Delayed Period: Causes, Symptoms & When to See a Doctor

A period delayed by one week is common and often benign. Persistent irregularity warrants evaluation.

Common Causes

• Pregnancy: #1 cause; test if sexually active.
• Stress: Cortisol disrupts GnRH → anovulation.
• Weight Fluctuation: Rapid loss/gain, low BMI, eating disorders.
• PCOS: Oligo‑/anovulation, hyperandrogenism.
• Thyroid Disorders: Hypo‑ or hyperthyroidism.
• Hyperprolactinemia: Prolactinoma or medication‑induced.
• Perimenopause: Age 40+; cycles become erratic.
• Medications: OCPs, antipsychotics, chemotherapy, glucocorticoids.
• Excessive Exercise: Energy deficit → hypothalamic amenorrhea.

When to Seek Care

• ≥3 missed cycles (amenorrhea).
• Associated symptoms: hirsutism, acne, weight change, galactorrhea, hot flashes.
• Positive pregnancy test.
• Trying to conceive >12 months (<35 y) or >6 months (≥35 y).

Initial Workup

β‑hCG, TSH, prolactin, FSH/LH, estradiol, free testosterone, DHEAS, pelvic ultrasound.