What is the situation if your period hasn't arrived?

Patient's question:

I came last time on 9/18, and it's still not here as of today, 11/24. My menstrual cycle is 40 days, and I've been tested and confirmed not pregnant. What could be the reason? Could it still be possible to be pregnant? I've been taking folic acid, does it have any effect?
First follow-up question: I've never experienced this long of a delay before. Can pregnancy not be detected after this long? If I do an ultrasound, can it determine if I'm pregnant? Thank you!

Doctor's answer:

Hello, generally speaking, if menstruation is delayed by one week or less, it is considered a normal phenomenon and usually does not require deliberate treatment. If menstruation is delayed by more than one week and pregnancy has been ruled out, it is classified as menstrual irregularity. To treat delayed menstruation, it is recommended to start by regulating qi and blood. You can take the Chinese herbal medicine Qixue He Capsule, which has a good effect on delayed menstruation. Of course, other issues involving organic lesions of the uterus and ovaries can lead to infertility, and specific treatment should be administered based on the symptoms.

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