What causes delayed periods after a previous Depo shot?

Question

Hello doctor,

I am normally around 33 days on average in my menstrual cycle, but today is day 35, and my period has not started yet. In the previous two months, my cycle was 33 and 31 days long. What could have caused the delay this month? I took a Depo shot one and a half years ago.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

I am looking at your menstrual cycle history. You had a Depo shot (Depot Medroxyprogesterone Acetate) last year, did not continue after three months, then no periods till 12 months, and since then they restarted, but with irregular menstruation (31 to 33 days mostly). Now you are on day 35, still no bleed.

A bit of variation after stopping Depo is quite common; sometimes the cycle takes time to fully stabilize. A two-to four-day delay here and there is not alarming. The first step is always to rule out pregnancy since you are sexually active; a home test is the easiest. If negative, we just wait a few days.

The probable cause can be post-Depo hormone recovery and natural cycle variation. It could also be pregnancy if unprotected intercourse occurred.

Investigations to be done as follows:

Urine pregnancy test (repeat in two to three days if still no period).
Blood beta-hCG (human chorionic gonadotropin) if doubt persists.
Thyroid profile and Prolactin if irregularity continues beyond two to three cycles.

I suggest you follow the treatment plan below:

If the pregnancy test is negative, just wait up to a week; sometimes periods will come on their own.
If irregularity keeps repeating, we can plan an ultrasound of the pelvis and a hormone profile to see the pattern. For now, no need for medicines unless cycles stay absent for more than 45 days.

I suggest you maintain regular sleep, weight management, a balanced diet, and exercise. Track cycles on an app to see the pattern. Update me with the pregnancy test result and whether the period comes in the next five to seven days. If still absent, I will suggest the next steps and investigations.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.