Late Period, Negative Pregnancy Test: Next Steps

Action Plan

1. Repeat home pregnancy test: Use first-morning urine; wait 48 hours if initially negative.
2. Consider non-pregnancy causes:
   • Stress (hypothalamic suppression)
   • Weight change (loss/gain), excessive exercise
   • Thyroid dysfunction (TSH)
   • PCOS, hyperprolactinemia
   • Medications (OCPs, antipsychotics, chemotherapy)
   • Perimenopause
3. See a clinician if:
   • Period >7 days late with negative tests
   • Irregular cycles persist >3 months
   • Associated symptoms (pelvic pain, galactorrhea, hirsutism, hot flashes)

Clinical Evaluation May Include

• Serum β-hCG (definitive pregnancy exclusion)
• TSH, prolactin, FSH, LH, estradiol
• Pelvic ultrasound
• Review of medications and lifestyle

Most delayed periods resolve spontaneously or with treatment of underlying cause.