Period Symptoms Without Bleeding + Late Period: Differential

Premenstrual-like symptoms (cramping, breast tenderness, bloating, mood changes) with a negative pregnancy test and no bleeding suggest:

1. Anovulatory cycle – follicular phase symptoms without luteal progesterone withdrawal bleed.
2. Early pregnancy (false negative) – test too dilute/early; repeat serum hCG in 48 hrs.
3. Hormonal contraception effects – breakthrough symptoms, missed withdrawal bleed.
4. Perimenopause – erratic cycles, fluctuating hormones.
5. PCOS, thyroid, hyperprolactinemia.
6. Stress, weight change, excessive exercise – hypothalamic suppression.
7. Uterine pathology – fibroids, polyps, adenomyosis (usually cause bleeding, but can cause pain).

Next Steps

• Repeat hCG (quantitative serum).
• If negative ×2 and no bleed → clinician eval: TSH, prolactin, FSH/LH, pelvic US.
• Track symptoms; lifestyle review.