Rule out pregnancy first
In any sexually active woman, the first step with a late period is a pregnancy test, even when using contraception.
Common non-pregnancy causes
- Stress: severe emotional or physical stress can suppress reproductive hormones and delay ovulation.
- Weight change: rapid weight loss, very low body weight or marked weight gain disrupt cycles.
- Intense exercise, especially with inadequate nutrition, can stop periods.
- PCOS: the most common hormonal cause of infrequent periods.
- Thyroid disease: both under- and overactive thyroid affect cycles.
- High prolactin suppresses ovulation and may cause nipple discharge.
- Breastfeeding naturally delays periods.
- Medicines: hormonal contraception, some psychiatric drugs and others.
- Perimenopause: periods become irregular in the 40s.
- Premature ovarian insufficiency: periods stopping before 40 need assessment.
When to see a doctor
- Negative pregnancy test and no period for three months
- Cycles consistently longer than 38 days
- Late periods with excess hair, acne, nipple discharge, headache or visual disturbance
- No period at all by age 15
- Irregular periods when planning a pregnancy
Assessment
Besides a pregnancy test, FSH, LH, oestradiol, prolactin, thyroid hormones and if needed androgens and AMH are checked, with transvaginal ultrasound of the ovaries and lining. Treatment depends on the cause.
Our period calendar tool helps you track your cycle and notice irregularities.
Frequently Asked Questions
How long can stress delay a period?
It varies from a few days to several weeks, and sometimes a period is skipped.
My test is negative but my period has not come. What should I do?
Repeat the test in a week. If still negative with no period, seek assessment.
Sources
- Munro MG, et al. FIGO systems for abnormal uterine bleeding (PALM-COEIN), 2018.
- ASRM Practice Committee. Current evaluation of amenorrhea. Fertil Steril, 2008.
The information on this website is for general information only and does not replace a medical consultation.
