Stress, Infections, Or Pregnancy: What’s Behind Late Periods?

  • 6 Mins Read
  • Health Conditions
  • Written by: Reshma Pathare
Know the causes behind late periods
  • Late periods are common among girls who have just started menstruating and women who are close to menopause.
  • In sexually active women, periods delayed beyond the normal range could indicate pregnancy, with some specific symptoms.
  • In women who are not sexually active, menstruation delay of more than 40 days since the last period requires a medical consultation.
  • Among all women, causes of period delay range from weight loss or gain and sustained stress to serious health issues.
  • PCOS is one of the serious health problems whose symptoms include late periods.

 

In some countries, periods are nicknamed ‘chums’ because they come around to visit regularly, like a close friend. So, when the chums don’t show up on time, a woman may start getting worried. But how late is too late? Does 4 days of menstrual delay, a 1-week delayed period, or 10 days of delayed periods qualify as late periods, or should we wait longer (missed period for a month) to understand symptoms of delayed menstruation, and act on them?
There are several factors behind why can periods be delayed.

These include:

  • Age bracket
  • Hormonal balance
  • Stress, weight, infection, pregnancy, and childbirth.
  • If more than 35 days have passed since the last menstruation, then it counts as late periods.
  • If the delay stretches beyond 38 or 40 days, then it is late periods that need a doctor’s attention.

How long does a regular menstrual cycle last?

The first day of menstrual bleeding is the first day of a particular menstrual cycle — that’s the day the uterus begins to shed its thickened lining and the unfertilized egg that was made available by the ovary in the previous cycle.

At this point, when a girl or a woman starts bleeding, the levels of the female hormones estrogen and progesterone have dropped very low, because of the egg fertilization — or, the pregnancy — for which the uterus had prepared itself hasn’t occurred. The hormone levels change again during the next cycle of ovulation (an egg being released from either of the two ovaries), and so the process repeats itself.

The median range of a menstrual cycle is 28 days, meaning a woman is supposed to have periods every 4 weeks; but the periods coming a few days early or a few days late, from month to month, is perfectly normal.

A woman starts menstruating around the age of 12-13 years and can keep having periods till her mid-50s, on average. The duration and flow of menstruation depend primarily on the play of estrogen and progesterone.

A variety of external factors affect these hormones, thus leading to irregular menstruation in the form of heavy periods, light periods, missed periods, or signs of delayed or late periods.

What can cause a delay in menstruation?

For a sexually active woman, the first thought that comes to mind when the period doesn’t arrive on the expected date is that she’s pregnant. If pregnancy is then tested and detected, then the case goes in a different direction.
Even for a woman who isn’t sexually active, the menstrual bleeding may be delayed well beyond the normal outer limit of 35 days, and she shouldn’t wait any longer than 40 days to get a medical opinion.

Common reasons for late periods Young age: When a girl first starts menstruating, it takes a few years for her hormones to fall into a rhythm. In other words, her hypothalamic-pituitary-ovarian (HPO) axis — the body’s brain-and-glands system that regulates female reproduction — takes some years to get in sync. Until that happens, her menstrual cycle will see-saw in duration, with menstrual bleeding sometimes starting earlier than expected, sometimes later than expected.

Occasionally, a young girl may miss a period altogether because of anovulation, the state when her ovary has not released an egg into the fallopian tube (connecting each ovary with the uterus) during a particular menstrual cycle.

Perimenopause: The years leading up to menopause (the time when a woman’s menstrual cycle would stop permanently) may see delayed periods or otherwise fluctuating periods, as the female hormone levels change with age and so does ovulation. This is again a transitional phase, and this is called perimenopause.

If you are in your late-40s to early-50s and your late periods are accompanied by other symptoms like hot flashes, vaginal dryness, and mood swings, they may be attributable to perimenopause.

Hormonal reasons: Using hormonal (hormone-based) contraceptives, or having hormone-related health problems can cause periods to get delayed due to a hormonal imbalance.

Hormonal contraceptives such as oral pills, vaginal rings, IUDs (intra-uterine devices), or injections can disrupt the balance of the female hormones estrogen and progesterone, in turn disrupting the menstrual cycle. Sometimes, a woman on such contraceptives can experience just spotting, a form of light periods, but not regular periods.

Health issues related to hormonal imbalance, especially problems of the thyroid gland, can also lead to delayed periods. While the thyroid gland, which secretes the hormone thyroxine, is primarily responsible for controlling a person’s body temperature and metabolism, an overactive (hyperthyroidism) or underactive (hypothyroidism) gland can also throw a woman’s periods out of rhythm.

Polycystic Ovary Syndrome (PCOS) is another hormone-related cause of delayed periods. Cysts in both the ovaries and abnormally elevated levels of the hormone androgen are two key aspects of this condition. This interferes with the release of an egg every month from the ovary, thus leading to irregular or late periods.

Weight loss, diet, exercise: Sudden or drastic weight loss, following excessive exercise or eating disorders like bulimia and anorexia, can cause calorie deficiency and prevent healthy ovulation. Stressful exercise also causes a lowering of estrogen production, which may lead to delayed periods.

At the other end of the weight scale, obesity is also linked to delayed periods. A body mass index (BMI) above 35 makes a woman obese, thus prompting her body to produce excess estrogen, which causes her menstrual cycles to get delayed.

Stress: Our bodies are equipped to handle a fair amount of stress, but if the stress levels shoot up beyond a certain level and remain high for longer durations, a woman’s body starts producing the hormone cortisol, which disturbs the HPO axis and delays her periods, causing 20 days late period or sometimes, heavy bleeding after 8 days of missed period or spotting after 8 days of a missed period, from the due date.

Infection: Pelvic Inflammatory Disease (PID), which usually starts through sexually transmitted diseases (STDs) like chlamydia and Gonorrhea, is an infection that can cause late periods. Starting at the vagina and cervix, the viruses from the STDs — if left untreated — go up to the uterus and result in PID.

  • Breastfeeding: A woman who is breastfeeding produces prolactin, a hormone that helps produce the milk, but also hinders the menstrual cycle by pushing up estrogen levels. This prevents the dip in estrogen that is required to start the periods. What to do if your menstruation is delayed? To keep track of when is my next period due and understand if your periods are getting delayed, begin by keeping track of your menstrual cycles and duration. You can use one of the many apps available online.

If you suspect pregnancy, or if your periods have been delayed for more than two months at a stretch, is time you use a pregnancy test with irregular periods/ visit a doctor for confirmation. Pregnancy-induced absence of periods may be accompanied by nausea, spotting, acidity, etc. The spotting occurs when the embryo, in the initial stage, attaches itself to the uterus lining. This is called implantation bleeding. If you see a pattern in the period delay, ascertain whether there’s a corresponding pattern of extreme exercise, crash diets, weight loss, or sudden and serious weight gain. If the patterns match, consult the respective professionals to recalibrate your exercise or diet. If pregnancy is ruled out, then, depending on your age, the doctor may suggest:

  • Routine blood test;
  • Pap Smear test (to check for infections);
  • Thyroid function test (to check for thyroid hormone imbalances);
  • Ovary function test (to see if the ovaries are functioning properly to release an egg);
  • Ultrasound or MRI (to check the reproductive organs or presence of any cancer, respectively).

Depending on the diagnosis, the doctor will suggest treatment, ranging from simple medication to biopsies. It is important to remember that even though pills for menstrual problems are available over the counter, self-medication without a doctor’s guidance is inadvisable.

Read our health conditions blogs to know about menstrual health and for ways to improve menstrual health.