Missed Period, Cramps, Negative Pregnancy Test: What Could It Mean?

Possible Explanations

1. Very early pregnancy: hCG below detection; repeat test in 3–5 days.
2. Ectopic pregnancy: hCG may rise slowly; urgent if severe pain/bleeding.
3. Recent pregnancy loss: Residual hCG can cause false positive, not false negative.
4. Hormonal disorders: PCOS, thyroid disease, hyperprolactinemia, perimenopause.
5. Stress/weight change/exercise: Hypothalamic amenorrhea.
6. Medications: Contraceptives, antipsychotics, chemotherapy.

Next Steps

Quantitative serum β‑hCG is more sensitive than urine. If negative and period absent >90 days, evaluate for secondary amenorrhea (LH, FSH, prolactin, TSH, androgen panel, pelvic ultrasound).