Dear Doctor,

I am 25 years old and have never been pregnant. However, my period is late by about three weeks and this has never happened. I took a pregnancy test and it came out negative. Can a test sometimes be wrong? Or is my body going through random changes?

Sandra

Dear Sandra,

Amenorrhoea (missing one’s period) could be primary, where periods have never occurred. It can be secondary, where a woman menstruating regularly misses her periods. The most common cause of secondary amenorrhoea in a woman of reproductive age is pregnancy. Second most common cause is lactation. A woman breastfeeding her baby may not have menses for the period of lactation. However, if the pregnancy test is negative, it means fertilisation has not occurred. This could be due to several causes. Hormonal disorders like those of pituitary, hypothalamus, thyroid gland, and polycystic ovarian syndrome, can cause amenorrhoea as one of the manifestations.  Hormonal contraceptives, particularly those containing progesterone, can also lead to temporary cessation of menses. Prolonged use of corticoids can also cause amenorrhoea. Malnutrition, both undernutrition and being overweight, can cause irregular or absent menses.  Physically active women or who train like men as athletes can have absent or irregular menses due to increased levels of testosterone, the masculinising hormone. Mental stress is also one of the factors that can disturb normal menstrual cycle and cause amenorrhoea.

Cause of amenorrhoea can be detected by an ultrasound and hormonal assays. Treatment depends on the underlying cause. Taking a balanced meal, regular physical exercise and being relaxed totally also help in keeping menstrual cycles regular and also help a woman to conceive.                      

Dr. Rachna Pande is a specialist in internal medicine.

E-mail- rachna212002@yahoo.com