How many days of delay is considered normal?
The length of the cycle for the same woman can vary, and a variation of up to several days is quite normal, especially after flights, illness or severe stress. A delay is considered to be the absence of menstruation for more than a week. One such episode per year without other complaints usually does not require examination. But if the delays recur, the cycle has become shorter than 21 or longer than 35 days, menstruation has been absent for three months or more or is accompanied by pain and unusual discharge, a visit to the doctor and examination is needed.
- Normal cycle - 21–35 days
- Fluctuations of several days are acceptable
- A delay of more than 7 days is a reason to take a test
- Repeated delays require investigation
- Absence of menstruation for 3 months - a mandatory visit to the doctor
Pregnancy and related conditions
The first thing to do when there is a delay is to take a pregnancy test, even if contraception was used: no method gives a 100% guarantee. A test on a morning urine sample is informative from about the first day of the delay, but with early pregnancy or diluted urine it can be false negative, so it is repeated a few days later or blood hCG is donated. It is important to remember about ectopic pregnancy: with it, the test is also positive, but one-sided pain and spotting appear - this is a dangerous condition that requires urgent treatment.
- Pregnancy test with morning urine
- Blood hCG with a questionable result
- Repeat the test after 3–5 days
- Ectopic pregnancy with pain and spotting
- Delay is also possible during breastfeeding
Hormonal and other reasons
The most common hormonal cause in women of reproductive age is polycystic ovary syndrome, in which ovulation occurs rarely and the cycle lengthens; Excessive hair growth, acne and weight gain are often associated. Thyroid disease and increased prolactin have a noticeable effect on the cycle. Lifestyle also matters: strict diets, sudden weight loss, intense training, night shifts, severe stress, and obesity. Failures are caused by some medications and the abolition of hormonal contraception. After 45 years, lengthening of the cycle is often associated with the approach of menopause.
- Polycystic ovary syndrome
- Thyroid disorders
- Elevated prolactin
- Drastic weight loss and strict diets
- Obesity
- Intense exercise and stress
- Taking and stopping hormonal drugs
- Perimenopause after 45 years
What examinations are needed
The examination begins with the exclusion of pregnancy and examination by a gynecologist. A pelvic ultrasound evaluates the thickness of the endometrium, the condition of the ovaries and the presence of follicles, and helps to see signs of polycystic disease. Next, the hormonal background is examined: TSH and free T4 for the thyroid gland, prolactin, if necessary, FSH, LH, estradiol, testosterone and DHEA sulfate. You need to take sex hormones on the days of your cycle prescribed by your doctor. If you are overweight and have signs of polycystic disease, glucose and insulin are checked. It is useful to keep a cycle calendar for at least three months.
- Pregnancy test and hCG
- Examination by a gynecologist
- Ultrasound of the pelvic organs
- TSH and free T4
- Prolactin
- FSH, LH, estradiol, testosterone as prescribed
- Glucose and insulin for suspected polycystic disease
What to do and how to treat it
Treatment is aimed at the cause, not at “inducing periods.” In case of diseases of the thyroid gland, the cycle is often restored after normalization of hormones; in case of increased prolactin, it is during treatment by an endocrinologist. With polycystic disease, the basis is weight loss, nutrition and physical activity, and the gynecologist, if necessary, adds hormonal therapy. If delays are associated with diets and overtraining, restoring normal nutrition and rest patterns helps. Taking medications to induce menstruation without a doctor's prescription is dangerous, especially if you are pregnant.
- Treatment of the underlying disease
- Normalization of weight and nutrition
- Reducing excessive workload and dealing with stress
- Hormonal therapy as prescribed by a doctor
- Do not take period medications on your own
- Maintaining a cycle calendar
- Re-examination if failures persist
