[22F] With missed period and negative pregnancy test

Patient Description

A 22-year-old female reports being 19 days late on her period with a negative pregnancy test. She experienced her last menstrual period from June 29th to July 3rd and has not had a period since. The patient is experiencing nausea, stomach twitches, and vaginal cramps for about a week, with the cramps rated as 4 out of 10 in intensity. She also reports breast tenderness and an increase in vaginal discharge that is similar to egg whites. The patient has regular menstrual cycles and no significant changes in stress levels, medications, weight, exercise routine, diet, or recent illnesses. She has a history of hypothyroidism but is not currently on any treatment for it. Additionally, she is experiencing insomnia. No other pre-existing conditions or chronic illnesses reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

1. Hormonal Imbalance

  • Hypothyroidism: Since you have a history of hypothyroidism and are not currently on treatment, this could be affecting your menstrual cycle. Hypothyroidism can lead to irregular periods, missed periods, and other symptoms like fatigue, weight gain, and mood changes.
  • Other Hormonal Imbalances: Conditions like Polycystic Ovary Syndrome (PCOS) or other endocrine disorders can also cause missed periods, nausea, and changes in vaginal discharge.

2. Stress and Lifestyle Factors

  • Insomnia: Chronic sleep disturbances can affect your hormonal balance and menstrual cycle. Even if you don't feel particularly stressed, insomnia can be a significant factor.

3. Gastrointestinal Issues

  • Nausea and Stomach Twitches: These could be related to gastrointestinal issues, which sometimes overlap with menstrual symptoms.

4. Pregnancy-Related Changes

  • False Negative Pregnancy Test: Although less common, it's possible to have a false negative pregnancy test, especially if taken too early or not according to instructions.

Typical Treatments and Testing

  • Blood Tests: To check thyroid function, hormone levels, and rule out pregnancy.
  • Ultrasound: To check for ovarian cysts or other abnormalities.
  • Lifestyle Modifications: Addressing sleep issues and stress management.

What you can do

Hormonal Imbalance

  • Consult Your Doctor: Given your history of hypothyroidism, it's crucial to consult your healthcare provider for a thyroid function test and possibly restart or adjust your medication.
  • Track Symptoms: Use MDandMe to journal your symptoms, track your menstrual cycle, and share this information with your healthcare provider.

Stress and Lifestyle Factors

  • Improve Sleep Hygiene: Establish a regular sleep schedule, avoid caffeine and electronics before bed, and create a relaxing bedtime routine.
  • Stress Management: Practice relaxation techniques like deep breathing, meditation, or yoga.

Gastrointestinal Issues

  • Dietary Adjustments: Eat smaller, more frequent meals and avoid foods that trigger nausea.
  • Hydration: Ensure you are well-hydrated, especially if you are experiencing nausea.

Pregnancy-Related Changes

  • Retake Pregnancy Test: Consider retaking the pregnancy test in a few days or consult your healthcare provider for a more accurate test.
  • Monitor Symptoms: Keep an eye on any new symptoms and document them using MDandMe.

What you should look out for

  • Severe Pain or Heavy Bleeding: Seek immediate medical attention if you experience severe abdominal pain or heavy vaginal bleeding.
  • Worsening Symptoms: If your symptoms worsen or new symptoms appear, consult your healthcare provider.
  • Signs of Thyroid Dysfunction: Watch for symptoms like extreme fatigue, weight changes, or mood swings, which could indicate your hypothyroidism needs to be addressed.

Remember, while I can provide information and suggestions, it's essential to consult a healthcare professional for a formal diagnosis and treatment plan. If you have more questions or need further assistance, feel free to continue the conversation.

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4 mo ago


People Also Ask


Can hypothyroidism cause missed periods and other menstrual irregularities?

Yes, hypothyroidism can lead to missed periods and other menstrual irregularities due to its impact on hormone levels. It can cause the menstrual cycle to become irregular, lighter, or even stop altogether.


What are the possible reasons for a false negative pregnancy test?

A false negative pregnancy test can occur if the test is taken too early, if the urine is too diluted, or if the test is not used correctly. It's also possible if the levels of the pregnancy hormone (hCG) are not yet high enough to be detected.


How can insomnia affect menstrual cycles and overall hormonal balance?

Insomnia can disrupt the body's hormonal balance, including those hormones that regulate the menstrual cycle. Lack of sleep can lead to increased stress hormones, which can interfere with the regularity of periods.


What are some common symptoms of Polycystic Ovary Syndrome (PCOS)?

Common symptoms of PCOS include irregular periods, excessive hair growth, acne, weight gain, and ovarian cysts. It can also cause changes in vaginal discharge and affect fertility.


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