What causes missed periods and negative pregnancy tests?

Question

Hello doctor,

I am a 21-year-old female, weighing 147 pounds and measuring 5 feet 2 inches. Two months ago, I took Primolut tablets during my period to stop bleeding. I took two tablets at night and two the following morning. However, in the previous month, I did not have my period. I wonder if this absence of menstruation could relate to the tablets I took. I also took a urine pregnancy test, which showed a negative result. What could be the potential reasons for this change in my menstrual cycle? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have read your query and understand your concern.

Based on your medical history, it appears you may have polycystic ovary syndrome (PCOS), which is a genetic condition. Excess cholesterol can be converted into estrogen when you gain weight, leading to hormonal imbalances. This can affect the balance between Follicle-stimulating hormone (FSH) and ovarian hormones, resulting in smaller follicle growth and the appearance of polycystic ovaries on scans. PCOS is often associated with obesity, irregular menstrual cycles, and extended periods of no menstruation, followed by heavy periods with clots, spotting, or irregular bleeding. It can also be linked to thyroid issues and elevated prolactin levels. Common physical signs include excess fat around the midsection, especially the waist, thighs, and breasts, with less fat on the extremities. Other symptoms include excessive body hair growth, hair loss, darkening skin on the lower face, acne, and oily skin. You may also have a family history of diabetes, especially from your father's side. PCOS can interfere with ovulation, making it difficult to conceive and increasing the risk of early pregnancy loss. However, it is treatable.

To address this issue, I suggest the following:

Your weight should ideally be the target weight range between 132 to 141 pounds. Once you reach a healthy weight, you may not require medication to regulate your periods or improve fertility.
Avoid fasting and junk food, including red meat. Reduce snacks between meals.
Choose low-calorie, high-protein foods.
Engage in regular exercise, primarily focusing on the waist and hip area. Activities like aerobics, yoga, brisk walking, and strength training can be beneficial.
Aim to lose five to nine pounds monthly; gradual weight loss is easier to maintain.
Even if you are within the normal weight range, these lifestyle changes can be helpful.

Regarding your use of the tablet Primolut-N (Norethisterone 5 mg), it contains progesterone hormone and only provides a temporary solution. Your absence of periods may be due to the underlying issue of excess weight and estrogen imbalance. To induce menstruation, I suggest you take any birth control pill, such as tablet Novelone (Desogestrel 0.15mg and Ethinylestradiol 0.03mg), Dear 21 (Levonorgestrel 0.25 mg and Ethinyl Estradiol 0.05 mg), Duoluton-L (Levonorgestrel 0.25 mg and Ethinyl Estradiol 0.05 mg), Ovral-G (Ethinylestradiol 0.05 mg and Norgestrel 0.5mg), or Intimacy plus 3 (Ethinyl Estradiol 0.03mg and Desogestrel 0.15mg). Take one tablet twice daily for 10 days (discard the 21st pill). Regardless of the cause, this should prompt menstruation within 7 to 10 days. After getting your period, I suggest you take one pill at night from the first day for 21 days, then take a seven-day break before starting the next packet on the eighth day (do not wait for your period). Continue this regimen for three to six months to regulate hormones and periods and give yourself time to reduce your weight. This will improve your chances of a healthy pregnancy and reduce the risk of miscarriage.

If your symptoms persist or you have concerns, please revert.

I hope this helps.

Thank you.