Menstrual Symptoms

The menstrual cycle is a cyclical and orderly sequence of events resulting from the interaction of the hormones secreted by the hypothalamus gland, the pituitary gland and the ovaries.

When this process functions normally, follicles develop and ovulate, and the lining of the uterus develops to support the embryo. Any disruption can result in fertility problems.

Anovulation

Anovulation is the absence of ovulation while amenorrhea is the absence of menstruation. Anovulatory women can still have periods, though they are typically infrequent. When a woman is not having her period, it could be because she is not ovulating (releasing mature eggs). If a woman is recording her daily basal body temperature (BBT) and there is no change, it could be because she is not ovulating. Shortened or extended cycles are also indicative of ovulatory problems and should be evaluated as well (usually cycles outside the range of 24–34 days).

It is difficult to accurately determine whether or not a woman is ovulating without using testing kits or seeing a healthcare provider. One of the following infertility diagnoses may be the cause of amenhorrhea:

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Excessive Bleeding

Determining whether a woman’s menstrual flow is excessive is a subjective assessment. A woman knows better than anyone what constitutes a normal period for her. When a woman thinks her period is heavy, it probably is.

Speroff et al., authors of Clinical Gynecologic Endocrinology and Infertility,  say that the normal duration of a period is four to six days (with variance from two to seven days). In that time, the normal volume of menstrual blood shed is 30 milliliters. If a woman bleeds more than 80 milliliters, that is considered high. The problem faced by most women is that measuring their own blood level is next to impossible. A good rule of thumb for most women is that bleeding may be excessive if you have to change your pad or tampon every 1-2 hours. If this is typical for you, you should consider having an evaluation by your healthcare provider.

Excessive bleeding during menstrual periods may suggest one of the following infertility diagnoses:

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Menstrual Cycle Abnormalities

Menstrual cycle abnormalities due to hormonal disruptions may manifest as having no periods, too few periods or too many periods. All of these situations can impact fertility.

Amenorrhea

Absence of menstruation or cessation of menstruation for 3 to 6 months; as a general rule, regarded as anovulation.

Oligomenorrhea

Intervals of > 35 days between consecutive menstruations.

Polymenorrhea

Intervals of < 24 days between consecutive menstruations.

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