Irregular Periods & Fertility
Irregular periods and fertility at a glance
- Irregular periods are caused by ovulation problems that can result in infertility.
- The primary ways a woman’s periods can be irregular are having no period (amenorrhea) and having them infrequently (oligomenorrhea).
- Some variations in menstrual cycles are normal, but it’s important that women with irregular periods see a doctor to determine the underlying cause, particularly if they are having difficulty conceiving.
- Medications are the primary form of treatment, as they can help correct the hormonal imbalances affecting normal ovulation and normal periods.
What is an irregular period and how does it relate to fertility?
When ovulation is abnormal, it is most often due to abnormal or underactive signals from the master gland at the back of the brain, the pituitary. The hormones produced by the pituitary gland, follicle stimulating hormone (FSH) and luteinizing hormone (LH), are termed gonadotropins. These irregularities in ovulation can result in having no period or infrequent periods.
Regular menstrual cycle periods
A menstrual cycle is the process by which a woman’s body goes through a preparation to become pregnant. This monthly series of changes results in one of the ovaries releasing an egg, which is called ovulation.
Most cycles last 28-35 days, and ovulation usually occurs 14 days before the next period. According to the National Institutes of Health, 14%-25% of women have cycles that are irregular.
During the cycle, the female body grows a new uterine lining (endometrium) to prepare the uterus to nourish a pregnancy. To initiate the release of the egg, the body experiences hormonal changes starting with the menses phase. The hormone FSH spurs growth of the follicle that contains the egg. The follicle wall cells secrete estrogen.
An LH hormone surge triggers a follicle to release an egg. If an egg is not fertilized, then the uterine lining will shed resulting in a menstrual period. Every woman’s cycle is different, and there are variations of the time frame for cycles and of the severity of symptoms, such as painful periods.
Types of irregular periods: amenorrhea, oligomenorrhea, menorrhagia & others
Abnormal menstruation can often be a source of concern for many women due to its discomfort and hindrance of her lifestyle. It can also be a cause of infertility, as well as indicating an underlying condition like polycystic ovary syndrome (PCOS) that has caused difficulty conceiving.
A fertility doctor is essential in determining the cause of the irregular period. The major types of irregular periods follow.
Amenorrhea (when periods stop)
Amenorrhea is a term used to describe when a woman stops getting her menstrual cycle for three or more months. Missing one period occasionally is not a concern; it can be a somewhat normal occurrence related to stress and other lifestyle factors. But amenorrhea means the woman is not ovulating and has infertility.
Oligomenorrhea (infrequent periods)
When a woman has infrequent periods and goes more than 35 days without menstruating on a regular basis, this is a menstrual disorder called oligomenorrhea. This can often be a side effect of going off birth control pills but can also be caused by thyroid issues, diabetes, eating disorders, and younger women doing high amounts of physical activity.
Oligomenorrhea most commonly suggests PCOS, which can cause infertility. It’s best for a woman who experiences more than 35 days without a period to seek a medical evaluation.
Treatments depend on the underlying cause. Birth control or hormone therapy may be effective, as can lifestyle changes when appropriate. Other treatments may need to address underlying conditions such as thyroid issues or diabetes.
Menorrhagia (heavy or prolonged menstrual bleeding)
Menorrhagia can cause infertility. It is caused by hormone problems, problems with the uterus and other health conditions.
Women who have to change their pad or tampon every 1 to 2 hours due to bleeding should seek medical care. Common symptoms include having to change a tampon or pad at night, bleeding that continues for over a week, the passage of blood clots larger than an inch, and signs of anemia such as fatigue and shortness of breath.
Possible causes of menorrhagia include:
- Hormonal imbalance.
- Uterine fibroids.
- Cervical or uterine cancer.
- Pregnancy complications.
- Side effect from a nonhormonal IUD (intrauterine device).
- Medications.
- Ovarian dysfunction (not releasing an egg).
- Polyps in the uterine lining.
- Adenomyosis (a problem with the uterine wall).
Treatment for menorrhagia will depend on the physician’s exams and testing. Specific treatments available are medications and surgical procedures.
Metrorrhagia (irregular vaginal bleeding)
Metrorrhagia is vaginal bleeding that occurs at irregular times not associated with the menstrual cycle. It’s similar to a regular menstruation cycle but does not represent a normal period. The many potential causes for metrorrhagia match those of menorrhagia.
There are several treatment options specific to the cause and needs of the patient. These include hormonal therapy, lifestyle changes and dilation and curettage if bleeding is causing other problems.