Why isn't my period starting?

Does the removal of an ectopic pregnancy cause missed periods? I have checked for pregnancy multiple times, but it is negative. Norah

Dear Norah, when a pregnancy occurs outside of the normal womb, it is referred to as an ectopic pregnancy. This commonly happens in the fallopian tubes or ovaries. Since the tubes cannot accommodate a growing baby, they are at risk of bursting, which can lead to dangerous internal bleeding.

In Uganda, the most common cause of ectopic pregnancies is sexually transmitted infections (STIs). These infections can narrow the fallopian tubes, allowing smaller sperm to pass through and fertilise larger stranded eggs. As a result, the fertilized egg may grow in the fallopian tubes instead of the uterus. Moreover, infections can damage the cilia (tiny hair-like structures), that help propel the eggs, leaving only the moving sperm to fertilise an egg within the fallopian tubes.

Women who have had one fallopian tube removed can still conceive through the remaining healthy tube. However, there is also a risk of experiencing another ectopic pregnancy, which may lead to missed periods. Some women who have had an ectopic pregnancy may find it harder, or even impossible, to become pregnant again.

Missed periods in women of childbearing age can be caused by various factors including stress (especially related to difficulty in conceiving), significant weight loss or gain, excessive physical exercise, the use of contraceptive pills, thyroid disease, polycystic ovarian syndrome (PCOS), unexpected menopause, or the surgical removal of an ovary after an ectopic pregnancy, which can disrupt the hormonal balance necessary for regular menstrual cycles.

If you are experiencing missed periods or are concerned about your ability to get pregnant, it is essential to consult your doctor. They can provide tests to determine the underlying causes of your symptoms and assess your reproductive health.