age 40. Women with these changes may also be experiencing hot flashes, night sweats, or sleep disturbances. Women can do some investigating on their own-using a fertility test. This test will let you determine your ovarian reserve. If it shows that you have diminished ovarian reserve, do check in with your health care provider for further evaluation and advice.

If you are trying to become pregnant, and are experiencing erratic periods, do contact your health care provider to help figure out the cause of the irregularity. We can assist with correcting the above problems, and offer advice on how you can get pregnant sooner. If you are not trying to conceive, but are finding menstrual irregularities bothersome, we can help override these changes, and get you more regular periods.