- Author: Melanie Dell’Oro
There can be many different reasons why your period is late. Some you can influence, others you cannot. Some are short-term, others require medical intervention. Let's investigate the causes together.
Your period is late, but you're not pregnant?
We should say it upfront, so here it is: The most obvious explanation for why your period is late is that you're pregnant. You can rule that out for sure, your bleeding is late, but the test is negative? Then there are other circumstances that have such a major impact on your hormonal system that they lead to anovulation and thus the absence of menstruation (you can read about the connection between ovulation and your period here).
First of all, puberty should be mentioned. During this period of development, your hormonal system transitions from childhood to adulthood*. So much happens in the body at this time that the individual gears of the hormonal system do not always mesh optimally. This can also cause your cycle to get disrupted and your period to seemingly be late. Keep an eye on it! If your cycle is shorter than 21 days or longer than 45 days for more than a year, you should discuss this with a gynecologist. You should also see a doctor if you haven't had your first period by the age of 16. In this case, it is referred to as primary amenorrhea.
A short-term absence of menstruation can be caused by equally short-term triggers, e.g., a severe infection or a very intense period of stress. However, if these conditions persist, they can result in secondary amenorrhea - the absence of menstruation for more than 3 months. In addition to persistent negative stress, which also includes emotional distress, psychological problems, and performance pressure, e.g., also in cases of infertility, there are other causes that signal to the nervous system that ovulation is not a good idea right now.
Why don't I ovulate?
(TRIGGER Warning: Eating disorders are discussed)
To understand why the body sometimes decides not to send an egg on its way into the fallopian tube, you have to broaden your perspective. After all, what is the reason we have ovulation, a cycle in the first place? Exactly: reproduction. Even if it seems somewhat remote to us with our current lifestyle, many of our bodily functions are still based on simple biological principles. When an egg is mature for fertilization, it is intended to lead to the carrying of viable offspring. However, some conditions of our body do not allow us to withstand a 10-month pregnancy.
One of these reasons is severe underweight, which is caused by severe, wasting illness, but also by eating disorders. On the one hand, the body simply does not have enough energy available with a very reduced diet to withstand a pregnancy. On the other hand, the severe drop in body fat leads to a hormone deficiency. Estrogen and leptin are affected by this, both of which are hormones whose production is directly or indirectly influenced by adipose tissue. If there is a lack of estrogen, ovulation cannot be initiated. If there is a lack of leptin, the hypothalamus reduces the production of GnRH, which in turn stops the pituitary gland from producing LH and FSH. Without these hormones, follicle maturation does not occur in the ovaries. And without ovulation, there is no menstruation.
Similar mechanisms occur in extreme athletes. But the leptin signaling pathway is also disrupted in severely overweight menstruating individuals. Due to a constantly too high leptin level, the brain eventually no longer responds to the hormone. This results in leptin resistance with the same consequences as a leptin deficiency.
No period after the COVID-19 vaccine?
After the first wave of COVID-19 vaccinations, there appeared to be an increase in reports of cycle irregularities (e.g., late period, intermenstrual bleeding, heavier bleeding) in vaccinated menstruating individuals. This was (mis)used to call the safety of the new vaccine into question. Vaccine side effects are closely monitored and evaluated. The Paul-Ehrlich Institute regularly publishes a statement on such side effects. From this, it is clear that the number of reports in relation to the total number of vaccinated women is not exceptionally high. No permanent damage has been documented. A connection with the COVID vaccine is unlikely given the frequency of cycle irregularities, but a connection between vaccinations and an influence on the cycle in general cannot be ruled out either. Normally, not so many menstruating individuals are vaccinated at the same time, and cycle shifts are possible due to a multitude of causes.
No period despite the pill?
“You say I don't get a period if I don't ovulate. But I take the pill, which suppresses ovulation, and I still get my bleeding!” Absolutely right! Except that this is not a normal period, but a so-called withdrawal bleed. This is caused by the hormone withdrawal during the pill break and has zero physiological benefit. It is more of a cosmetic bleed to give you the feeling of a normal cycle. But you don't have one without ovulation. You can tell by the fact that in some menstruating individuals, this withdrawal bleed is absent if the pill is very low-dose or if the preparation is changed. Nevertheless, even if a withdrawal bleed is absent, you should always check whether you might have become pregnant due to a missed dose.
If you stop taking the pill because you want to get pregnant, it can take up to 14 cycles for your sex hormone system to settle back in. During this time, it can therefore also lead to anovulation and thus a missing monthly period.
By the way, you can read more myths about menstruation here.
My period is late, when should I see a doctor?
In principle, you should discuss any absence of your period that lasts longer than 3 months with your doctor. They can investigate the causes, advise you if you are currently trying to get pregnant, and - if necessary - initiate therapy. More serious conditions such as hyperprolactinemia, polycystic ovary syndrome, hypothyroidism, or other even rarer metabolic diseases also lead to the absence of a monthly period and should definitely be medically clarified.
What can I do if my period is late?
First of all, you should make sure that you are not pregnant. You can rule that out? Then you should investigate the causes!
Have you been very stressed lately? Then it certainly cannot hurt to support your adrenals a little in stress management. A healthy, balanced diet with long-chain carbohydrates, such as those found in vegetables, legumes, and whole-grain products, relieves your adrenal glands. Folic acid, which is found in, e.g., brewer's yeast, legumes, dark leafy greens, cabbage, and kitchen herbs, seems to have a positive effect on egg maturation. Soy and foods rich in phytoestrogens can also promote ovulation. Oils and plant-based foods rich in omega-3 fatty acids should be a regular part of your diet.
You should avoid refined sugar, such as that found in sweets, soft drinks, and many processed products. Unfortunately, coffee also does not help with stress management. Meditation, yoga, sufficient sleep, sports, exercise in the fresh air, good time management, and the courage not to have to please everyone do, however. Also have your prolactin level checked. It can be elevated due to chronic stress and thus prevent ovulation. And you can probably already guess: alcohol and tobacco consumption do not help either.
A healthy, balanced diet also helps you with weight management. Try to meet your daily calorie needs. If you feel that you need help with this, contact nutrition medical professionals or nutrition counselors.
For organic causes that affect the hormonal system, there are various treatment options that you should discuss with a doctor.