Irregular Periods and How They Can Cause Infertility

Irregular periods key concepts

• An irregular period is a menstrual cycle that is different from the normal range for women or different from an individual’s normal cycle.
• Irregular periods can cause infertility by disrupting ovulation.
• The primary types of irregular periods are having no period (amenorrhea), infrequent periods (oligomenorrhea), heavy bleeding during periods (menorrhagia), and painful periods (dysmenorrhea).
• Amenorrhea and oligomenorrhea can directly cause infertility, while menorrhagia and dysmenorrhea can contribute to infertility and are frequently indications of other conditions that can cause infertility.
• Treatment includes medications to correct hormonal imbalances causing the irregularity and to address symptoms of underlying conditions; surgery is sometimes needed.

What is an irregular period (abnormal period)?

Irregular periods, also called abnormal periods and irregular menstruation, are those that vary from the normal menstrual cycle for women, which ranges from 21 to 35 days with 28 days being the average gap between periods. An irregular period can also be one that is different from an individual’s normal pattern of menstruation.

Abnormal periods are fairly common, affecting up to 25% of women, according to the National Institutes of Health. Intermittent irregularity is usually not cause to seek medical care. But women should speak to their primary care physician, gynecologist or fertility specialist if the irregularity continues.

Periods are usually irregular when a young woman first starts having periods or when she is older nearing menopause.

Tracking your period with a period tracking app

Women should track their periods to determine if theirs is abnormal. They can use a diary to do so or a period tracking app. These are very popular, easy to use and some are free.

The first day of a woman’s period is Day 1 of her menstrual cycle. The day before her next period is the last day of her cycle.

Types of irregular periods

Four primary kinds of abnormal periods are related to infertility or subfertility (abnormal difficulty conceiving). Amenorrhea and oligomenorrhea can directly cause infertility. Menorrhagia and dysmenorrhea can contribute to infertility and are often related to underlying conditions that can cause infertility.

An overriding issue with these conditions is that they can make it difficult to detect when the woman is ovulating. This can make trying to conceive more difficult, as these issues can mask when the window of fertility occurs (the five days leading up to ovulation and the day of it).

Abnormal vaginal bleeding is sometimes confused with irregular periods. But it is actually an umbrella term that includes irregular periods and other conditions such as spotting between periods and bleeding after intercourse.

Amenorrhea (no period)

This is the absence of a period, either permanently or temporarily. Amenorrhea makes fertility impossible, as there is no egg to be fertilized. The American College of Obstetricians and Gynecologists says the 1 in 25 women who are not breastfeeding, pregnant or going through menopause will experience amenorrhea.

Primary amenorrhea is the absence of a period by age 15. Secondary amenorrhea is absence of a period for three cycles or six months in women who previously menstruated.

Oligomenorrhea (infrequent periods)

Oligomenorrhea is when periods are infrequent and the woman doesn’t menstruate for more than 35 days. Infrequent periods like this often indicate PCOS (polycystic ovary syndrome) is present. Going off birth control pills can cause oligomenorrhea.

Menorrhagia (heavy periods)

Menorrhagia involves blood loss of about 80 milliliters, whereas typical menstruation bleeding is 30 to 40 ml. It’s not easy to measure the volume of bleeding. These markers indicate menorrhagia.

• Soaking through one or more tampons or pads every hour for several consecutive hours.
• Bleeding for more than 7 days.
• Presence of large clots.
• Needing to double up on protection, such as using a pad and tampon together.

Dysmenorrhea (painful periods)

This is unusual pain with a period. Primary dysmenorrhea is a painful period due to relatively normal cramps caused by overproduction of prostaglandins, chemicals that cause uterine contractions.

Secondary dysmenorrhea is when menstrual pain is caused by a structural abnormality or an underlying disorder such as endometriosis, uterine fibroids, pelvic inflammatory disease and adenomyosis (when the uterine wall grows into the muscle). If over-the-counter medications do not relieve a woman’s pain, she should seek medical care.

Causes of irregular periods

A variety of issues can cause irregular menstruation. A primary cause is hormonal imbalance related to ovulation.

Hormonal imbalance disrupts ovulation, resulting in abnormal periods

The connection between irregular periods and infertility often relates to issues with reproductive hormones. The gonadotropin hormones FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are produced by the pituitary gland, which receives signals from the hypothalamus.

When these signals are faulty, the pituitary gland doesn’t release the levels of FSH and LH needed to mature and release an egg. This disruption in ovulation results in irregular periods. These ovulation issues can result in infertility or subfertility.

Conditions, diseases and medications that can trigger abnormal periods

In addition to hormonal issues, various other conditions, diseases, medications and situations can trigger period dysfunction. These include the following.

• Losing or gaining a considerable amount of weight.
• Anxiety and stress.
• Excessive exercise.
• Hormonal contraceptives.
• Blood thinners, antidepressants, chemotherapy, steroids and other medications.
• PCOS.
• Underactive thyroid gland.
• Gynecologic cancers.
• Diabetes.
• Eating disorders.
• Pregnancy.
• Puberty, when periods start.
• Beginning of menopause.

Other things can cause dysmenorrhea (painful periods) and menorrhagia (heavy periods). These include uterine fibroids, endometriosis, bleeding disorders and pelvic scarring.

Irregular menstruation treatments

Treatments depend on the type and cause of irregular menstruation.

Diagnosing irregular menstruation

The first step is diagnosing the issue. The patient’s doctor will discuss her symptoms and medical history. After a pelvic exam, the doctor may conduct tests. These can be hysteroscopy, endometrial biopsy and ultrasound.

Medications to treat irregular menstruation

The type of treatment will be determined by the diagnosis and can involve addressing underlying conditions such as PCOS. The first line of treatment for abnormal periods is medication.

• Hormonal birth control can help when underlying conditions such as endometriosis, uterine fibroids and others are causing the issue. For women trying to conceive, this treatment should be completed before attempting pregnancy.
• Clomiphene (Clomid) can be used to address irregular ovulation and to induce ovulation. The drug letrozole may also be used.
• Medications called gonadotropin-releasing hormone agonists can control heavy bleeding and reduce the size of uterine fibroids.
• Tranexamic acid can promote more efficient blood clotting in the uterine lining to reduce blood flow.

Surgical treatments for irregular menstruation

Depending on the condition and the patient’s age, surgery may be needed to correct underlying issues causing irregularity.

• Myomectomy removes uterine fibroids.
• Uterine artery embolization can cut off the blood supply to the uterus to get rid of fibroids.
• Endometrial ablation is a means of destroying tissue in the uterine lining to reduce bleeding during a period.
• A hysterectomy is a last resort treatment if the uterus is heavily damaged.

Prevention of abnormal periods

Some steps of self-care and prevention relate to managing underlying conditions. In general, women with irregular menstruation should maintain a healthy lifestyle, including getting adequate rest and maintaining a healthy weight.

• Take over-the-counter pain relievers.
• Try stress reduction and relaxation techniques.
• Use contraceptives as directed.
• Change tampons and pads every 4 to 6 hours to help avoid infections.

In conclusion on abnormal periods

This is a condition that can be difficult for women to deal with as well as affecting fertility. One thing that I often see is that in many cases, women do not seek medical advice for irregular menstruation soon enough. The key is to track your periods, make note of problems and see a doctor sooner rather than later.

The providers at Conceive NJ are experts in this area and can provide the proper care based on the reason for this problem.