No Period and Negative Pregnancy Test

No Period and Negative Pregnancy Test

The very first at-home pregnancy test was introduced to the public in 1976. Since then, women around the world have been able to check if they have fallen pregnant at the first sign of a missed period from the convenience of their home.

Unfortunately for women, these pregnancy tests do not provide much information beyond a positive or negative result leaving women confused if the test is negative and their period has not arrived. Is the test accurate? Can I still be pregnant? Lets try to answer this.

Firstly assuming your period is very regular, there are several reasons why you may have no period and a negative pregnancy test, such as:

• Delayed ovulation
• Early miscarriage
• Stress
• Diet
• Excessive exercise
• Losing weight
• Sleep
• Alcohol
• Recreational drugs
• Medical conditions

Delayed Ovulation

Delayed ovulation (and implantation) is a very common cause of no period and a negative pregnancy test. In fact, approximately one third of ovulations occur 2 or more days later than ideal (cycle day 14) in normal women with regular menstrual cycles. This means it is possible to have a negative pregnancy test result when your period is due and a positive result the next day once hCG levels increase beyond the pregnancy test sensitivity threshold.

Assuming a pregnancy test sensitivity of 25 mIU/mL, approximately 1 in 10 women may still be pregnant even if they have no period when expecting and test negative. However, in reality the risk of a false negative is likely to be higher since not all pregnancy tests are as accurate as claimed according to Gnoth and Johnson. Fortunately, hCG levels doubles every 48 hours, so testing on the fourth day of a missed period will always give a more reliable result.

Early Miscarriage

Early miscarriage (also known as a chemical pregnancy) is a common cause of no period and a negative pregnancy test. Surprisingly, the majority of early miscarriages (8 out of 10) are not detectable with at-home pregnancy tests. Research suggests the risk of early miscarriage is linked to delayed implantation (and maybe ovulation).

Stress

Stress is a very common cause of irregular or no periods among women. This can be either mental or physical stressors such as undernutrition, weight loss, illness, or emotional or social issues.

Although it is believed that every woman has a different level of resilience to stress (high stress resilience, medium stress resilience or stress sensitive) as reported in animal studies.

In moderate cases, stress causes anovulation and oligomenorrhea, which is noticeable as a late period. However, in severe cases stress can cause no periods for a long period of time (functional hypothalamic amenorrhea) and polycystic ovarian morphology (PCOM).

Overall, the sum of evidence to date suggests a woman’s body naturally suppresses reproduction to protect the health and well-being of the woman while under duress. Thankfully this suppression is not permanent and a woman’s regular period resumes once the stressors subside.

Diet

Changes in diet can also cause irregular or no periods for women assuming exercise levels did not increase.

Specifically, any changes to a woman’s daily intake of calories, fat or vegetable protein alters hormone levels and can significantly impact menstrual cycles.

Nonetheless, this change in cycle is not permanent and a woman’s regular period returns as soon she resumes her normal diet.

Excessive Exercise

Excessive exercise is a common cause of irregular and no periods among active women. Specifically, at least 4 hours or more exercise per week can significantly impact menstrual cycles and even IVF success rates. Although this depends on the intensity of exercise as reported by Baranauskas et al.

Nevertheless, simply decreasing the duration (or intensity) of exercise per week, or increasing calorie intake to sufficiently meet the body’s energy needs, restores regular periods again.

Losing Weight

Losing weight is a known cause of irregular or no periods among women. Most studies indicate that low energy availability (i.e. calorie restriction) during weight loss is the underlying cause of menstrual cycle changes.

Although a large study by Ko et al. also suggests menstrual irregularity during weight loss is more likely in obese women (including women with central adiposity) than non-obese women (BMI <25kg/m²) after adjustment for calorie intake.

In short, women trying to conceive with regular periods should avoid trying to lose weight unless for health reasons during pregnancy. In which case it may be better to postpone trying to conceive until the target weight has been reached.

Sleep

A lack of sleep, changes to sleep pattern (e.g. night or shift work) and poor sleep quality are known to alter female hormone levels and rhythm causing irregular or no periods. According to Michels et al. anovulation (and no period) is most likely to occur in morning chronotype women.

Overall, studies suggest the minimum amount of sleep women need a day is 7 hours for regular menstrual cycles.

Alcohol

Alcohol consumption is a rare but possible cause of irregular or no periods for some women. Specifically, women who binge drink just prior to ovulation increase the risk of anovulation (and changes to their cycle) according to animal studies.

Unfortunately, human studies have primarily focused on the impact of alcohol on fecundability. Although these studies did not identify anovulation as a risk, researchers clearly showed that the probability of achieving a pregnancy within one menstrual cycle was significantly decreased after alcohol consumption in the ovulatory and luteal phases.

Recreational Drugs

Recreational drugs such as marijuana and cocaine are known to disrupt female hormone levels and cause delayed ovulation, anovulation, irregular periods and sometimes no periods.  Animal studies reveal these drugs interfere directly with the hypothalamus-pituitary-adrenal axis (which controls the reproductive system) and or the production of progesterone by the ovaries.

Medical Conditions

Various medical conditions are known to cause irregular or no periods. However, only a few of these conditions are likely to occur spontaneously in women who otherwise have always had regular periods.

Specifically, primary ovarian insufficiency, hypothyroidism, or ectopic pregnancy. About 1% of women will be diagnosed with primary ovarian insufficiency before the age of 40 years.

Meanwhile hypothyroidism can be caused by iodine deficiency when a woman spontaneously changes her diet, although this is rare.

In very rare cases, approximately 3 in 10,000 pregnancies will be ectopic and remain undetectable by normal urine or blood tests. This can become a life-threatening condition if symptoms (such as pelvic or abdominal pain, and abnormal bleeding) are ignored.

A Final Tip from Fertility SCIENCE

In cases where no period means a woman failed to ovulate that cycle (i.e. sporadic anovulation), caused by mental or physical stressors, several studies report this has a negligible impact on overall time to pregnancy for fertile women and is not an immediate cause for concern.

However, if your period fails to return by the end of the next cycle, and a pregnancy test result is still negative, please go see a doctor for further investigation.

fertilPEDIA

Diagnosis of Irregular Periods

Diagnosing the cause of irregular periods and subfertility is a thorough process. The Doctor will ask you about your recent cycles, carry out a…. Read more

Treatment of Irregular Periods

Treatment of irregular periods varies according to which WHO Group you fall into and the exact cause. Fortunately, almost all cases of irregular periods…. Read more