What It Means if You Get a Negative Pregnancy Test (Plus, Next Steps!)

Trying to conceive can be nerve-wracking as it is. But if you have all the early pregnancy symptoms, and a pregnancy test still comes back negative, you might be extra confused. Here, experts break down why you might get a negative pregnancy test when you think you’re pregnant—and what to do next.

Reasons You May Get a Negative Pregnancy Test

There are a variety of reasons you might get a negative pregnancy test when you think you’re actually pregnant—experts say that testing too early is a common one.

You’re not pregnant

It’s possible to have some subtle symptoms of pregnancy that are actually indicative of another medical condition. If you’ve been actively trying, it’s also plausible that you could be critically scanning and overanalyzing every tiny little bodily function in hopes that it points to pregnancy.

You’re testing too early

Pregnancy tests detect the hormone human chorionic gonadotropin (hCG), which only ramps up when a growing embryo starts to burrow into the uterine lining (roughly two weeks after ovulation and conception, or around the time of a missed period). “If you test too early and baby’s not attached yet, you’re not going to have that positive hCG level,” says Catherine Caponero, DO, an ob-gyn with Cleveland Clinic in Beachwood, Ohio.

Some tests promise to pick up hCG levels up to a week before your missed period, with the caveat that there’s still a decent chance you’ll get a false negative. For example, the First Response Early Result pregnancy test promises to accurately detect pregnancy in 76 percent of pregnant people five days before their period. That rate increases to more than 99 percent in people who test up to three days before their presumed period.

Charlene Emmanuel, MD, an ob-gyn at NewYork-Presbyterian/Columbia University Irving Medical Center in NYC, says that everyone ovulates at a different time in their cycle. If you ovulate on the late side, you may not get a positive pregnancy test until “a couple of days past” a missed period, she notes.

You’re ovulating

Not everyone experiences symptoms when they ovulate. That said, some women are very in tune with their bodies. According to the American Pregnancy Association, common signs of ovulation can be similar to early pregnancy symptoms (think: spotting, cramping, breast soreness, bloating, etc.) So if you’re unsure of your cycle timing, you could mistake one for the other. In this scenario, you’d get a negative test simply because you’re ovulating. In other words, you might not be pregnant—even if you’re feeling all the “telltale” things.

Your period is late

Do you have a negative pregnancy test, but no period? Your period could be late. Premenstrual syndrome (PMS) can also cause some of the same symptoms as early pregnancy, including tender breasts, mood swings and bloating, notes Jordan Schaumberg, MD, an assistant professor of obstetrics and gynecology at Duke University School of Medicine.

Certain infections and some medication changes can cause a single missed period. “Generally, one missed period with otherwise regular cycles and a negative pregnancy test is not cause for alarm,” Schaumberg adds. If your period is consistently unpredictable, there may be an underlying cause, such as polycystic ovary syndrome (PCOS). Adds Caponero: “Along with PCOS, patients who experience elevated stress levels, extremities in weight, thyroid disorders, chronic health conditions such as diabetes, primary ovarian insufficiency, perimenopause or uterine scarring can also have delayed or missed periods. Birth control can also cause irregularities in your cycle.”

You didn’t use your first morning urine to test

When you don’t drink or pee for many hours overnight, your urine becomes concentrated, says Emmanuel, making your hCG levels more detectable right when you wake up. The time you test matters less the further along you think you might be. If at least a week has passed since your expected period, you can most likely test any time of the day and still expect an accurate result, she adds.

You drank a lot of water

Chugging a ton of fluids soon before taking your pregnancy test can dilute your urine, potentially leading to a false negative, says Emmanuel.

You didn’t follow all the testing instructions

You’re human—and user error happens! Be sure to read and follow all boxed instructions before testing, which usually includes waiting two minutes to read your result. And make sure to test “mid-stream” as you’re peeing—otherwise, the test “can be contaminated with bacteria and cause a false negative,” says Emmanuel.

The test is expired

“Home pregnancy tests are just as reliable as the [urine] tests that your doctor’s office is using,” says Caponero. That said, there’s a reason they have expiration dates: They do become less reliable with time. “Always check the expiration date before use,” Emmanuel advises.

You’re unexpectedly expecting twins

Very high levels of hCG in twin pregnancies can potentially cause false negatives in both blood and urine pregnancy tests at around the end of the first trimester, says Emmanuel. Known as the “hook effect,” the ratio of hCG “overwhelms the pregnancy test,” explains Caponero.

You have a (rare) unviable pregnancy

The hook effect—a false negative due to very high hCG levels—can also occur with gestational trophoblastic disease (GTD), says Caponero, a rare group of conditions including molar pregnancy that occur in roughly 1 in 1,000 pregnancies. In GTD, abnormal trophoblasts—the cells that surround a recently fertilized egg and help it implant in the uterine lining—form a tumor. GTD pregnancies aren’t viable. Treatments vary and include surgery, chemotherapy and radiation therapy.

In an ectopic pregnancy, a fertilized egg implants outside of the uterus. Because hCG levels are lower in ectopic pregnancies, you may get a negative test result for the first couple of days after a missed period, explains Emmanuel. Ectopic pregnancy occurs in about 2 percent of all pregnancies. It’s not viable and can cause life-threatening bleeding, so your provider will provide you with medication to stop cell growth.

Keep in mind that both of these conditions are rare and that they’re usually accompanied by symptoms such as pelvic pain and bleeding not related to your period. “There are other reasons to not see a positive pregnancy test right away, so don’t panic if you don’t see a positive pregnancy test immediately with a missed period,” says Schaumberg.

Next Steps If You Get a Negative Pregnancy Test

Wait a few days and test again

If you used an expired pregnancy test or didn’t follow testing instructions, it doesn’t hurt to test again right away. Otherwise, it’s best to wait a week before using a home pregnancy test again. A pregnancy test “may or may not be positive right at the first day of your missed period, even if you’re pregnant,” says Schaumberg.

Reach out to your provider

A one-off missed period is usually nothing to worry about. But if you’re concerned about your symptoms, especially if you have unusual pain or bleeding, Schaumberg suggests reaching out to your healthcare provider. Consistently irregular periods may signal a medical condition like PCOS, says Caponero. And pregnancy-like symptoms, including irregular periods, cramping, back pain, pelvic pain and abdominal bloating, may be due to other health conditions, including uterine fibroids or ovarian cysts, notes Emmanuel.

Remember, it takes time

Caponero reminds patients that it can take up to an entire year to get pregnant, even if you’re healthy and under 35. “Giving your body time to conceive is really important,” she says. If you’re over 35, talk to your doctor if you’ve been trying for at least six months; if you’re over 40, schedule an appointment right away.

Try out an ovulation kit

Still feeling stressed? Schaumberg suggests trying an over-the-counter ovulation predictor kit, which can help you nail down the day you’re ovulating and maximize your odds of conception.

Be kind to yourself

Trying to conceive can feel stressful—and stress doesn’t help with conception. Find ways to bring more joy and self-care to your everyday life: Exercise, eat nutritious foods, make sure to get enough sleep, and spend time with your family and friends. Caponero also recommends meditation (consider trying a meditation app if you’re new to it). “There are some pretty good studies that show that meditation can actually improve fertility rates,” she says.

Talk about it

“For a patient who’s actively trying to conceive, the stress and pressure that come with pregnancy testing can be very intense,” Schaumberg says. Keep the lines of communication open with your partner and healthcare provider. If fertility concerns are impacting your overall well-being, talking with a therapist, especially one who specializes in fertility issues, can help.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

Plus, more from The Bump:

15 Early Signs of Pregnancy

What a Positive Pregnancy Test Really Looks Like

The 8 Best Pregnancy Tests Out There, Tested and Approved