Your period is late.
That simple phrase makes many women's hearts skip a beat, either with hopeful anticipation or fearful dread. (Missing a period is almost never a neutral experience.) So you take a test. What happens if the test is negative but you feel pregnant?
First, let’s talk about what is going on in your body during your menstrual cycle. The week before you start your period, your progesterone levels begin to go up and your estrogen levels begin to drop. This can trigger the classic PMS symptoms of breast tenderness, mood changes, fatigue, bloating, anxiety, and ravenous cravings. If your period is delayed, these symptoms are sometimes increased. It can be confusing because the way your body feels when you’ve missed a period can feel very similar to pregnancy symptoms. And if you really want to be pregnant (or really don’t want to be pregnant), you might overanalyze each symptom, adding to your stress and anxiety, which can further delay your period and amplify the symptoms even more.
If you are feeling pregnant, when should you take a home pregnancy test? With the newest home tests promising super early results, it’s tempting to take a pregnancy test in the week before your cycle. This is not the best idea. The problem is that even if the home pregnancy test is positive, then there is still a chance of a chemical pregnancy. Up to 30% of fertilized eggs that survive the journey from the fallopian tube to womb will dissolve within a few days of implantation and end as “chemical pregnancies” (this is in addition to the 10% of pregnancies that end in miscarriage). Chemical pregnancies are a type of pregnancy loss where the initial pregnancy test is positive, but then the period starts a few days later. They are heartbreaking but not a sign of anything that is medically wrong. Because of this, I encourage patients to wait until a week after their missed period to take a pregnancy test. Home pregnancy tests are quite sensitive, so there is no need to take a million tests. Try to limit them to one a week for your sanity.
If you test a week after your missed period and get a negative result but still have all the pregnancy symptoms, you’re probably really confused. What could be going on?
Stress affects our bodies in weird ways. If life is overly stressful physically (think training for a marathon) or emotionally (think global pandemic), then our subconscious brain sometimes decides that we don’t need a baby right now and we don’t ovulate. If you don’t ovulate, then you don’t have a period (but you do have PMS symptoms -- which can look like pregnancy symptoms).
Medications can have an effect on your menstrual cycles. One of the biggest culprits is steroids. Whether taking a steroid dose pack for that nasty sinus infection or getting a shot in your knee from that pain you got from the marathon, steroids can definitely make you miss your period and feel very “hormonal” (in other words, pregnant). Herbal supplements and essential oils can also have these effects at times. If you are on hormonal birth control (pill, patch, or ring), this can also affect your cycle and make you skip random periods. Changes in thyroid or diabetes medication can also have an effect.
The average age of menopause is 52, but some women start to experience the hormonal fluctuations of perimenopause in their early 40s. With perimenopause it is common for cycles to become irregular, and because the hormonal levels tend to fluctuate from one extreme to the other, some of the pregnancy symptoms, like breast tenderness and moodiness, might be more prevalent.
If you are late for one cycle or skip one altogether, it could be due to one of the reasons above or it could simply be a random occurrence. If you have one funky cycle and then return to your normal flow and cadence, that is not a big deal. But experiencing continued irregular cycles and hormonal symptoms is not normal, so follow up with your doctor for some additional testing.