Pregnancy Isn't the Only Cause of Absent Periods

Pregnant until proved otherwise

One of the most used lines in medical schools all over the world is this: ‘Any woman who walks into your consultation room is pregnant until proved otherwise’. It is a piece of dry humour that may offend some people but actually carries a very serious message. One of the gravest errors that a doctor can make is to miss a pregnancy. That kind of error can lead to extremely serious consequences and finding out about possible pregnancy is, in most cases, asking the simple question: When was your last period? It does not matter whether the person is presenting with a seemingly unrelated ailment, let’s say, pain in the shoulder (you may want to order an x ray), just establish the status, even if she walks in in a nun’s garb.  The other side of this coin is the question of missed periods.

No periods; not pregnant. What's going on?
No periods; not pregnant. What's going on? | Source

Amenorrhoea: Many Causes

There are several other causes of missed periods other than pregnancy. Amenorrhoea is the medical term for absent periods. Primary amenorrhoea is where a girl/woman has never had periods at all. This will be a subject of a separate hub. In this hub, we are going to look at secondary amenorrhoea whereby periods which had hitherto been normal, cease. On many occasions I have seen questions, even here on Hubpages, about missed periods and pregnancy tests that have been repeatedly negative with a bewildered air of ‘what is going on?’. Here are some of the possible explanations:

Polycystic Ovarian Syndrome (PCOS):

This is a fairly common condition, affecting many women to varying degrees of severity. The commonest manifestations of PCOS are being overweight/obese, increased body hair (hirsutism) and erratic periods. In a typical case of PCOS, the affected woman may find that her periods are unpredictable sometimes going several months without one. This particular feature tends to be masked by the use of the combined contraceptive pill. With the pill, the periods will arrive on time like clockwork. It is when the woman decides to come off the pill, usually because she wants to conceive, that this particular feature will be manifest. She may, in fact, believe she has conceived but a pregnancy test will show she is not pregnant. Were she to pursue this further, a hormone profile blood test and a pelvic ultrasound scan will clinch the diagnosis. Absent or erratic periods in polycystic ovarian syndrome (PCOS) are caused by the abnormal hormone environment that underlies this condition. In the majority of cases, a successful reduction of body weight to a normal body mass index (BMI) will lead to a resumption of normal regular periods.

Thyroid dysfunction

This is not a common cause of missed periods but its importance lies in the fact that thyroid disease affects the functioning of many vital organs hence the need to be aware of the possibility of this being the underlying cause. Bothunder- and over-active thyroid disease can cause absent or erratic periods.

In underactive thyroid, the thyroid hormone is produced in insufficient quantities leading to a feeling of lethargy, cold even in warm weather, weight gain, dry and brittle hair and nails, low mood and, yes, erratic periods.

Excessive production of thyroid hormone tends to be characterised by, in the main, the opposite symptoms except for the issue with the periods. A sufferer will experience a sense of restlessness and even hyperactivity, palpitations, feeling warm and poor tolerability of heat, weight loss even though there may be increased appetite, occasionally hair loss, sweatiness and, yes, there may be erratic or absent menstrual periods in this case as well. A condition called Graves’ disease is the main cause of excessive thyroid hormone production.

In both under- and over-active thyroid, correcting the thyroid hormone problem leads to resumption of regular periods and resolution of the other symptoms.

Absent periods is a common occurrence among Marathon and other long distance athletes
Absent periods is a common occurrence among Marathon and other long distance athletes | Source

Excessive exercises

Up to a half of long distant runners and around 4 in 10 of professional ballet dancers will experience secondary amenorrhoea. Excessive exercises will tend to lead to the shutting down of the process in the part of the brain called the hypothalamus which control the menstrual periods. It is one of the ways that the body deals with the excessive energy expenditure that it is being put through. In the case of ballet dancers, the situation is enhanced by the fact that they tend to maintain a restricted calorie intake.  Once the athlete cuts down on her training or exercising, the periods will resume

Pituitary tumours

The tiny gland in the brain called the ‘Pituitary’ is responsible for production of a variety of vital hormones. One of the hormones is called Prolactin. Prolactin hormone is responsible for milk production. Sometimes a hormone producing tumour, usually small in size will develop in the pituitary and start producing prolactin hormone in ever increasing quantities. This will have the effect of suppressing periods and like a pregnant or breast-feeding woman, a person with this type of tumour will experience absent periods.  Prolactin producing tumours are overwhelmingly benign and treatment involves taking medication that suppress the production of the hormone. This is usually effective and periods will resume once the prolactin levels have dropped back to normal. A condition where there is excessive prolactin is generally called hyperprolactinaemia.

Cushing’s disease

This is an entirely different disease from the one described above. Another hormone produced in the pituitary gland is known as ACTH. When ACTH is produced in excessive amounts it, in turn, leads to excessive production of the steroid cortisol. This leads to the condition known as Cushing’s disease. The presentation of Cushing’s disease is rather dramatic with rapid weight gain, thinning of skin usually with easy bruising; stretch marks may appear on the abdomen and thighs and periods tend to stop. Cushing’s disease is part of the wide spectrum of what is known as Cushing’s syndrome, the common factor in all these being excessive cortisol in the body. This brings us to another cause of absent periods due to problems in the adrenal glands (below).

Adrenal gland problems

Adrenal glands which are perched on top of kidneys are vital for production of various hormones and other chemicals. These include the steroid cortisol. Sometimes cortisol producing tumours develop leading to the condition discussed above i.e. Cushing’s syndrome. Among other things, Cushing’s syndrome will be characterised by cessation of periods (until the excessive cortisol situation is brought under control)

Another cause of Cushing’s syndrome is when the systemic steroids are prescribed to treat other diseases such as severe asthma or some types of arthritis.

Medications and drugs

Apart from steroids mentioned above, prolonged use of other drugs can lead to temporary cessation of periods.  Phenothiazines are drugs that are employed mainly as anti-psychotics in schizophrenia. Some are used in heart conditions and weaker ones are used for controlling nausea and vomiting. They include such drugs as Chlorpromazine, Thioridazine, Prochlorperazine etc. They are available in an array of different brand names. Long-term use of these drugs can lead to cessation of menstrual periods.

Metoclopromide is used mainly as an antiemetic (to control nausea and vomiting). It is therefore unusual for this to be taken for a prolonged duration and, in any case, it should never be used for more than three months. Side effects are rare but Metoclopromide can also cause temporary cessation of periods. Metoclopromide is more popularly known by the brand names Maxolon, Reglan or Pramin.

Cocaine is an illicit drug with many potential side-effects one of which could be absent menstrual periods. The problem tends to resolve spontaneously within a few weeks of the person coming off the drug.


Stress of the emotional kind can and does often cause missed periods. Events such as bereavement, exams, marital difficulties or even severe sustained stress at work could cause a woman to miss her periods, sometimes for several months at a stretch.

Anorexia nervosa

Anorexia nervosa, a serious psychiatric condition the hallmark of which is being severely underweight is almost always accompanied by absent periods.

Excessive weight loss starting from normal weight not associated with this anorexia can also lead to missed periods especially if the weight is lost rapidly over a relatively short period of time.

Obliterated uterine cavity

Menstruation is a result of breakdown of the lining of the womb. Sometimes, especially following the procedure dilatation and curettage (D&C), adhesions form within the uterine cavity effectively obliterating it. As a result, the woman may find that she does not get any more periods after undergoing this. The condition is known as Asherman’s syndrome. In some cases, it is possible to reverse this through surgery.

Premature ovarian failure

This can also be called premature menopause. It is estimated that up to 1% of women go into menopause before the age of 40. It is not clearly known why ovaries stop functioning at such an early age. Premature ovarian failure has been known to happen to girls in their late teens and early twenties. Often, the most notable symptom is disappearance of periods without any obvious explanation. A hormone profile blood test will usually clinch the diagnosis. Premature ovarian failure is usually irreversible.

Damaged pituitary gland

We discussed this little gland with regard to over-production of the hormones Prolactin and ACTH. There is another way that the Pituitary gland can come into the picture when a woman is experiencing absent periods. There is a condition known as Sheehan’s syndrome. This describes a situation where the Pituitary gland has been damaged by disease, trauma, radiotherapy or, in some cases, prolonged deficiency of blood supply to the gland as can happen when there is undue delay in correcting severe blood loss for any reason as can happen following childbirth (postpartum haemorrhage).

Post-pill amenorrhoea

Some women, after using the contraceptive pill for a prolonged duration will find that, when they come off, the periods do not resume, at least not for a few months. This is known as post-pill amenorrhoea. This can also happen after using other forms of contraception especially the injection ‘Depo-Provera’.

The final Word...

Now, this may appear like a long list. The main message for clinician is to always be diligent in taking the woman’s history when she presents with unexplained absent periods. The answer is often clinched there. For the affected woman, it is really to highlight the fact that there are many and varied causes of absent periods. For somebody who is sexually active, it is perfectly legitimate to rule out (or in) the possibility of pregnancy. When the pregnancy test is negative, it is prudent to get to see a doctor to establish what is going on especially because some of the underlying conditions require early intervention. Pregnancy isn’t the only cause of absent periods.

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Comments 32 comments

Pebbles 5 years ago

Is it safe for a pregnant woman to have unprotected sex or sex...What causes the dark brown discharge on a pregnant woman?

anusujith profile image

anusujith 4 years ago from Nilambur, Kerala, India

Hi Doctor all of your hubs are informative.shall I ask one doubt for my wife? She was suffering from this delayed period,but she is 8months pregnant now.Is this delayed periods affect their delivery?

akanga1 profile image

akanga1 4 years ago Author

Hi anusujith, thank you for your comments. Previous erratic periods should have no bearing whatsoever on timing or mode of delivery. My best wishes to you and your wife

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akanga1 4 years ago Author

Unprotected sex is never a good idea at any time unless one is in a monogamous relationship. This applies in a pregnancy as well. A dark bown vaginal discharge will be regarded as a case of bleeding and has got to be investigated as such. In most cases, the source of bleeding remains obscure and this problem is usually self-limiting

lauranap12 profile image

lauranap12 3 years ago from Vermont

Hi, may I suggest that you add MRKH to your list? It is a congenital condition and affects around 1 in 4,500 women and the simplest explanation is that it means a woman is born without a uterus. There are many other "symptoms" associated with the condition.

Please visit or to learn more. Even a simple Google search would suffice.

Thank you,


akanga1 profile image

akanga1 3 years ago Author

@lauranap12; thank you for your helpful comment and suggestion. In fact MRKH (Mayer-Rokitansky-Küster-Hauser syndrome) was left out deliberately. This is because, as mentioned above, this hub was going to discuss those conditions which cause 'secondary' amenorrhoea i.e. absence of period where they have occurred before. As you quite correctly pointed out, girls with MRKH syndrome have an absent uterus and an absent or underdeveloped vagina. As such, they almost always present with failure to start having periods ('primary' amenorrhoea). The condition therefore falls outside the scope of this hub. The cause of this syndrome is not clearly understood.

lauranap12 profile image

lauranap12 3 years ago from Vermont

Oh ok, I didn't see that explanation of the secondary amenorrhoea. Thanks for your answer though.

janvi13 3 years ago

I am 16years old and frm stating i am having an irregular periods of 2 months but now it has been 4 months i have not got periods.

And i have never been to sex !!

Soo please help me why is this happening??

akanga1 profile image

akanga1 3 years ago Author

Thanks janvi13 for your comment and query. At 16, with a history of rather erratic periods from the outset and now going 4 months without a period, the most likely explanation in your case is Polycystic Ovarian Syndrome (PCOS). This condition is covered above. It is the commonest cause of erratic period. Even though this condition is also characterised by being overweight and having skin problems such as acne and increased body hair, in fact many women affected by polycystic ovarian syndrome may be of normal weight and have no skin problems. The only feature of the condition may very well be erratic unpredictable periods. If you want more details about the condition, this is a good link:

Tessa 2 years ago

I'm totally confused and need another opinion from a second person. I'm 19 years old and have a 16 month old daughter! I recently back in September had my normal period then five days later on the 29 of September had another "period" was very odd and confusing. So then that was it come October I bleed for not even a full day not even a couple of hours. That happened a week before I was due for my period that month of October. I am now 12 days late took 3 hpt all neg. Took a urine test at the doctors it came back negative I asked for a blood test and still waiting on results. I am sexually activie. The doctor told me I have amenorrhea witch I don't understand at all..I'm healthy I don't ever have health problems nothing can be wrong with my overies when I just had two pregnancies less then 2 years!! Have regular periods on time. Nothing has changed life wise to cause me to have missed my period I'm really confused!!

akanga1 profile image

akanga1 2 years ago Author

Hi Tessa, Thanks for your input here. I can understand why you would be confused and anxious about the pattern you just described here. However, I have a feeling your dates are probably incorrect and, for me, difficult to decipher. If you had a period on 29th of September, your next period would not have been due till around the 25th of October (assuming a 4 weeks cycle). If you had a brief bleed a week before that date, that would be around the 17th of October. If we were to take that to be a true period, albeit different from your norm, it will mean your next period isn't really due until around the 13th of November. Technically you have not yet missed a period. A negative pregnancy test is therefore to be expected.

The erratic pattern you have experienced these last few weeks is, in fact, not uncommon and is generally termed as 'Dysfunctional Uterine Bleeding (DUB)'. I would expect that to settle in the coming weeks but if it doesn't, you may need a review by a gynaecologist. That may lead to your being advised to go on the pill to regulate your periods (unless you are actively trying to conceive). Hopefully, that won't be necessary. Best wishes.

Danielle 2 years ago

I had no period for over two years and last month was so glad to see its return. I thought it was back for good and to my disappointment the time of the month that it came has already passed with no period. It was meant to be there on the 26th. My partner and I want Children and im so scared that its not gonna happen for us. We have been trying just over a yr now. I went to a gynacologist and he ruled out pcos and my blood testing all came back normal. I made a few lifestyle changes before my period came back as I want to be healthy to increase our chances. I cut out fizzy drinks and reduced the amounts of junk food I eat dramatically and upped my exercise. I also took adios and lost over a stone. I'm trying so hard and am so disappointed to see no period this month.

Blondy 2 years ago

Hi there

I have a son who is 8 months old and still breastfeeding during the night and day. I missed my period this month and that makes it the 6th week of me missing my period. I'am assuming that I'am pregnant but did not show any early signs and symptoms of it.

Gigi 2 years ago

I had my last menstrual period last feb.7.. And up to now, I haven't had menses... Sexually active.. 2 pregnancy test results negative .taken last march 22 and 26 respectively... No signs and symptoms of pregnancy... What could be the possible cause for this...really appreciate your response to this matter..thanks

kem 2 years ago

I missed my period and conducted absorbent strip test which proved posstive, but there is no early signs and symptons of pregnancy

akanga1 profile image

akanga1 2 years ago Author

#Danielle, thanks for your comment. Your experience isn't unique but I know that is no consolation. As you can see in the hub, there is a whole variety of potential causes of absent periods. If your hormone profile blood tests were normal, that is a major worry out of the way. You do still need to be under the care of a specialist and, if you have been trying for a baby for a year without success, formal fertility tests ought to be initiated. My best wishes in your quest.

#Blondy; your missed period could of course be a one-off, something that is not uncommon for mothers who are breast-feeding. However, you may wish to perform a pregnancy test just to be sure.

#Gigi; difficult for me to say from the brief information supplied as to why your period is delayed. Two negative pregnancy tests would tend to suggest that you are probably not pregnant. Again, I would advise that you review the information in the hub to see whether any of the mentioned causes of missed periods could potentially apply in your case. If nothing seems to fit your picture and the period hasn't arrived, a visit to the doctor may be the next logical step.

#kem; the positive test indicates that you have conceived. I do not know whether this is your first pregnancy but it is worthwhile knowing that not every woman experiences perceptible pregnancy symptoms early on. Apart from a missed period, many women can go for several weeks unaware that they have conceived. If you are still in doubt, you may wish to repeat the test or even arrange an ultrasound scan. My best wishes.

Jill 2 years ago

Is it possible for a woman to miss her period for ten days at the same time vomiting and spitting without pregnancy? What could be the other cause of these?

swapna mondal 2 years ago

i am 22 years old. my perod off 4 months. i don't have pregnancy, thyroid. i have hair falls. what should i do please tell me?

akanga1 profile image

akanga1 2 years ago Author

#Jill: Yes, it is possible for a person to miss her period for several days without being pregnant even with the said symptoms. In fact, it is fairly unusual for a woman to experience morning sickness (nausea and vomiting) immediately after missing her period. For most, this tends to set in gradually several days after the period was due. If you or somebody you know has missed a period (and the pregnancy test is definitely negative) and is getting nausea and vomiting, the two events may be unconnected. If the symptoms are persisting, a review by a doctor for examination and tests may be appropriate.

#swapna: Absent periods and losing hair from your scalp could be features of polycystic ovarian syndrome (PCOS). If your periods have tended to be erratic and you have other features suggestive of this condition (overweight, hirsutism, acne etc), you should arrange, if possible, to have a hormone profile blood test and a pelvic ultrasound scan to see if, indeed, you have PCOS. I am including a link for you to read a bit more about the condition (below)

sally 2 years ago

Hi there,

Should I get a second opinion?

I am 27, always had regular periods until recently. I have now missed 3 periods, my doctor ruled out everything on the above list including pregnancy. I was told "it will probably sort itself out and we will wait and see"

akanga1 profile image

akanga1 2 years ago Author

#sally: It is possible, albeit uncommon, for periods to cease with no obvious explanation. Such a scenario tends to be transient and, as your doctor said, when all the 'usual suspects' have been objectively ruled out, you can reasonably expect a spontaneous resolution in a matter of months.

I do not have a list of tests that have been carried out and their results so cannot comment on how comprehensive your doctor has been. If, indeed, all the potential causes discussed in the hub have been ruled out, this justifies the term 'idiopathic amenorrhoea' meaning the cause is unknown. In such a case, a second opinion is likely to be an unnecessary expense and expectations of a spontaneous resolution are not unreasonable. My best wishes.

natasha 2 years ago

Hi i had been on implanon for nearly 10 years, had it taken out in feb, it was nearly years overdue to be taken out, the last year i had it in my periods were here every mth in and around the same time time, since having it removed in feb i had 1 period which was 22nd march an have had nothing since. I am waiting for the results of a blood hormone profile? Could my situation be caused due to having the implant taken out??

akanga1 profile image

akanga1 2 years ago Author

#natasha: The taking out of the implant cannot be responsible for your current experience but the long term use of that implant could. Some women who use Implanon or Depo Provera injections over an unbroken period of several years do find that, when they come off, the pattern of their periods could be erratic. This could include phases of absent periods that can last months. This scenario is usually transient and sooner or later the normal cycles resume. How quickly the normal menstrual pattern comes back also depends on the woman's age. Having a hormone profile blood test is obviously the right thing to do to get clarity.

coop24 2 years ago

My husband and I have been ttc for months. My last period was on July 4, 2014. Today, is August 19 2014 and I have not started. I am always on time, every 28 days. I am currently 19 days late with 4 negative pregnancy tests. I am extremely tired, have a K9 nose, cramping, back ache. My Dr. wants me to come in for a blood test. I have had 1 ectopic and tube removed and cervical cancer cells removed. Has anyone else ever experienced this?

akanga1 profile image

akanga1 2 years ago Author

#coop24: Clearly worrying times and understandably so. This hub was meant to at least try to explain situations such as yours. 4 negative pregnancy tests would suggest that you are almost certainly not pregnant and your absent/delayed period has a different underlying cause. It is difficult to envisage four tests being falsely negative and current tests are quite sensitive. Your doctor would try to confirm this by checking the pregnancy hormone (beta-hCG) level in your blood. A negative blood test will be confirmatory and definitive. If, indeed, that is negative, your doctor will then need to do tests for alternative explanations for the absent/delayed period most of which are discussed in this hub. I do hope you get clarity on the situation soon and my best wishes on you and your husband's quest.

Charlene 2 years ago

I have an irregular period cycle some ranging mainly between 27-29 day cycle how ever I have not had a blood flow period since the 1st of July 2014. .. for the last 2 months when i'm due for my period i've been experiencing spotting which only last a few times when i wipe after going to the toilet for eg. 27th july I thought my periods were coming i had a brown spot/clot thingy looked like my periods were starting then nothing all day, 30 july 2 bright pinkish spots, 31 july 1 spot. 20th august 2 pinkish spots, 22 aug about 3 spots of the same pinkish watery spots and no more since then. I was just wondering if anyone has experienced this before? - I took a pregnancy test on the 5th august which was negative but haven't taken another one. Going to the drs to see what I need to get check out & was wondering what you would suggest. Thanks :)

camille 2 years ago

My name is Camille bruno Valdez my partner and I have been trying for a baby for over two years now, We were going to a fertility clinic for about 5 months before somebody told us to contact this spell caster who is so powerful, We contacted him at this email; , for him to help us, then we told him our problem, he told us that we will either conceive in February 2014 or March 2014,but after two years of trying we were at a point where we were willing to try anything. And I'm glad we came to Dr Dahiru, Because his pregnancy spell cast put us at ease, and I honestly believe him, and his gods really helped us as well, I am thankful for all he has done. contact him via email: if you are trying to get a baby or want your lover back. he has powers to do it, he has done mine,

Lost Girl# 18 months ago

I'm turning 22 this month and since last year there was a time whereas I've missed my period for almost 4 months,decided to go on the pill and it came back but this time its very light and accompanied by period pains on the 1st day. It seems my period won't appear unless I'm on the pill. I'm overweight yes and recently always feel bloated,tired and Gasy. I don't Understand this situation and I've done several preg tests and all came negative.

Senah 6 weeks ago

I read your hub and it helps me a lot.. I want to ask some questions. I'm 19 and

I'm 3days delay my LMP was aug.8 and I've been regular since june. I'm afraid of being pregnant but I already took a pregnancy test last sept.9 and it result to negative. Yes, I'm having sex with my boyfriend but not actively like that.. once a month for sure..I'm a nursing student and two weeks ago prior to my due date of menstruation , I'm so stressed with our paper works to be passed, missed meals, sleeping 4 to 5hrs, taking meds for my colds and cough and multivitamins as well.. and it really bothered me missing my period.. and I already read some articles about Amenorrhea. . I'm going to repeat my urine pregnancy test this coming sept 16 if I'm still not have my menstrual period. And if it result to negative I'm going to have HCG via serum to make it more accurate. so please help me.. what could it be the reason ? Thank you hoping for your response! Godless!

Stella 5 weeks ago

I'm 44. I've been on Yaz for a year due to severe PMS. This time around I took two months worth of pills back-to-back due to going on vacation, and wanting to skip my period while away. I had a couple of late pills on non-consecutive days during vacation. By "late" I mean a few hours late. Now my period is 12 days late. I've had three negative urine tests and one negative ultrasound. The last possible day of conception would have been one month ago. I am having symptoms of pregnancy (I have two kids, so I know). I wonder what's up? Any insight or suggestions for next steps?

akanga1 profile image

akanga1 4 weeks ago Author

Hi Senah

Sorry to hear of all the stress. Though not impossible, I think it is unlikely that you are pregnant. The stress you describe is the most likely explanation for the absence of the periods. Your plan to do a blood hCG test to be certain is clearly the right strategy if you remain amenorrhoeic and the urine pregnancy test is still negative


Hi Stella,

This is likely to be post-pill amenorrhoea. Even though this tends to happen after a person has been on the pill for a long time, it has been known to happen after a short stint like yours. Pregnancy is unlikely in the circumstances described. If the period does not arrive in the next 4 weeks or so, I would suggest you have a hormone profile blood test specifically for beta-hCG and FSH. Best wishes.

fridah 2 weeks ago

My period miss five day I'm worried coz I have back pain an cramps breast thunder an i did pregnancy test come negative an also did scan nothing show I don't know what is going on Pls help me

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