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Reproductive Health

Missed Period and Not Pregnant: What Could Be The Reason?

woman wondering about missed period

Ah yes, the familiar stress that most women can related to over a missed period. Nothing quite provokes a flurry of questions like: does it mean I’m pregnant? Could it be something else? Should I worry?

Here’s the thing: a missed period doesn’t always mean you’re pregnant. In fact, knowing when to expect your period versus when it’s missed can give you a major clue into your overall health. But, the key to decoding these clues is knowing your cycle.

To help you know what to look for, this post will cover:

  • What are the major causes of a missed period?
  • Does it mean you’re pregnant?
  • How can you track your cycle?

Missed Period Reason #1: Hormone Issue

A missed period can be major insight into whether your hormones are imbalanced, and the reason why comes down to why your period happens in the first place. After ovulation occurs, the follicle ruptures and releases an egg, and the rest of the follicle turns into the corpus luteum. This structure secretes progesterone, building up the uterine lining in preparation for implantation to occur. But, if implantation doesn’t occur, then corpus luteum shrinks, progesterone levels drop, and uterine lining begins to shed aka your period.

So, if you have a missed period, then it could potentially signal a problem with hormones involved in ovulation (aka luteinizing hormone) or building up the uterine lining (aka progesterone).  Remember, if you’ve ovulated, then under healthy circumstances, either you’ll get your period or you won’t get your period if you’re pregnant. But, if you don’t get your period, then it doesn’t necessarily mean you ovulated. In fact, it’s possible to experience anovulatory cycles, or cycles without ovulation, and experience light bleeding or breakthrough bleeding.

When you track your cycle, make sure to record start of period because this is cycle day one and track your cycle length and frequency. Regular cycles are usually 21 – 35 days long. However, irregular cycles can be shorter or longer than that. If you’re not sure if you have irregular cycles, cycle tracking can help you tell the difference between missed periods versus irregular periods.

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Missed Period Reason #2: Changes in Weight

Changes in weight, whether the gaining or losing weight, can cause you to miss your period. While it’s not clear exactly how significant the weight change has to be to cause a missed period, both obesity and anorexia have been linked to missed periods. One of the primary reasons is because adipose tissue, or fatty tissue, can actually make hormones like estrogens and other molecules involved in inflammation. So, major changes in weight, whether losing a significant amount of fat or gaining it, can result in major hormone imbalance, disrupting fertility and ovulation.

The bottom line? If you have recently begun a new and intense exercise regime or have recently gained weight, it’s possible that this could explain a missed period. It’s always a good idea to manage a healthy bodyweight, so talk to your doctor if you think weight management is affecting your cycle.

Missed Period Reason #3: Breastfeeding

Breastfeeding can be a reason for missed period. The biological processes related to lactation are complex and fascinating, but in the context of your period, it’s important to know that breastfeeding can lower circulating estrogen levels. Without estrogen to boost luteinizing hormone, there is no ovulation, and therefore, no period.

BUT, if you’re breastfeeding and having unprotected intercourse, it’s also possible that you’re pregnant if you’re not tracking your cycle (or the return of your cycle). If you’re not sure if your cycle has resumed or ovulation occurred, having unprotected intercourse during the the five days before ovulation and the day of ovulation (aka the fertility window), then it’s possible you’re pregnant. Check out the last section to know when is the earliest you could take a positive pregnancy test to know.

Missed Period Reason #4: PCOS

PCOS, or polycystic ovarian syndrome, is a reproductive condition that can result in irregular or missed periods. However, missed periods don’t necessarily mean PCOS. In fact, have two of the three following symptoms can indicate this condition is present:

  1. Irregular or absent menstrual cycles
  2. Excessive production of androgens (testosterone)
  3. Enlarged ovaries with multiple follicle growth.

In addition to missed periods, here are additional symptoms women may notice:

  • Hirsutism, or excess hair growth in unexpected places like face, bac, thumbs, toes, chest, and abdomen.
  • Hair loss
  • Infertility
  • Weight gain
  • Acne
  • Mood disruption
  • Pelvic pain
  • Sleep problems
  • Headaches

While there is no cure for PCOS, the good news is that PCOS can be managed with lifestyle changes and hormone interventions, and you can talk to your doctor about which option is right for you.

Missed Period Reason #5: Post-pill readjustment

Coming off the pill can lead to “post-pill amenorrhea” which simply means your hormone levels are readjusting and can lead to a missed period or two.

The combination birth control pill (which has synthetic estrogen and progestin) works by suppressing or preventing ovulation. When you stop taking the pill, you’ll first experience a withdrawal bleed because of the drop in hormones. After that, resuming cycling can be highly variable. Some women begin cycling normally right away, and some women take some time.

One study found that after discontinuing oral contraceptives, 58% of women had ovulatory cycles on the first cycle after the pill. However, overall cycle length was longer and luteal phase was shorter, and it took up to nine months to resume cycling.

If you’ve been off the pill for two months and still have missed periods, it’s a good idea to talk to your doctor about post-pill amenorrhea and what can be done. Sometimes, being on the pill can actually cover up whether you have other conditions like PCOS. Your doctor can help distinguish whether your post-pill missed period is because of these conditions or if hormones can return to healthy levels.

Missed Period Reason #6: Extreme Stress

Stress has been linked to missed periods, but stress tends to be used a convenient scapegoat for poorly understood ailments. From causes of miscarriage to cycle irregularity, stress is used as a catch-all to explain the unexplained, even when stress isn’t necessarily a problem.

Conceptually, yes, stress could interfere with the menstrual cycle. This is because the hormones of the menstrual cycle are controlled by the hypothalamus and pituitary gland, which communicated via different hormones to ultimately release hormones like estrogens from the ovaries. But, this system doesn’t exist in isolation, and different hormones and molecules, including the primary stress hormone cortisol and the immune system, can interact with estrogens to ultimately affect processes like ovulation and menstruation. Here’s the tricky question: you always have some amount of circulating cortisol, so how much is too much that it can actually disrupt ovulation and your cycle? It’s a tricky question subject to a lot of variability, so science research can’t answer that quite yet.

Bottom line? Managing stress is always a good idea for both your physical and mental health. While the stress of a bad day or working more doesn’t likely translate to very high physiological levels (or cortisol levels in your bloodstream), prolonged levels of stress, especially high stress, can be negative for your health.

Missed Period Reason #7: You’re Pregnant

A missed period or late period is a classic early pregnancy symptom. If you’ve had unprotected intercourse in the five days before ovulation or the day of ovulation, then it’s possible you’re pregnant. But, you don’t need to wait until you’re sure you’ve missed your period to take pregnancy test. In fact, a positive pregnancy test can happen as early as 12 days after ovulation.

How Can I Track My Cycle?

A lot of the information covered in this post mentions events in relation to ovulation and cycle length, and if you’re already tracking those, then great! But, if you’re new to tracking your cycle, there are many benefits to knowing your cycle. Knowing cycle length, frequency, and when you ovulate means you’re never surprised or out-of-tune with what’s happening with your body, which can be empowering for your overall health.

You may have heard of the calendar method, which basically assumes every single woman has a 28-day cycle and mechanically ovulates on day 14 of the cycle. But, if you’re a human woman, then it’s highly likely you don’t robotically ovulate at the same day of each of cycle In fact, most women have cycles between 22 – 36 days, and 42% of women experience cycle-to-cycle variability.

To better understand how your cycle works, make sure to record the first day of your period—  that’s cycle day one—and get a sense of your cycle length and frequency. At-home ovulation tests can also help track ovulation.

One of the easiest ways to track your cycle is to use the Ava bracelet. It collects 3 million data points from several health measures, just while you sleep. The Ava algorithm analyzes your data and can deliver personalized insights into your cycle when you wake via our app. Knowing your cycle doesn’t have to be a complicated science, but Ava can help you be your very own data scientist.

Aarthi Gobinath, PhD

Aarthi Gobinath earned her PhD in neuroscience from the University of British Columbia. Her research covers the ways that stress affects the male and female brain differently.

She tackled the issue of sex bias in research by looking at why standard treatments for depression don't always work in the case of postpartum depression. Her work has been covered by Vice and Massive Science.

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