“Has your period come yet?” my boyfriend asked one day.

“No, why?” I replied.

“I'm just a little worried we could…be pregnant.”

The idea dumbfounded me; I couldn’t be pregnant. It had never even crossed my mind. In fact, I was so busy with school that I had forgotten about my period.

Maybe you’ve had a similar realization. A missing or delayed period is anxiety-inducing, and it can be followed by other confusing events, like spotting or early pregnancy (or is it PMS?) symptoms. So before you buy a pregnancy test, let’s explore some possible causes.

By the end of this article, you’ll know:

• Causes of a missed period (and what your birth control may have to do with it)
• Causes of spotting after a missed period
• How to tell early pregnancy symptoms from PMS symptoms
• When to take a pregnancy test for the most accurate results
• What to do if you get a negative result, but still don’t have your period
• What to do if you get a positive pregnancy test result

So what could have caused you to miss your period?

Missing your period on birth control

When you’re experiencing menstrual irregularities, birth control makes everything a little more complicated. Is your contraception interfering with your hormones? Did you have a birth control failure, and now you’re pregnant? Depending on what form of contraception you’ve been using, especially if it contains hormones, a missed period could be caused by many different things.

Missing your period on the pill

Most oral contraceptives, or birth control pills, allow you to have a monthly bleed. You may take 21 active (hormone-containing) pills and 7 placebo (non-hormonal) pills. The placebo pills allow a monthly bleed because of the withdrawal of daily hormones from the active pills.

If you’re on an “extended-use” oral contraceptive, you only take active pills, and no placebo pills, for longer periods of time. That means you’re taking active, hormone-containing pills everyday, and it may eventually lessen or stop monthly bleeding completely. If you’re on an extended-use regimen with the pill or switch to an extended-use regimen, your period may become irregular or stop over time.

If you missed your period when you expected it on the pill, and you haven’t recently changed your birth control routine, you could be pregnant. If it’s been a week since your expected period, consider taking a pregnancy test for peace of mind.

Missing your period with an IUD

Every woman's body reacts differently to an Intrauterine Device (IUD). The insertion of an IUD will most likely impact your period, especially during the first three months.

Hormonal IUD

If you’re using a hormonal IUD, your period may become lighter or even stop completely. If you miss your period while using this form of contraception, the hormones from the IUD may have caused your period to stop or become lighter or irregular, rather than pregnancy.

However, if you had unprotected sex during the first seven days after implantation, you may have conceived. Take a pregnancy test or schedule an appointment with your OBGYN.

Copper (non-hormonal) IUD

If you are using ParaGard, studies have shown that some women experience heavier menstrual flow, and their periods don’t usually stop after insertion, especially since the copper IUD does not contain hormones.

If you have not had a regular period while using a copper IUD, call your doctor to discuss the issue and investigate a possible pregnancy.

Missing your period on the contraceptive implant

If you’re using a hormonal contraceptive implant, the most common side effect is irregular bleeding. One contraceptive’s website even says, “...one out of ten women stopped using the implant because of an unfavorable change in their bleeding pattern.” This is probably a symptom of the progestin it releases into the body, which can have unpredictable effects on your hormones.

If you miss your period, talk to your doctor to ensure it’s a side effect of your birth control rather than pregnancy.

Other forms of hormonal birth control

If you’re on another form of hormonal birth control, like the shot, patch, or vaginal ring, this article covers their possible effects on bleeding. It will also provide more information on the birth control methods already covered.

Missing your period after starting new birth control

If you’ve recently begun taking hormonal birth control or changed birth control methods, your body needs time to adjust to the introduction of hormones from your contraceptive. Your cycle could be disrupted by this sudden hormonal shift, including irregular bleeding.

If you’re on the pill, it can take up to seven days before it’s effective. If you had unprotected sex during the first week of starting a new form of birth control like the pill, you may become pregnant.

Lifestyle-related causes of a missed period

Chronic stress

Stress does weird, often unpleasant things to your body. It can cause ulcers, make your weight fluctuate, and even cause you to miss your period. If you are under extreme or chronic stress such as the death of a loved one, a move, or a job change, a hormonal imbalance from being in constant “fight or flight” mode can occur. And this can delay your period, or cause you to miss it completely.

It will probably help alleviate your anxiety to take a pregnancy test. It may also be beneficial to find ways to reduce anxiety in your life.

Weight gain or loss

A sudden significant weight gain or loss can disrupt your normal hormonal cycle, leading to a late or missing period. If you recently started a new diet or rigorous exercise routine, and your body weight dramatically dropped, you may miss your period. This usually indicates malnutrition, and a lack of sufficient (calorific) energy. The opposite is also true: if you are struggling with obesity, you may also have irregular periods.

Excessive Exercise

Like we covered before, a combination of too much exercise, low caloric intake (including eating disorders such as anorexia), and low bone mineral density can lead to irregular periods or a condition called amenorrhea. This means you miss at least three periods in a row.

“In women who participate in sports that emphasize aesthetics or leanness, such as ballet or running, the prevalence of secondary amenorrhea can be as high as 69%, compared with 2% to 5% in the general population.” (Source)

If you engage in any rigorous sport or high intensity activity, and have started to notice irregular periods, or your period stops completely, visit a women’s health professional to determine a healthier exercise routine or sufficient diet.

Causes of spotting

Maybe you missed your period, and now you’re experiencing light bleeding or spotting. What could be the cause? And how do you tell the difference between spotting and a period?

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Spotting vs. Period

Most women get their period about every 28 days, and it lasts an average of 3-7 days. Period blood will typically range from a bright red in color to a darker red or brown, and the flow is heavier and more consistent, even if it gradually gets lighter. Light bleeding at the beginning or end of your period is still considered menstrual bleeding, not spotting. And if your typical PMS symptoms are still present, you can probably consider your bleeding a period.

Spotting is generally considered to be any non-menstrual bleeding during your cycle. It may only last one or a couple days, and is much lighter than menstrual bleeding. Spotting may look like a couple drops of blood in your underwear or on toilet paper after wiping. It’s also probably lighter in color, from pink to light brown..

If you are bleeding lighter than normal, but not quite spotting, during the time you expect your period, it’s probably not a cause for concern. If you’re experiencing something other than your normal period, like spotting, consider investigating what’s causing a change in your cycle.

Non-pregnancy related spotting

There are many reasons you may be spotting before or after a missed period that do not involve pregnancy. Chronic stress, sudden weight gain, significant weight loss, excessive exercise, or starting a new birth control method can all contribute to spotting. If any of these lifestyle changes cause a hormonal imbalance, it can also affect your menstrual cycle, including a missed period or spotting.

In some cases, spotting could also be a sign of an underlying health issue. These are a few reasons you may want to seek medical advice and talk to your doctor:

Polycystic Ovary Syndrome

Polycystic ovary syndrome (pcos) is caused by an overproduction of androgens by your ovaries. This often causes a hormonal imbalance that can inhibit ovulation (when your ovaries release an egg). Messing with the hormonal process that governs ovulation can lead to missed periods or spotting instead of your period.

If you suspect you may have PCOS, look out for these other common symptoms:

• Weight gain
• Balding
• Excess body hair or acne
• Multiple cysts on your ovaries

Sexually Transmitted Infections

If you have had unprotected sex, even with a long-time partner, you can still contract a sexually transmitted infection (STI). Spotting at any point of your cycle can be a symptom of STIs like chlamydia or gonorrhea.

Additional symptoms could include:

• Pain when urinating,
• Anal itching
• Lower abdominal pain

If you’re experiencing any of these symptoms, schedule an appointment with your doctor. Untreated STIs can progress to more serious medical conditions, like pelvic inflammatory disease.

Thyroid Issues

Producing too much thyroid hormone (hyperthyroidism/overactive thyroid) and producing too little thyroid hormone (hypothyroidism/underactive thyroid) from your thyroid gland can both cause bleeding changes in your menstrual cycle.

Hyperthyroidism especially can cause irregular or lighter periods. Other symptoms include:

• Weight loss
• Hyperactivity
• Anxiety
• Trouble sleeping

Your doctor can administer a blood test to check your hormone levels if you think you may have thyroid issues.

Pregnancy-related spotting

Spotting can also be a sign of pregnancy. Sanford Health found that “Approximately 25 to 40 percent of women will experience bleeding at some point from the time of conception until delivery.”

If you are experiencing spotting and have missed your period, you could be pregnant. Your bleeding could be implantation bleeding or even the sign of an early miscarriage.

Take a pregnancy test to confirm the pregnancy. If it comes back positive, it’s time to make an appointment with your OBGYN. Or, if it’s negative, you can discuss other reasons for your spotting.

Implantation Bleeding

Around 6-12 days after fertilization, the fertilized egg will implant in the wall of your uterus (and mature into an embryo). Around the time this happens, some light implantation bleeding may occur.

Implantation bleeding can be confusing because it normally occurs around your expected period. Menstrual bleeding varies from woman to woman, but is generally bright or dark red. Implantation bleeding will probably be lighter in color or brown, and it will look more like spotting than a heavier menstrual flow.

You can’t tell if you are pregnant by possible implantation bleeding alone. But if you’re experiencing other pregnancy symptoms as well, consider taking a pregnancy test.

Ectopic Pregnancy

An ectopic pregnancy occurs when the embryo attaches somewhere besides the uterine wall, most often in the fallopian tubes (known as a tubal pregnancy). An ectopic pregnancy can cause prolonged brown spotting. Other main indicators are sharp abdominal pain, sometimes on one side, and a positive pregnancy test.

If you have a positive pregnancy test and prolonged spotting, contact your doctor. Ectopic pregnancies will develop into a medical emergency.

Chemical pregnancy

A chemical pregnancy is a very early miscarriage, usually resulting from problems with a fertilized embryo. Many women never know that they’ve had a chemical pregnancy, because the loss happens around 5 weeks or earlier. After that, the miscarriage shows up as an “early period.”

If you had a positive pregnancy test and then period-like bleeding, you may have had a chemical pregnancy. But bleeding after a pregnancy test does not always indicate a chemical pregnancy.

Missing a period and pregnancy

Of course, when you miss your period it can also be a sign of pregnancy. Getting pregnant on birth control always makes me think of Ross and Rachel from Friends. When Ross is told that Rachel is pregnant, and that condoms don’t always prevent pregnancy, he freaks out,

“But hey, in my defense I just found out condoms are like only 97% effective.”

Early pregnancy symptoms vs. PMS symptoms

The key difference between early pregnancy symptoms and premenstrual syndrome (PMS) symptoms is whether or not you end up having a period.

Mom of four and She Might author, Charity, explains how to know the difference between pregnancy and PMS.

Most common symptoms of PMS:

• Cramping
• Breast tenderness
• Mood changes
• Heightened Appetite
• Bloating

Most common symptoms of early pregnancy:

• Nausea
• Fatigue
• Light spotting before your expected period
• Food cravings or aversions

Key differences between PMS and pregnancy

Many of the symptoms between PMS and pregnancy are the same. Headaches, bloating, moodiness, and breast tenderness can happen before you start your regular period or after you have conceived. But there are several symptoms that can be key indicators of pregnancy.

Spotting

If you are spotting around your expected period but never actually start your period, you could be pregnant. Spotting is not a PMS symptom, although you can experience light bleeding at the beginning or end of your period. You may experience PMS and then a light period, but that bleeding will likely require protection of your undergarments, and last 3-7 days. Spotting a few days before your regularly scheduled period may be a sign of implantation bleeding.

Nausea & Vomiting

Nausea could be caused by an increase in hormone levels, which is why it is a symptom of both pregnancy and PMS. However, nausea and vomiting is more closely associated with pregnancy, and most women do not experience nausea as a PMS symptom. If you are experiencing nausea, vomiting, and dizziness, these are more likely signs of pregnancy.

Fatigue

Increases in progesterone can lead to increased tiredness. Many women feel exhausted while PMSing but then regain energy when their period starts—unless you have incredibly heavy bleeding and become tired from a lack of iron or anemia. Either way, your period has started, and you know you aren’t pregnant. If you missed your period and feel exhausted all the time, a common first trimester symptom, you may be pregnant.

After I found out I was pregnant, my fatigue made sense. I had been falling asleep in the student lounge at school, or in my car as soon as I parked at home. I don’t normally fall asleep in random places, but my pregnancy explained this new, strange behavior.

If you are displaying early signs of pregnancy, consider taking a pregnancy test.

When to take a pregnancy test

If you’re anything like me, you don’t like to wait—much less waiting for life-changing information like whether or not you’re pregnant. We were at the store 30 minutes after my boyfriend mentioned that I could be pregnant, and I took the pregnancy test in the Walmart bathroom (Don’t do that! Go home first, so you can digest the test result with privacy).

I had no idea how the test worked, I just wanted to see if the test in my hand looked like what the instructions described as a “positive result.”

To avoid wasting money on tests and fretting about the accuracy of them, take a test at the best time to get accurate results.

How long should I wait?

A pregnancy test is designed to detect a certain level of hCG, a hormone created by the placenta, in your urine. To ensure you have detectable levels of hCG, you should wait about a week after your missed period before testing.

What time of day should I take it?

For the most accurate results, take the pregnancy test in the morning. It’s even better if you use your first urine of the day. After sleeping all night, your body has had time to build up hCG in your urine, so pregnancy is more likely to be detected. If you happen to take a test later in the day 5-10 days after your expected period, don’t stress, your results are probably accurate.

What type of test should I take?

I suggest doing some research about which pregnancy test you want to take. They can cost anywhere from $7 to $20 (which warranted their own line in my budget in college), and there are so many options. You may want to evaluate information from sources that have done research on the test’s accuracy, not simply based on how pretty the box looks.

Here are a few pro-tips on selecting pregnancy tests:

Price varies: You don’t have to spend too much. The dollar store or Walmart have the same quality of pregnancy test as your local grocery store or Target, but they are a few dollars cheaper.

Note that dollar store pregnancy tests aren’t as sensitive as their more expensive counterparts that promise early results. So if you choose a dollar store test, wait until a week after your missed period to ensure an accurate result.

Location of tests: Pregnancy tests are normally found near the family planning and female toiletries section of the store, by the pads and tampons in a line of pink and blue boxes. I was in hysterics the first time I shopped for a pregnancy test, and I couldn’t find them. Some stores lock up items like pregnancy tests, so you may have to ask a store attendant to access it for you.

Digital vs. non-digital tests: I prefer the tests with pink lines to the blue ink or digital tests, but there are pros and cons to digital and non-digital pregnancy tests. Our article on when to take a pregnancy test for accurate results explains some of those differences.

Once you’ve found the right test for you, find a safe, quiet place where you can be comfortable taking the test.

The test was negative, but I still don’t have my period

When your pregnancy test comes back negative, but you still don’t have your period, you may feel relief, a tinge of regret, or an extra dose of confusion. If you find yourself in this situation, use these questions to help determine a next step:

1. How long have you been missing your period?

If it’s been a few days or even weeks since your missed period, try retaking another pregnancy test 2 or 3 days later, and see if you get a different result. If you’ve been missing your period for several months, talk to your women’s health provider about possible causes.

2. Have you experienced any major life changes?

If you’ve changed birth control methods or experienced a major life event that caused stress or anxiety, you could be missing your period due to a contraceptive or stress-induced hormonal imbalance. If you aren’t displaying pregnancy symptoms, you can wait another month to see if your period returns. But if you are feeling “off”, experiencing unusual symptoms like spotting, or think you still may be pregnant, schedule an appointment with your provider.

3. Could there be an underlying health issue?

Missing a period could be a symptom of an underlying health issue such as amenorrhea, contraceptives stopping your period, or other medical issues.

For a more in depth explanation of why you may be missing your period but still testing negative, check out our article for non-pregnancy related reasons for a missed period.

False Negatives

If you’re wondering whether your negative pregnancy test may be a “false negative,” and you actually are pregnant, we’ve compiled the most common causes of false negative results.

The test is positive, now what?

I remember the day I saw two faint lines on a pregnancy test. Afterwards, my boyfriend and I sat in my car crying. We had no idea what to do next.

1. Recognize your emotions

There’s no “wrong” way to feel about pregnancy, especially when it comes as a surprise. It can take time to fully come to terms, emotionally and mentally, with being pregnant. This is true if you’re single, married, a first time mom, a mom with other kids, someone who wanted kids, or someone who didn’t.

Even if your emotions after a positive pregnancy test are overwhelming or negative, choose to face them, and be honest with yourself about how you feel. They lose the power to control you and your choices when you acknowledge them.

2. Talk to someone

Process this unexpected change with someone. It could be your partner, a trusted friend, or your OBGYN. Having one person to hug you in a hard moment or talk out your next steps is incredibly comforting.

We’ve even created a guide for how to break the news of an unexpected pregnancy.

If finding out you’re pregnant leads to feelings of depression, tell someone. Prenatal depression is common, but you have to let someone in to help. If you have suicidal thoughts please reach out to a 24/7 suicide hotline, a lifeline chat or another trusted person in your life.

3. Make an appointment

Have your pregnancy confirmed by your medical provider. They may have you take another pregnancy test at the clinic and perform an ultrasound to make sure the pregnancy is progressing and healthy.

It’s important to find a practitioner who you feel comfortable with seeing. You may want to look into midwife practices and doula assistance.

Conclusion

A missed period does not automatically mean you’re pregnant. It could be connected to your birth control method or lifestyle change like chronic stress.

If you’re spotting instead of experiencing your period, investigate a possible cause. It could be pregnancy-related, like implantation bleeding, or non-pregnancy related, like a hormonal imbalance caused by PCOS or another underlying health condition.

You should also evaluate what symptoms you’re experiencing. Are they PMS or pregnancy related? Because many of these symptoms overlap, it’s important to be attentive to what your body is telling you.

And if you do suspect pregnancy, take a pregnancy test. Make sure you take it after your missed period and in the morning for the most accurate results.

It can be difficult to choose what type of test you prefer, especially if you’ve never taken one before. But a little online research before heading to the store will give you the information you need. If the test is negative and you’re still missing your period, make an appointment with your OBGYN to determine what could be going on.

If you are pregnant, I understand the whirlwind you may be experiencing. But if you take it step-by-step, day-by-day, and with someone you trust, you’ll navigate the decisions that are coming next. Here at She Might, we want to navigate those next steps with you.

If you took a pregnancy test and it was positive, take the 10 minute Pregnancy Clarity Quiz to gain self-awareness, confidence, and clarity about the future of your pregnancy.

Your journey might be unexpected, but your future is bright!