Could I be pregnant even though my test was negative

Patient

Q: I usually have a 46 day long cycle for my period but I am a week late and the last few days I have been having a bit of old dark bloody discharge not much it's just noticeable when I wipe. I took a pregnancy test when I was 2 days late but it was negative. The only other symptom I have is I have been a bit tired lately. Could I be pregnant?and could the bleeding be implantation bleeding? My last period started on January 29 and I had intercourse around the feb 23.

Symptoms:  Dark old bloody discharge for the last 2 days but has stopped today. Tired the last few weeks
Doctor

A:   Hello,
Thanks for the query,

If your LMP was Jan 29th then your menses should have been due on 16th march considering a 46-day cycle in your case. And if still after a week your pregnancy test is negative then you are not pregnant at all. The bleeding in the form of dark brown discharge is likely to be breakthrough bleeding due to progesterone imbalance during the cycle. As you are already delayed, it is suggested that you get a hormonal profile done including thyroid profile along with an ultrasound pelvis to check for endometrial thickness which if found to be more than 10mm, and no pregnancy again, then you may opt for a withdrawal bleed with progestins to resume your menses.
A second possibility may be PCOS which can be ruled out after ultrasound pelvis. If detected then you may have a to be placed on low dose OC pills to regularise your cycles and androgen levels. Please visit you physician for a discussion and take an informed decision.

I hope I have answered your query in detail,
Regards

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