PMS symptoms but period hasn't shown up yet
January 10, 2017 9:55 PM   Subscribe

If a woman was experiencing her normal PMS symptoms like cramps & unusual emotional fluctuation on and off for a certain amount of time, but her period has failed to show up, how long would a doctor want to wait to see if it's just a flukey cycle? Or if the doctor didn't want to wait, decided enough time had passed, what would they do next? Assume pregnancy is a million-percent impossible. Assume Dr. Google has already been consulted.

Not asking for a diagnosis or anything that would be impossible for an Internet stranger who isn't my doctor to provide. It's just something I'm curious about.

To reiterate I'm not asking about potential causes. I'm interested in hearing peoples' experiences (personal or professional) about how a doctor might proceed from hearing about this for the first time.
posted by bleep to Health & Fitness (17 answers total) 1 user marked this as a favorite
 
It could of course be any number of things but since you are asking, I have had these symptoms. First step: hormone levels. Conclusion: peri-menopause. Causes wonky hellish cycles. Yay!
posted by DarlingBri at 10:01 PM on January 10, 2017 [5 favorites]


A good doctor, an average doctor, or someone like my ex-doctor? (Who said, "I don't know why that happened", and ended the conversation there, when one cycle was truncated quite early [by excruciating pain].) (I guess I'm asking, what can we assume about the quality of care you might get? Do your appointments often follow the protocols proposed by Dr. Google? How good/average/not-good is your doctor? I think experiences/answers might vary a lot, depending on that and the systems people are in.)
posted by cotton dress sock at 10:08 PM on January 10, 2017


Assume competent doctors in a major metropolitan area blue state.
posted by bleep at 10:16 PM on January 10, 2017 [1 favorite]


But all experiences accepted!
posted by bleep at 10:17 PM on January 10, 2017 [1 favorite]


They'd probably ask about symptoms and run a hormone panel. If there's pain it could be more like Endo or cysts. I assume that if it doesn't start soon you could request some bloodwork to start. Have they fluctuated in the past? That would probably make your doctor more eager to start testing.

When I skipped one my GP and GYN were unphased. I was freaking out a bit because I already have health problems and some funky hormones. The GYN thinks I have endo and my GP agrees. The ultrasound was negative and I'm awaiting some of my health issues to hopefully improve for further testing. I have an amazing GP and GYN so I'm sure if I asked for bloodwork I could have gotten it, just endo seems more likely.

Sometimes you just skip one. They've mostly been normal times since coming off birth control. There's no way for me to be pregnant.

I also had PMS symptoms from the days it was "supposed" to start until it actually started. Anywhere from 5 to 30 days. They've normalled out again.

As an aside, I use a tracking app which is really helpful for doctor's appointments as "evidence" of funkiness.
posted by Crystalinne at 10:31 PM on January 10, 2017 [3 favorites]


All kinds of things can cause a skipped period. Stress alone can be enough to do it. I'm not even sure a doctor would do labs (besides a pregnancy test) based on missing one period.
posted by praemunire at 10:38 PM on January 10, 2017 [1 favorite]


Again, not looking for causes or guesses.
posted by bleep at 10:39 PM on January 10, 2017


I have also not specified the amount of time that has passed. Because I'm not looking for causes.
posted by bleep at 10:40 PM on January 10, 2017


I had a long history of cycles in my teens through late twenties so irregular I tried to use statistical analysis on it. As a result, my CNM stated that her personal rule was not to let someone who normally sloughs off tissue go more than around ninety days without doing so - that is, if one was using continuous pill or other hormones to prevent endometrial accumulation, it wasn't a problem, but otherwise it was wise to cycle at least four times a year to clear out.

In order to make that cycle happen, I took a course of progesterone for a few days, then got a cycle at the withdrawal of the same.

Now, if you haven't had irregular cycles before, or there are other factors - personal or family history of certain things, age, etc - there might be cause for various rule-out testings like hormone levels or ultrasound.
posted by cobaltnine at 10:54 PM on January 10, 2017 [2 favorites]


[A couple deleted. Please try to specifically answer the questions rather than guess about causes, or discuss / complain about doctors generally. OP's questions: 1) how long would a doctor want to wait to see if it's just a flukey cycle? 2) if the doctor decided enough time had passed, what would they do next? OP has indicated in follow-up: "Assume competent doctors."]
posted by taz (staff) at 11:34 PM on January 10, 2017 [1 favorite]


When it happened to me, the doc said I had to miss at least two consecutive cycles, so probably something like 60-70 days from my last period. It wasn't clear whether her estimate would have been different if I was on birth control. My period showed up a few days after the appointment, so I can't speak to next steps.
posted by Fish, fish, are you doing your duty? at 12:10 AM on January 11, 2017 [2 favorites]


Three months
Guidelines for what a doctor should do
posted by SyraCarol at 5:25 AM on January 11, 2017 [1 favorite]


When this happened to me my doctor basically said "Wait til next month and see if it comes around, as long as you are confident that you are not pregnant" and then by the next month, they ran some hormone tests to see if there was an obvious answer. In my case there was so I wound up going to a fertility-type doc (I was not trying to get pregnant, but this is how it worked in my medical establishment) who basically worked with me to see if this was an issue *I* was concerned about (no) to determine next steps. I think I got an abdominal ultrasound and then an MRI to rule out other issues and then confirm the diagnosis.

So, my doctor was very low-key about this because I was low key and nearly my only symptom was no periods at a young enough age that peri-menopause was very unlikely. My experience, dealing with this same issue with multiple doctors, is that a lot of times they will follow your lead about how much of a concern it is for you, how much you are concerned about your fertility, etc.
posted by jessamyn at 7:09 AM on January 11, 2017 [1 favorite]


Three months for me, although in my case I didn't "miss" a cycle so much as I had intense spotting and a longer, heavier period one month, then random periods the second month, and then a third month of nonstop bleeding.
posted by Young Kullervo at 2:38 PM on January 11, 2017 [1 favorite]


My periods were odd in the other direction (coming way too often) and my doctor wanted to wait at least 3 months to look into it. My problem resolved itself before then so I didn't learn what the next step would have been.
posted by apricot at 2:52 PM on January 11, 2017 [1 favorite]


I've had this happen (well, to be honest I went about 6 months with barely a period once before going to the doctor, but that was my fault). I have PCOS and when we talked about it, my doctors (I moved several times so had different ones) all said that at the 3 month mark they would do a round of progesterone to induce bleeding (and I've done that before) and then do hormone testing. Maybe after the labwork they would do an ultrasound to make sure I had shed the lining and didn't have any big cysts or other excitement growing. They had a limit as to how many millimeters a lining could build up before they wanted to force shedding or do a D&C but I can't remember what that number was (I actually wasn't building up much lining anyways due to the hormone imbalance so I never got near that mark).

So based on my experience, the 3 month mark seems to be typical, although for someone who has had zero problems in the past I could see a doctor wanting to start labwork and such after the 2nd missed period or 2nd month. The ultrasound is easy to do at the doctor's office and I've had them done the same day as my regular appointment before (as long as the ultrasound tech was there).
posted by MultiFaceted at 9:48 AM on January 12, 2017 [1 favorite]


Thanks all for putting my mind at ease, very glad I asked
posted by bleep at 3:09 PM on January 18, 2017


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