Missed period - what tests can be done? (TTC)

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Hi all, hope you can help.

If you've missed a period, what medical tests can be done to check what's wrong? I don't want to wait around for several more months to see if my cycle gets back to normal (I'll be 39 in October!).

Last summer I had the usual hormone tests, but they were based on specific cycle times - which I now have no idea about (due to my period suddenly disappearing).

I'm now on day 35 of my cycle - no sign of AF and not pregnant (done several tests). Previously, my cycles have been reasonably regular (26 days, on average).

I've also started looking into private fertility testing - but it may be too soon for this. I've been pretty stressed, which I'm trying to improve on - but the uncertainty just makes me more stressed. So maybe tests will help. I'm just really conscious of not wasting time. If there's a problem, I want to know ASAP so we can tackle it before I get any older...

Hi OP,

Are you sure you have actually missed a period? Is it possible that you've ovulated later and therefore simply aren't due yet?

I know GPs can be hesitant to do certain tests so might be worth trying to start the temperature method to confirm ovulation and see how long your luteal phase is. And then go from there, as it can show things like hormone imbalances.

Can I really strongly recommend a book called taking charge of your fertility? By Toni...something. Its about two inches thick, but it basically explains how your cycles work, and lots of signs you can pick up on yourself. It has a great section about how stress can cause you to ovulate late/not ovulate - I had a similar freakout one month when TTC about seeming to not ovulate and realised that I'd been bitten by a dog (!) the previous month a few days before I was due to ovulate. Nothing too traumatic, but a bit of a shock and enough to throw my cycle off track.

I'd recommend reading it and taking some steps yourself before considering anything further, it will also help you track your cycle. Are you temping?

@NoCallerID - Thanks for your reply :)

I had a positive OPK (LH surge) on day 14, right on schedule - so if I ovulated, it should have been shortly afterwards.

UNLESS stress caused ovulation to be delayed... but I'm not sure if that's possible once the LH surge has happened? Or is it possible to have more than one LH surge in one cycle - like a 'second attempt'?

My concern is that despite the LH surge, I didn't ovulate - and thus I'm worried about fertility.

What tests do you think the GP could do, other than the 'usual' ones (which I had last year)?

I've literally just started monitoring my BBT, but I'm not sure how useful it'll be without the context of my cycle! Which is really frustrating.

@worriedmama1980 - Thanks also for your reply - and the recommendation! :) From your name, I'm guessing you're a year older than me :)

That's really interesting, about the stress thing. In my case, I had the LH surge (positive OPK) - and on that very same day, a super-stressful work issue came up that affected the entire week.

So I've wondered if my body was all set to ovulate, then the stress stopped it from actually happening.

I just don't know where it leaves me, with my current cycle timings and options. I'm so confused!

I don't think a gp would run any tests. After three months without af, some prescribe norethisterone (provera) to induce a bleed. There's not really a lot they CAN do... some might even try to convince you that going onto the contraceptive pill will cause periods to become regular once you've stopped it, which is nonsense.

It's very possible to get more than one lh surge in a cycle.

The idea of 'hormonal imbalance' doesn't carry a lot of weight with gps. Especially the three sex hormones. Especially if you still have cycles (even if they're irregular).

@physicskate - Thanks - that's actually really reassuring! I thought it was only possible to have one LH surge per cycle, thus one 'chance' at ovulating. But if it can happen twice, perhaps I did ovulate later.

Re: 'Hormonal imbalance' - Do you mean the impact of stress or similar? Or do you mean that they only take hormone issues seriously if cycles seem to stop entirely, for months on end?

My GP did tests last summer (usual hormone ones) because my periods went a bit wonky after stopping breastfeeding. So I assume they'd do the same ones again... but only once my cycle is back on track.

So in the meantime, I'm keen to find out if there are other ways to investigate.

And often, they don't even take hormonal issues seriously when cycles disappear. It's a man's world, after all... and yes, western medicine is fairly sexist - just look at how endometriosis, menopause and pcos are treated (or not!!). Just look at the debate around abortion!!

In pcos, for example, tracking with opks is really useless because women with pcos a) can have a raised baseline lh and b) can have a large number of surges before ovulation.

It's not always impossible to become pregnant with pcos (and I keep mentioning pcos because it is an endocrine disorder), even though pretty much every women diagnosed with it is told they can't become pregnant, which is why there are quite a lot of unplanned pregnancies in women with pcos.

They won't run any tests for a late period simply because tests wouldn't tell them anything other than you either ovulated late or simply didn't ovulate this cycle (an anovulatory cycle or two is very very normal in women who aren't on hormonal contraception).

I say 'hormonal imbalance' because a lot of women suffer the misapprehension that there are few hormones (there are hundreds, if not thousands - endocrinology is a branch of medicine) that can be 'fixed' with a few tablets or something...

You see the phrase mentioned on these boards fairly regularly...

@physicskate - Thanks, that's all useful to know.

All I really know so far about hormones (which may be completely wrong!) is that certain levels being low or high can affect the chances of conception, one way or another.

I guess I would like to know if I'm ovulating or not. But I know it's about more than that. If we don't have success, I may need to consider tests to find out more about egg quality, quantity, etc. But it feels too soon for that (maybe).

The only test for egg quality is ivf.

The hormone panels (as you discovered already) must be done on certain cycle days to have any meaning for fertility.

After ttc for a year or more, head to the gp for tests.

The most common tests check indicators of ovarian reserve (but again the best test for this is how you respond to the ivf drugs), and if you ovulated that cycle. Sometimes they will also check for pcos indicators and thyroid function. Not a lot else, as the tests are geared to seeing how you'd respond to ivf, as that is by far and away the most common treatment for infertility.

One weird cycle doesn't mean much in fertility terms, but lots of weird cycles might...

@physicskate - Yes, a private clinic near us offers a 'Fertility MOT', which includes an AMH (?) test, ultrasound, etc (prior to considering IVF).

Some friends of ours went through a similar process and it revealed problems, so they decided to go for IVF (they had no children already).

I guess that would be the next step for us, if we have no success.

I'd also like to know if my c-section in 2017 caused any issues - scar tissue or whatever.

UPDATE - Typically, the day after posting the above, AF has finally decided to hint at making an appearance (around 10 days later than usual).

The good news is that things seem to be 'working', to some degree. I must have had a second LH surge and ovulated later in the month (I had some EWCM around day 25 - which did seem rather random at the time).

Thanks for your input, all - it was still really useful, even though I was wrong about the missed period.

Hiya, I can see this is the 3rd thread you’ve started about the same thing. I had very similar last month and AF finally appeared on day 59. No rhyme or reason behind it - sometimes we just “miss” periods but my dr said if it happens again I can go for a blood test to check my hormone and thyroid levels. If it happens for you again I’d also request the same from your GP - just so you know everything is working ok. Generally speaking missed periods can happen and are rarely anything to worry about

@mrsmummy111 - Thanks for your reply. Actually, while the three threads are connected, the issues are different.

One is about pregnancy testing, one is about fertility testing, and one is about cycle timings.

I did this deliberately, as I think it's more useful for others to be specific, when searching through discussions. They're all such complicated issues!

I've already had GP tests (last year) - all normal. But things change, so I may request more if things stay a bit weird.

Sorry I've completely forgotten to reply...

I think the best step for you would be temping, just to see how everything is going.
Like @worriedmama1980 said, taking charge of your fertility by Toni weschler is the most helpful book. I've learned so much about fertility and my body using this. And it's incredibly easy to read and to go back to find certain topics. If you were referred to fertility specialists this can help them massively and shorten otherwise long weeks or months of trying to find out what's going on.
I have very irregular and long cycles so have started taking Agnus Castus up to ovulation which helps a lot.
It's a very personal choice how to approach things, in my case I'm trying to do it as natural and gently as possible and want a few more months of cycle tracking before I take further steps.

@NoCallerID - No problem, thanks for taking the time :)

I'm the same - I need to track things for a little longer (with my newfound knowledge) before taking any drastic steps.

I started temping a few days ago, so it'll be interesting to see what that reveals. I mostly just want to see what happens when, to get an idea of how 'normal' my cycle is.

Also, I discovered that my local private clinic will do an AMH test (to check egg quality/quantity) at quite a reasonable fee, if I get a referral form from my NHS GP. I've got a phone appointment with the latter next week.

Re: Agnus Castus - How does it help? Where do you get yours from? What quantity/frequency, etc.? Sorry for all the Qs!