A reader asks:
My period is a week late, but I don't think I'm pregnant. I've had penetrative vaginal sex twice in the last month, and used condoms (successfully, I think) both times. I have been pretty stressed though. Any ideas what could be up?
Late or missed periods can be super stressful, even when it seems like pregnancy isn’t a likely cause. While pregnancy is probably the best-known cause of amenorrhea (the medical term for missed menstrual cycles), it’s definitely not the only one. Let’s break down some of the possibilities and (hopefully) put your mind at ease, or at least give you some ideas for next steps in trying to figure out what's up.
Are you stressed out? Mental and emotional stress can have a significant impact on many systems and functions within your body, including menstruation. Big changes in your usual routine and environment such as travel, moving, a new job, and other major life events can cause your body to hold off on menstruating or skip a period entirely until things settle down.
Have you been sick recently? Physical illness can compel your body to delay ovulation (the release of an egg from an ovary) until you’re healthy enough to sustain a hypothetical pregnancy. Because ovulation is a key step in the menstrual cycle, delayed ovulation = delayed period.
Have you experienced any weight changes? Rapid or unusual weight gain or loss can cause hiccups in your usual menstrual cycle. People with low body weight are also prone to irregular or missed periods, and in extreme cases may stop having periods altogether.
Have you changed your exercise routine? An increase in the amount or intensity of physical activity that you engage in can delay or interrupt your menstrual cycle.
Have you started taking any new medications lately? Some meds can influence your period, so if you've started taking anything new recently it's worth a quick Google search to see if “changes in menstrual cycle” is listed as a side effect. It's not just birth control that can affect your period–many drugs that have nothing to do with the reproductive system can have unexpected effects on menstruation.
This list of questions is certainly not all-inclusive, but it does cover some of the most common causes for a delayed or missed period. Outside of these factors, there are some medical conditions that can manifest in part as interruptions in a person’s menstrual cycle, like polycystic ovarian syndrome and thyroid disorders. If unexplained menstrual mishaps continue, or if you notice other symptoms that are out of the ordinary for your body, it’s a good idea to check in with a healthcare provider.
Now let’s talk about the (baby) elephant in the room: The possibility of pregnancy.
Since you used condoms both times you had vaginal sex in the last month, your chance of pregnancy is significantly reduced. But while using condoms is a great way to reduce your risk of both STIs and pregnancy, they’re not 100 percent effective.
The best way to determine whether or not you may be pregnant is, of course, to take a pregnancy test. Even if you’re confident that you’re not pregnant, sometimes taking a test to confirm can set your mind at ease enough to reduce your stress level — and since stress is a potential cause of delayed menstruation, that may even help bring on your delinquent period! Most pregnancy tests become effective on the first day of your missed period, so you're well within the range where a standard home test will be accurate.
While taking a pregnancy test has the power to greatly reduce your anxiety if the result is negative, the anticipation and uncertainty tied up in the act itself can create its own stress. If you decide to take a pregnancy test, try to make arrangements to ensure that you have the support you need. Do you want a friend, partner, or family member to be with you the whole time? If you would prefer privacy, is there someone you can make a plan to call or talk to if you need support afterward? Is there a comforting activity, like taking a bath, eating a good meal, or a Great British Baking Show marathon you can schedule for yourself later in the day, regardless of the outcome? As in all situations, it's important to take care of yourself in whatever way works for you.
If pregnancy-related anxiety is popping up more often than you’d like, it also may be a good time to check in with a healthcare provider about birth control options that align with your needs and lifestyle. Pairing condoms with other contraceptive methods can provide added protection and even regulate your cycle, helping to avoid angst like this in the future.
Best of luck solving the mystery of your missing period!