So You Just Missed Your Period But You’re Not Pregnant. Here’s What Might Be Going On

For anyone whose period comes like clockwork every month, it can be jarring when it just doesn’t show up at its regularly scheduled time. If there’s a possibility you could be pregnant, your next step is probably to take a test. But what if it’s negative? Meaning, you’ve had a missed period but you’re not pregnant? (Or at least that at-home pee test says you’re not.)

Before you freak out, know this: It’s pretty normal for your period to not show at some point, and it can happen for a variety of reasons. “Our periods can be a hormonal barometer, telling us if we are in sync with our body,” Sherry Ross, MD, an ob-gyn in Santa Monica, California, and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period., tells SELF. “It’s very common for many medical and life circumstances to affect this balance and make [you] miss a period.”

Below, experts give more details that can help you figure out what’s messing with your menstruation—and when a late or skipped period warrants a check-in with your doctor.

Stress—both mental and physical—can cause your period to be late or go missing any given month.

Anything that really messes with your mental state—like stress, grief, and travel, to name just a few things—can have a trickle-down effect on your period because of how these factors can influence your hormones, Alyssa Dweck, MD, a board-certified ob-gyn at Well by Messer, in New York, tells SELF. A big wave of stress can alter the typical activity in parts of your brain called the hypothalamus and the pituitary gland, which drive the hormonal fluctuations necessary for you to ovulate (a.k.a. release an egg from an ovary), she explains. And without ovulating as normal during this distressing time, you may not get a period.

The same thing can happen with excessive exercise or extreme and rapid weight loss (whether in the context of an eating disorder or otherwise) or even with coming down with a bad infection: These things place a significant amount of physical stress on the body, Dr. Dweck says. The end result can be a similar kind of menstrual shutdown causing you to miss one or more periods. And that makes sense from an evolutionary standpoint, Dr. Dweck points out. Your body basically prohibits you from being able to get pregnant (by pausing your typical cycle) when it’s low on bandwidth from dealing with one or more of these stressors, she explains.

A skipped period could also be a sign of hormone fluctuations tied to perimenopause or breastfeeding.

Another possibility if you’ve missed a period or two but you’re definitely not pregnant: You’re entering perimenopause. This is the transition phase leading up to menopause when your estrogen levels start to dip (and often get a little volatile), making ovulation less regular, Dr. Dweck says. For some people, that can look like getting a period one month and then skipping it the next…and so on and so forth until it eventually stops for good. Perimenopause can last 4 to 1src years, and although the average age of menopause is 51—putting a typical start to perimenopause somewhere around 45—it’s certainly possible for your hormones to begin changing in this way and interfere with your periods earlier than that. If this happens before age 4src, though, it could be a sign of primary ovarian insufficiency, or POI, which is when your ovaries stop working as they should at this stage of life (more on this later).

Separately, breastfeeding typically entails high levels of a hormone called prolactin, which can put the kibosh on ovulation (and periods)—generally a helpful measure for avoiding pregnancy right after giving birth. But even once you stop nursing, there can be a bit of a delay in the return of menstruation as your prolactin level comes back down, Dr. Dweck says. And while your hormones level out, you might have irregular periods, skipping a month here or there.

If you miss a single period, ob-gyns generally advise waiting it out and seeing if it returns the following month.

Because of the many variables that can cause a one-off missed period, it’s possible that it returns without a hitch next month. In the interim, it’s smart to keep a menstrual diary and write down any bleeding or spotting you may notice, Christine Carlan Greves, MD, a board-certified ob-gyn at the Orlando Health Women’s Institute Center for Obstetrics & Gynecology, tells SELF. If your period starts up again with no issues, awesome—you can just talk to your ob-gyn about things the next time you go in. If it’s still a little off, you’ve got more info to give to your doctor. (That said, if you’re experiencing any pain or other unusual symptoms alongside a skipped period, don’t hesitate to make an appointment.)

While you’re waiting for that period to show, it can’t hurt to abstain from drinking and take another pregnancy test after a week, just to be sure, Dr. Greves says. Those little pee sticks look for the presence of the hormone human chorionic gonadotropin (HCG), which the body produces during pregnancy. But if you just got pregnant, it’s possible that you don’t have quite high enough levels of HCG in your body yet for the test to detect it, Dr. Greves says. (Within a week’s time, though, there should be plenty of it to get picked up.) The first morning pee tends to be the most concentrated with this chemical, so testing right after you wake up will give you the most accurate result, Dr. Dweck notes. And be sure the test you’re using isn’t expired, she adds.

If you’ve checked all those boxes, you can trust that a second negative result indeed means no pregnancy given that these tests are “very, very accurate,” Dr. Dweck says. In this case, again, you’ll want to keep tabs on your period into the following month. “The majority of the time, there is nothing to worry about and your body will quickly reset without a trip to a doctor,” Dr. Ross says.

But if your period is still MIA after two months, it’s important to see your doctor to rule out a health issue.

Missing a period for two or more consecutive months could be a red flag that something else is causing your hormones to go wonky. In some scenarios, it could point to a condition called polycystic ovary syndrome (PCOS), which generally causes you to overproduce sex hormones called androgens. The resulting symptoms include things like cystic acne, unusual hair growth, and, yes, sporadic or missing periods. You might skip several in a row and then bleed a ton, which Dr. Dweck says may not even follow ovulation, as in a typical period, but could be the result of uterine tissue having built up so much over time that it just breaks free.

It’s worth noting that irregular or random bleeding over multiple months is as much a reason to see a doctor as a consistently missing period, given you could be dealing with a different health issue like endometriosis, an STI, fibroids or polyps in your uterus or cervix, or, in rare cases, cervical or uterine cancer.

A couple other medical conditions with hormonal effects could also be at the root of a missing period, like a thyroid disorder (when your thyroid gland is over- or underactive)—because thyroid hormones are regulated in the same parts of your brain as ovulation hormones, Dr. Dweck explains—or a non-cancerous growth called an adenoma in your pituitary gland, which creates too much of the prolactin hormone that can interfere with ovulation.

Again, it’s also possible that you’re heading into perimenopause, perhaps earlier than usual, which is something that your doctor can help suss out via a few hormone tests. If you’re under the age of 4src and you’re missing your period and experiencing symptoms tied to menopause (like hot flashes, night sweats, and vaginal dryness), that could be suggestive of primary ovarian insufficiency, Dr. Dweck notes. The cause isn’t always clear, but certain genetic abnormalities, autoimmune disorders (when your body mistakenly attacks ovarian tissue, in this case), and medical treatments like chemotherapy and radiation are common culprits.

Not to mention, seemingly unrelated chronic illnesses—like type 1 diabetes and celiac disease—can also stand in the way of your period if they’re not well-controlled, as they put your body under a lot of stress, Dr. Dweck adds. And even certain medications could screw with your typical cycle, for instance antidepressants and antipsychotics (which, in a roundabout way, may pump up your levels of ovulation-blocking prolactin) and steroids, which mimic the cortisol release of a stress response. Some forms of birth control, especially if you’ve started a new one recently, can also cause irregular bleeding until your body adjusts.

All to say, it’s vital to see your doctor if you’ve bypassed more than one period and you’re sure pregnancy is off the table. (Your doc may also do a blood test to double-confirm your pregnancy status, Dr. Dweck notes.) They can do some digging to figure out what’s at the bottom of your missing or late period—whether that’s a lifestyle situation, a medication change, or a health condition—and determine if you may need to take certain measures or get on a particular treatment plan to resolve a medical issue.

And again, it’s especially important to book that appointment if you’re also experiencing any pain or other body changes, like for instance the cystic acne or hair growth of PCOS; shifts in your weight, energy level, pulse, or mental state that could point to a thyroid disorder; or typical harbingers of menopause. In these cases, it’s more likely that your MIA period is just one sign of an underlying condition, and connecting with your doctor is the first step to getting both your menstruation and your overall health back on track.

Related:

• Why Do I Feel Ridiculously Tired During My Period?
• 7 Period Problems You Shouldn’t Ignore
• Yep, Your Period Can Cause Awful Anxiety. Here’s How to Deal

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