Why was my period late?

Since the day I started getting my period, it has been regular until this month when it was five days late. I also suffered from painful abdominal cramps, which has not been the case. What could have caused the delay? Sumaya

Dear Sumaya,
Having a regular period means the period comes every month (every 21-35 days). So, a delay of less than 14 days could happen. Also, now that you are older, you are more likely to have developed conditions such as fibroids that may lead to obstruction of the womb’s opening, hence delaying the period and bleeding with clots. 

However, like in your case, a delayed period, and then getting a period with clots can also happen if a woman was pregnant and loses the pregnancy unknowingly.

Even without a miscarriage, this can happen if an adult woman (before menopause) has irregular ovulation say related to severe weight gain or loss, severe stress, hormonal issues (thyroid (hypothyroidism), ovary (polycystic ovarian syndrome), pituitary (prolactin), and being young (after period starts) or when one has developed swellings in the womb called fibroids, which usually happens as a woman grows older without getting pregnant in some cases. Womb infection can also lead to irregular and heavy periods with clots.

A pregnancy test, an ultrasound check, a hormonal check or a body mass index (BMI) check may be necessary before starting any treatment.

Usually, the uterine period contents are made liquid by enzymes in the womb called plasmin. The blood is made up of the inside membrane (endometrium) of the womb, blood and liquids from the cervix and womb among others, which when the period delays or is missed and it appears may come out as blood clots. 

This happens because, if one misses a period, the tissues in the womb builds up hence becoming too much for the limited plasmin to make them liquid, leading to clots.