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with Jane Harrison-Hohner, RN, RNP and Laura Corio, MD

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Thursday, September 20, 2007

Feel Pregnant but the Pregnancy Test is Negative?

I frequently see posts on my message board which state, “My pregnancy test is negative, but I feel pregnant” or “What about common symptoms of pregnancy; if I’m not pregnant what could be causing them?” Let’s look at some of the most common signs of pregnancy:

Nausea and vomiting. Generally speaking the nausea and vomiting of pregnancy are presumed to start about four weeks from conception. Some other causes of nausea and vomiting are viral, or bacterial, infections in the bowel. Appendicitis, or problems with the gall bladder or pancreas, can provoke nausea. Neurologic conditions such as migraine headaches or increased intracranial pressure can induce nausea. Even severe emotional or physical stressors can make one queasy. Less common are the psychiatric causes including anorexia, bulimia, and anxiety disorders.

Breast tenderness/sensitivity. 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 (e.g., infections, herpes zoster) but most often these occur on one breast – not both.

Enlarging abdomen. It is not until the second trimester that most women can begin to feel an enlarging uterus by pressing on the abdomen. Sometimes a large fibroid can feel and look like a pregnancy, but this is not very common. Overall abdominal distension can arise from fluid shifts in the bowel (cause of premenstrual bloating), air in the bowel, or food intolerances (lactose, gluten, etc). Much more remotely, fluid in the abdominal cavity (“ascites”) can be a product of ovarian cancer or liver disease.

Fatigue. While many women complain of fatigue in their premenstrual week, early pregnancy can produce profound tiredness. Fatigue in the first trimester has been attributed to the rapid rise in progesterone. One of the metabolites of natural progesterone uses the same brain binding sites as the “Valium-type” drugs. Fatigue is also one of the most common symptoms for a myriad of medical conditions as well. Infections, anemia, electrolyte imbalances, low thyroid, diabetes, MS, cortisol abnormalities, cancer, depression, stress, and a variety of medications have all been linked to the symptom of fatigue.

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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 you 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 the 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 amount 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 clinic and get some additional testing.

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Technorati Tags: pregnancy symptoms, pregnancy test, womens health

Posted by: Jane Harrison-Hohner, RN, RNP at 12:31 am

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