• Irregular Periods and Infertility

    Irregular Periods and Infertility

    Irregular Periods and Infertility

    The regular menstrual cycle is supposed to be 28 to 30 days. That is, the woman is supposed to have her period every 28 to 30 days. When the period comes more frequently than this, it is referred to as dysfunctional uterine bleeding and it can be a major cause of infertility. If the woman is bleeding constantly, it can cause infertility simply because the couple will not be able to have sex because of the bleeding. For example, I had a patient whose period lasted for a full 17 days. Even though the period was not heavy it created a problem because it made it impossible for her and her husband to have intercourse. The period would go on for days, clear up for a few days only for the spotting to start again. They were married for 6 years without getting pregnant. About 70 percent of women who have dysfunctional uterine bleeding do not release an egg during the menstrual cycle. Their irregular periods are due to a hormonal imbalance between estrogen and progesterone. This is a very significant cause of infertility making up to 10% of the causes of infertility.

    A woman’s menstrual cycle is controlled by two hormones, estrogen and progesterone. The levels of these two hormaones vary during the month. During the first half of the month, estrogen is high to stimulate the growth of the uterine lining which is called the endometrium to produce the egg. When the egg is mature and ready for fertilization around the 14th day, progesterone raises and causes changes to the endometrial lining to prepare it for pregnancy. If the egg is however not fertilized, the progesterone level falls and the unfertilized egg is shed in the monthly period. If estrogen levels are abnormal, there will be no production of eggs. This will also disturb the production of progesterone and therefore periods will be irregular. In cases of irregular periods even when the couple have intercourse during the times the woman should normally be fertile, there may not be any eggs to be fertilized as she is not producing any eggs. Irregular periods are therefore the first sign that there are problems with a woman’s reproductive systems. Dysfunctional uterine bleeding is also caused by many other factors such as polycystic ovarian syndrome, which are cysts on the ovaries. Women who are on dialysis may also have heavy or prolonged periods. So do some women who have used an intrauterine device (IUD) for birth control.

    Most young girls will have irregular periods when they first start menstruating. But by the time they are 20 years old their periods should have settled down to the normal 28 to 30 day cycle. By the time most women are 45 years old and are nearing menopause they will have irregular periods until their period finally stops by the time they are about 50. Many women nearing menopause may not actually be producing any eggs even when they have their periods because of the irregular rise and fall of the two hormones estrogen and progesterone. For some women this dysfunctional uterine bleeding occurs when they have just gotten married. This of course will be a big problem, as newly married couples will be trying to get pregnant.

    When a patient comes to the clinic complaining of abnormal periods, one must first rule out all causes of abnormal uterine bleeding such as cancer, infection, or pregnancy, before one can make a diagnosis of dysfunctional uterine bleeding. The doctor would do an ultrasound scan of the pelvis and other evaluations to rule out abnormalities of the uterus like fibroid or small polyp growth, which can also cause bleeding. Then perform hormone measurements of the two hormones estrogen and progesterone, which control the menstrual cycle and the production of the egg.

    After ensuring that the dysfunctional uterine bleeding is caused by a hormonal imbalance of estrogen and progesterone the patient can then be placed on a 3 month course of birth control pills. When birth control pills are given to a woman for an abnormal menstrual cycle, they will supply progesterone and estrogen in the right amount at the right time during the month and thus artificially induce normal production of the egg during the month and normal shedding of the endometrial lining leading to regular menstruation at the right time in the month. This treatment will provide for regular periods and the normal production of eggs in the ovaries. A woman undergoing such treatment can expect to get pregnant after being treated with the birth control pills for 3 months.

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