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Missed Period And Negative Pregnancy Test: What The Heck Is Going On?

have-you-missed-a-period-and-pregnancy-test-was-negativeHave you missed your period and your urine pregnancy test was negative?

Did you take a couple of extra tests just to make sure you really were not pregnant?

Did you wonder what the heck was going on with your body?

As a fertility surgeon, I specialize in helping people become pregnant after their tubes have been tied. I specialize in tubal reversal surgery. My patients want to become pregnant again and many start trying soon after reversal surgery.

The main risk of reversing tubal ligation is the risk of ectopic pregnancy (a pregnancy in the fallopian tube). My patients take frequent pregnancy test because they want to detect pregnancy as soon as possible. Once my reversal patients determine they are pregnant they can take the necessary steps to make sure the pregnancy is not in the tube.

It can be very common for any woman to miss a period and have a negative pregnancy test. Many women are bewildered and confused. They figure they must be pregnant and many ultimately end up seeking medical attention to help figure out why their pregnancy test is negative.

On social media, I often see comments about women missing periods and having a negative pregnancy tests. Many women are understandably concerned because they are having all the symptoms of pregnancy but their urine pregnancy tests are persistently negative. I can’t tell you how many times I have seen someone post,

“I missed my period, my boobs are sore, and I am feeling nauseated…but my pregnancy test is negative….does anyone know what is going on?”

I will explain the common reasons. By the time you have finished reading this article you should be able to diagnose why you skipped a period.

My goal is to educate readers and, hopefully, prevent someone from having an unnecessary doctor’s visit …or at least…provide enough education so when they do see their doctors they will know what questions they should ask.

Missed Period: ‘Oh Shit’ vs ‘OMG’ Response!

It is very common for women… at least at some point in their lives… to miss a period. Most women have experienced missing a period.

Your reaction to your missed period will be a direct result to what your pregnancy desires are at that time in your life.

Don’t Want To Be Pregnant: “Oh shit…I’m pregnant! I am so screwed!”

Want To Be Pregnant: “OMG…I’m pregnant! This is so amazing.”

Everyone will eventually take a pregnancy test.

The person who does not want to be pregnant will often go into denial…and pray a period comes soon. If they take one pregnancy test and it is negative, they will thank the Lord they are not pregnant…probably get on birth control and forget about the fact they missed a period.

The person who wants to be pregnant will immediately take a pregnancy tests. If the test is positive their suspicion will be confirmed. If their test is negative, they will probably repeat the test about 20 different times, convince themselves they are having pregnancy symptoms, obsess about their missed period, and then ask themselves, “What the heck is going on?”

Have You Ever Had A Missed Period With a Negative Pregnancy Test? Understanding Observation Bias

The above two examples nicely illustration what scientist refer to as observation bias. This means the interpretation of the outcome is dependent on what you want to see.

  • The person who missed a period and did not want to be pregnant is glad they are not pregnant. They focus mostly on the fact they are not pregnant… they quickly forget about their missed period.
  • The person who missed a period and really wants to be pregnant will only see they are not pregnant but will also see…and then begin to focus on the fact they skipped a period.

My point is there could be many other times in life you were late or skipped a period but may not have cared so much as long as you were not…or were…pregnant. As a result of observation bias, you could have skipped periods in the past but being pregnant (or not wanting to be pregnant) were not as important to you as they are now..and, perhaps, you did not focus so much on your missed period.

Skipping periods is very common. When your pregnancy test is negative it is easy to forget about the skipped period. When you want to be pregnant you focus on it…..I see this all the time with my patients.

Missed Period: Most common reasons

Here are the most common reasons for missing a period.

  1. Pregnancy
  2. Anovulation
  3. Perimenopausal
  4. Ovarian cyst
  5. Thyroid problem
  6. Elevated Prolactin hormone
  7. Extreme stress and/or weight loss

Most common reason to miss a period: Pregnancy!

can-you-be-pregnant-if-your-urine-test-is-negativeBeing pregnant is one of the most common reasons for young sexual active woman to miss a period.

So…why would your pregnancy test be falsely negative if you are really pregnant?

If your urine pregnancy test is falsely negative (and you really are pregnant) then perhaps you used a crappy pregnancy test… or perhaps you tested too early.

Crappy pregnancy test. There are many different pregnancy tests on the market. Some are very inexpensive and some are more expensive. It is always possible you bought a defect pregnancy test. Perhaps you bought a poor quality brand. Maybe your test was made in some far off country, sat in a warehouse for several months, was placed in the hold of a cargo ship in 100 degree plus heat, and was then stored in a freezing warehouse for several months before being shipped off to your local discount dollar store. It is always possible the test is defective. Not every pregnancy test is perfect…most are good..but most is not all.

Most tests sold in the United States are of good quality but there are many different brands with different thresholds of sensitivity for the pregnancy hormone level.

You should consider changing pregnancy tests if you are not sure about the quality of the test kit you used. You should immediately repeat the test again with a different brand to be certain. If you really think you are pregnant and your first urine pregnancy test is negative then you should always repeat the urine test in one (1) week to be sure you did not test too early.

Testing too early. Urine pregnancy tests detect the presence of pregnancy hormone in your urine. Most urine test instructions advise you to starting testing your urine after you miss your period. It is also better to take a morning test using urine which has collected in your bladder overnight. Your morning urine has higher concentrated amounts of pregnancy hormone because it has collected over a longer period (over night) and has not been unnecessarily diluted with what you have drank during the day.

Most over the counter urine pregnancy test will turn positive after you miss your period. You are already approximately 2 weeks pregnant by the time you miss your first period.

multiple-urine-pregnancy-test-confirming-pregnancy

Does this look familiar?

The early response pregnancy tests will usually turn positive about one (1) week BEFORE you miss your period…. so these pregnancy tests are really good. These tests are just as good as the urine test used by most doctors offices.

Being patient is the key… some people test every hour on the hour. You are just wasting your time and increasing your anxiety. The urine test cannot detect changes in hormone levels over several hours.

The mind is a powerful thing…just because you may ‘want to be pregnant’ does not mean you are pregnant. You can’t do a Jedi mind trick and make yourself be pregnant!

So acknowledge what your desires and fears are… deal with them… take your time and be patient.

Important comment: We cant talk about false negative urine pregnancy tests (testing too early) and not mention false positive urine tests (letting the test sit too long before you read it). This is when your home urine test is positive but you really are not pregnant. The most common reason for a false positive is because you let the test set for too long….and it eventually turned positive.

The tests are supposed to be read within the first five (5) minutes. The longer you let it set you get what is called an evaporation line and the test will gradually turn faintly positive. The best way to avoid this is to throw the test away after 5 minutes….don’t stare at it and play mind tricks with yourself….and definitely do not go dig it out of the trash and read it the next day!

You can be reassured if you really are pregnant…your urine test will turn positive real quickly and you won’t have to guess. If you have to guess the test result then it should be considered a negative test…no matter how much you want to be pregnant. You cant will your test to be positive!

Pregnancy Test: Urine or Blood Test Which Is Best?

This one comes ups lot. Most people mistakenly think a pregnancy blood test is the best way to diagnose pregnancy. Wrong!

which-is-best-blood-or-urine-pregnancy-testA good quality urine test is the best, first way to detect pregnancy.

There are two categories of test: qualitative and quantitative.

Qualitative. Looks at qualities and provides a “Yes” or “No” answer.

Quantitative. Looks at amounts and provides a definite amount in numbers.

It is always best to start with a qualitative test….you want a “Yes” or “No” answer to start. Are you following me? If not let me simplify it.

Does your partner love you? Quality vs. Quantity

Have you ever asked your partner if they love you? They will usually say “Yes” (hopefully) or “No” (sorry).

This is a qualitative question. Once you have determined if they love you do you stop with that answer? Most likely, you will then proceed to determine how much they love you.

Have you ever followed up the first question with this second question…”Then how much do you love me?” If so then you asked them a quantitative question….you want an answer that suggest the amount or level to which they love you.

A urine pregnancy test is a qualitative test. It says yes or no.

A blood pregnancy test is usually a quantitative test…it gives you the exact amount of hormone….ever wondered why doctors call the blood test a quantitative HCG test?

So just like with love questions…you need to perform the pregnancy test the same way.

  • Urine pregnancy test or first question: Do you love me? Yes or no. If they say “No” then no reason to ask the second question. If they say “Yes” then proceed to second question.
  • Blood pregnancy test or second question: How much do you love me?

The urine pregnancy test is the best test to give you a yes or no answer. The kidneys filter the blood out and excrete concentrated HCG in the urine. The urine test can easily detect HCG in the urine.

The blood pregnancy test is the best test to give you an exact level of HCG. The problem with the blood test is that some of us have proteins in our blood similar to HCG and can make the blood test falsely positive…it is called phantom HCG. This is why the urine tests are often the better and most cost effective way to diagnose pregnancy.

It is always best to start with a good urine pregnancy test. Only if the urine test is positive is it then advisable to go with a blood test to check your pregnancy hormone levels over time to see if they are increasing.

Only women who are at high risk for ectopic pregnancy or pregnancy miscarriage need quantitative blood test to determine what is going on with a possible pregnancy.

Second most common reason to miss a period: Anovulation!

Missing your period does not have to mean you are pregnant! Maybe you did not ovulate!

Anovulation sounds like a big word but it simply means you did not ovulate…or you did not release an egg. ‘An’ means without and ‘ovulation’ means you did not release an egg. You went without an ovulation.

common-reason-for-skipping-periods-is-not-ovulating-or-anovulationThe second most common reason to miss a period and have a negative pregnancy test is….you did not ovulate or release an egg that month. If you don’t ovulate you won’t have a period.

When you skip periods and are not pregnant doctors call this condition ‘anovulation” …or without ovulating. It is a generic term that captures all possible reasons. It is kind of like the term precipitation, which could mean rain, snow, ice, sleet, hail, fog, mist, etc.

There are many reasons to have anovulation. You can sometimes skip ovulation from stress. Other more common causes are Polycystic Ovarian Syndrome (PCOS) and weight gain. Also possible are hormonal abnormalities (thyroid and prolactin hormone abnormalities).

So..if you skipped a period and your pregnancy test is negative then perhaps you did not ovulate. You don’t have to be pregnant.

Skipped A Period, Negative Pregnancy: Maybe you are perimenopausal

The strict definition of menopause is not having a period for 6 months or greater, not being pregnant, and being around the age of menopause.

missing-a-period-could-be-a-sign-of-menopauseThe average of of menopause is 51 years of age. It can happen as young as 45 or as old as 55.

The word “peri” means around…so if you are PERI-menopausal then you are “around the age of menopause”. On average it takes women about two years to go through the transition to get to menopause…so the perimenopausal term refers to women who are in this two year transition.

The periomenopausal time frame is a time where women start to have irregular periods (which means your periods come whenever they want or you can skip several months). Most women, but not all, will start to have symptoms of estrogen deficiency (hot flashes, vaginal dryness, sleep disturbances, etc).

It can be very common to skip periods during the perimenopausal time period. The ovaries become stubborn and don’t listen to the hormonal signals the brain is sending. The brain releases large amounts of Follicle Stimulating Hormone (FSH) to stimulate the ovaries but the ovaries are not listening, they don’t release eggs…and if you don’t release an egg then you will not have a period.

To better understand FSH and your menstrual cycle: Increase Your Chances of Getting Pregnant: Understand Your Menstrual Cycle

Here is a big pet peeve of mine:

Perimenopausal. You cannot be perimenopausal under the age of 43… or at least it is very rare! We commonly throw this term about because, as a doctor, it is an easy thing you can tell women to get them out of your office when they are obsessively complaining about minor things that do not indicate a serious disease diagnosis. It is also an easy excuse for patients to hear because they feel they have a safe diagnosis (not pregnant and not cancer) that they can leave the office and be content. Also becoming menopausal and perimenopausal are rights of passage… people understand these situations (if not medically then at least conceptually) and they are more comfortable with hearing these ‘diagnosis’ from their doctors. Doctors commonly throw the this term around because patients easily understand and accept it.

So if you are skipping periods…and your pregnancy test is negative…and you are between 45 to 55 then you are most likely anovulatory and it could be from being perimenopausal.

If you are 38 years of age…. and have skipped a period for 8 months and are not pregnant then you are not perimenopausal!

You are anovulatory until proven otherwise. In this situation, the most common reason is from weight gain. I see it all the time.

No Period With A Negative Pregnancy Test: Ovarian cyst?

A large ovarian cyst can sometimes make you miss your period. A large ovarian cysts will also commonly cause pelvic pain…and either a late or, in some cases, an entirely skipped period. Many times patients will have pelvic pain and believe they have an ectopic (tubal) pregnancy. Usually these patients have a history of regular periods and then all of a sudden they skip one and their periods then resume their regular cycle after the cysts resolves without needing treatment.

Abnormal Thyroid Hormone Levels

Thyroid disease can cause missed periods and a negative pregnancy test.

Either an overactive (hyperthyroid) or an underachieve (hyperthyroid) can cause irregular or skipped periods.

Abnormal thyroid function does not cause a negative pregnancy test. Your pregnancy test is negative…because you are not pregnant!

Thankfully this is not very common. Most people with ABNORMAL thyroid function will have REGULAR periods.

A simple thyroid blood test can help make or exclude thyroid dysfunction as a cause for irregular periods.

Elevated Prolactin Hormone

Prolactin hormone is secreted by the pituitary gland (small gland that sits at the base of the brain and in between the eyes). When this hormone is elevated women will stop having periods.

Some people can just develop increased levels of prolactin and other people can have tumors in their pituitary gland.

Stress and weight loss

I put this on the list because you will see it on other lists of reasons to skip a period and have a negative pregnancy test. Every woman jumps to this reason and believes stress is their problem…because we all have stress in our life right?

The reality is stress and weight loss are not common causes of missing period for the majority of women who reading this article. Although many women think their stress is the cause… stress and weight loss are rarely the cause for most women in the United States.

extreme-stress-can-cause-you-to-miss-a-periodEvery person feels they have more stress than the other person. The reality is that it takes a hell of a lot of stress and extreme weight loss to make you miss your period.

Just because your work is stressful…your partner may not be ‘acting’ right …. or you have financial difficulties and a low credit score…that is not enough stress to make you miss your period. If you lose 5 pounds from ‘vigorous’ exercise you started with your New Years resolution…that is not enough weight loss to make you miss your period. Sorry….

Stress and weight loss seem more likely to make teenagers miss their periods but not necessarily older women. Women who are extremely anorexic may have enough weight loss and stress in their lives to cause them to miss a period.

Stress. You would have to have extreme stress to cause you to skip your period. I mean the kind of stress that is prolonged and makes you come close to having a psychotic break. Medical studies described about 80% of Jewish women in Nazi concentration camps stopped having periods because of both stress and weight loss. This is the kind of stress you would need to make you stop having periods.

Just because your boss is a jerk at work…you can’t blame your boss for causing enough stress to make you miss a period.

Weight loss. Studies on Olympic Marathon runners…women who run on average 70 miles per week…show that only 1 out of 5 don’t have a period. The other 4 out of 5 will have regular periods…so the 2 miles a week on your treadmill is not enough to explain your skipped period…sorry!

Basically you would have to have enough stress and exercise in your life to drop your Body Mass Index below 20 to cause you to have irregular periods. If you need to know what your BMI is…you are welcome to use our BMI calculator: BMI Calculator for Women

Missed Period With A Negative Pregnancy Test: What to do?

Most other medical website will not provide you any meaningful information on what to do when you miss your period…other than “consult with your health care professional.”

I, on the other hand, am a doctor and I am qualified to provide medical advice…so I will.

I will not overburden you with too much medical detail…instead we will cut right to the chase and based on my years of medical experience, I will try to make it as easy as I possible can for you.

Step 1. Check for the most common reason: Take a pregnancy test!

The most common reason for missing a period is being pregnant. That does not mean you are pregnant…it is just that being pregnant is the most likely reason for missing a period.

If the pregnancy test is positive then either 1) I am sorry if you did not want to be pregnant or 2) Congratulations!

  • If your pregnancy test is positive then start a Women’s One A Day multivitamins, stop drinking and smoking (yes vaping counts as smoking) and doing other bad stuff, and see your doctor soon for evaluation.
  • If your test is negative then wait a week and repeat the test because you could be pregnant but just tested too early. I know you will probably do 5 tests every day but take my advice, chill, and repeat the test in seven (7) days. It is also best to take the test first thing in the morning with urine that has collected in your bladder overnight…you are more likely to see a positive result if you really are pregnant.

Step 2. Think about the second most common reason: Not ovulating!

If you pregnancy test is negative (or all 20 of the urine tests you have taken are negative) then you are not pregnant. If you want you can take test #21 just to be certain…I am kidding but I know you will think about it.

To be certain, you should always repeat the test in one (1) week to be sure you did not test too early.

The most common reason for not having a period and not being pregnant is lack of ovulation (not releasing eggs). This is a common and is mostly seen with increasing age and, more importantly, increasing body weight. Have you been gaining weight?

  • Age. Have you noticed as you have become older that you have skipped periods here and there? Have you gone several months without a period in the past?
  • Weight gain. Have you gained weight as you have become older? Most of us will gain weight as we become older because of life’s circumstances. It is hard to work out and go to the gym when you have kids and a job. When your little ones don’t eat their chicken nuggets or cheese pizza then who does? After working all day and coming home to take care of kids…who has the time or desire to go to the gym?

Review your history. Have you steadily gained weight as you have aged and then got to a weight and noticed your periods then became irregular? If so then that weight may be your body’s tipping point for developing irregular or inconsistent ovulation.

Before we chalk it all up to anovulation we should do a quick run through of the other reasons. If everything else checks out then we can come back to this one.

Step 3. Perimenopausal? Do the drivers license test

Sit down and take out your drivers’s license. Check out the information at the top that says DOB…or date of birth. Calculate how many years are you from your DOB until today’s date. Round up to the nearest year. Is the number 45 through 55? If so then you are most likely perimenopausal.

Now I know some people are freaking out about this calculation stuff because they don’t like math. If that is you then just say your age..and if the number is between 45 and 55 then you may be perimenopausal. We don’t need any expensive lab test to help figure this one out. Don’t even waste your time asking your doctor for a FSH test? What difference will it make?

To better understand FSH: Pregnancy and FSH: Understanding A Crappy Fertility Test!

Step 4. Ovarian cyst?

Have your periods always been regular up until most recently. Did you miss your period and have unusual pelvic pain (mild/moderate/or severe) around the time of your missed period?

If so then you could have an ovarian cyst. You should see your doctor for a pelvic examination and a pelvic ultrasound.

Step 5. Do you have a thyroid problem?

Review your symptoms to see if you may have a thyroid problem.

Overactive thyroid. If you have an overactive thyroid you would have weigh loss, hand tremors, difficulty sleeping, and restlessness…essentially you would feel like you just drank 5 cups of espresso.

Underactive thyroid. If you have an underactive thyroid (hypothyroidism) then you would have weight gain, excessive sleeping, and feeling of extreme fatigue. You would feel like you had the vigor of life sucked out of you.

Ultimately you will need to see your doctor for an exam and thyroid hormone blood test.

In my experience it is very rare to actually diagnose thyroid abnormalities as the cause of skipped periods.

Step 6. Do you have elevated prolactin?

You could have slight elevations in your prolactin hormone levels and not have any symptoms (other than  missing your period).

If you had a prolactin pituitary tumor you could have symptoms of headache, blurry vision, double vision, and galactorrhea (milk coming from your breast).

As with the thyroid, you would need to see your doctor and have your prolactin hormone level checked.

Some medications can cause an increase in your prolactin levels…most of these medications are psychiatric medications used to treat people with very, very serious psychiatric problems.

These are medications that can increase prolactin levels: phenothiazines, metoclopramide, risperidone, selective serotonin reuptake inhibitors, estrogens, verapamil.

My experience has been that elevated prolactin hormone is rarely a cause of most peoples skipped period.

Step 7. Review your stress levels

Are you so stressed so much that you have not slept in 7 days…or perhaps slept all 7 days?

Do you suffer from anorexia nervosa (body image problem in which has caused you to have severe weight loss)?

Do you have so much stress and have lost so much weight that you can see your ribs? Not just one or two of the lower ribs but can you see all 24 of them? If you can’t see all of your ribs then you most likely have not lost enough weight to make you skip your period.

Have you run in 3 marathons in the last 3 months….are you currently running 80 miles or more each week?

If the answer to all the above questions in Step 7 is “No” then stress and/or weight loss are not the causes of your missed period and negative pregnancy test. Sorry.

Skipped Period and Negative Pregnancy Test: In Summary

The most common reason to skip a period and have a negative pregnancy test is pregnancy. Again this does not mean if you skip a period that you are pregnant! It means this is the first thing to think about.

The second next most common reason is anovulation (not ovulating).

If you are between the ages of 45 to 55 then you could be perimenopasual and this is the first sign of approaching menopause.

If you are under age 45 then it is very likely you have slowly gained weight over the last several years. The increase in body fat will cause an imbalance in your hormone levels . Your ovaries respond to hormonal imbalances by stopping the release of eggs.

In my experience…skipping periods and not being pregnant is most commonly caused by not ovulating because of increased body weight that comes with aging and declining exercise levels.

Who am I? Why am I writing these educational articles?

dr-monteith-fertility-surgeon-raleigh-ncI am Dr. Charles Monteith. My area of expertise is Obstetrics and Gynecology. I specialize in fertility surgery to restore fertility after tubal ligation and vasectomy.

More information: Dr Charles Monteith Tubal Reversal Doctor

The intent of these articles is to provide better education to women trying to become pregnant after reversal surgery by explaining the most common questions women have when trying to become pregnant.

If you are interested in trying to become pregnant again after tubal ligation or are having problems from your tubal ligation and would like more information then visit our website: Tubal Reversal A Personal Choice Raleigh NC

If you have questions about getting pregnant after tubal reversal you are welcome to submit a contact form on our website and we will respond to you as soon as we possibly can!

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