A woman’s menstrual cycle is how her body prepares for possible pregnancy after ovulation, which is the monthly release of a mature egg. The average menstrual cycle lasts 28 days, beginning with menses that is signaled by cramping, change in mood, bloating, fatigue, and breast tenderness. During the cycle, hormonal changes regulate the release of the egg from the ovary and prepare the uterine lining for receiving a possible fertilized egg (embryo) for a pregnancy.
The hormones at play in menstruation and the preparation for pregnancy act in concert, beginning with the secretion of estradiol when the egg is mature. An increase in estrogen production results in a surge of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). An uptick in LH usually indicates that ovulation is about to occur, typically around day 14 of the cycle.
Women experience periods differently, and one woman can have different experiences with her own periods. Fluctuation of menstrual cycles is common. But when a woman has symptoms during her period such as no bleeding, heavy bleeding, or others listed below that are abnormal for her menstrual cycle, she should consider seeing a doctor to determine whether these are indications of a menstrual disorder that requires treatment.
Menstrual disorders are not always the cause of these types of symptoms. A doctor can help determine the root of the irregularity and whether further examination is needed to determine if a menstrual disorder exists. The following can cause symptoms that might appear to be due to a menstrual disorder.
Menstrual irregularities often cause pain and inconvenience, making them a cause for concern for many women. These disorders may or may not indicate an underlying condition related to infertility or difficulty getting pregnant. A fertility doctor can be helpful in determining this.
Abnormal ovulation is often the underlying cause of irregular periods. Hormones regulate the menstrual cycle and ovulation. While menstrual disorders can be caused by alterations in hormone levels, these disorders can also sometimes disrupt the hormonal balance, further affecting the menstrual cycle.
Amenorrhea is the absence of a menstrual period. This can be a temporary or permanent lack of menstruation. Missing one period is generally not cause for concern, and missing a period can also be an indication of pregnancy. But missing more than one period in the absence of pregnancy may be a sign of an underlying disorder that can cause infertility.
Amenorrhea caused by a structural, genetic, or hormonal condition that prevents menstruation from beginning in puberty is called primary amenorrhea. Conditions that can result in primary amenorrhea include gonadal dysgenesis, Turner syndrome, PCOS, androgen insensitivity, and congenital adrenal hyperplasia.
Amenorrhea occurring after a woman starts having periods is called secondary amenorrhea. It is most often caused by conditions that affect the uterus or the organs involved in hormone production including the ovaries, hypothalamus, and pituitary gland. Causes of secondary amenorrhea include:
Oligomenorrhea is the medical term for when a woman has infrequent periods and regularly goes more than 35 days without menstruating. This menstrual disorder is most often due to a side effect of hormonal birth control. It can also be caused by thyroid problems, diabetes, eating disorders, high levels of physical activity in younger women, and increased prolactin in blood that can be caused by medications.
But oligomenorrhea can sometimes indicate the presence of PCOS, which can cause infertility. Oligomenorrhea that is untreated can increase a woman’s risk for endometrial cancer and endometrial hyperplasia. For these reasons, it is best for a woman who regularly goes more than 35 days without a period to seek medical evaluation.
Menorrhagia is the medical term for heavy and/or prolonged bleeding during periods. It is often marked by the loss of so much blood and cramping that the woman cannot go about her normal activities.
Women should seek medical care if their bleeding soaks one or more tampons per hour over more than two hours. Other symptoms that may indicate that treatment is needed include needing to change sanitary protection during the night, bleeding for more than a week, presence of large blood clots, and signs of anemia such as fatigue and shortness of breath.
There are several possible underlying causes of menorrhagia, some of which can impair a woman’s fertility. Causes include:
Menorrhagia can be treated, and the type of treatment will depend on the physician’s findings during exams and testing. Treatments can be medications or surgical procedures, such as removal of uterine fibroids, and, in extreme cases, endometrial ablation or hysterectomy.
Metrorrhagia is regular bleeding between periods, which occurs in addition to normal bleeding during menstruation. The causes can be very similar to those for menorrhagia listed above. Treatments depend on the diagnosed underlying cause and are also similar to those for menorrhagia.
Premenstrual dysphoric disorder is a systemic problem in which a woman experiences tension, irritability, and strong symptoms of depression prior to menstruation. Hormonal changes are thought to be involved but the exact cause isn’t known. Symptoms are similar to but more debilitating than those of premenstrual syndrome (PMS), which is considered a mild menstrual disorder.
Women who suspect they have premenstrual dysphoric disorder should seek medical attention to take steps to reduce its effect on their lives. Causes are most often unknown but can relate to alcohol abuse, depression, being overweight, and lack of exercise, things that can be detrimental to a woman’s overall health and her fertility.