Experiencing irregular periods is often disruptive to daily routines; it's not fun to guess when day one will arrive. When trying to conceive, unpredictable cycles create confusion and uncertainty about your fertility. It is helpful, therefore, to understand how menstrual cycles and irregular periods in particular can relate to your reproductive health when trying to conceive.
Irregular Periods When Trying to Get Pregnant
Regular periods are, on average, approximately every 28 days. However, it may range from 21 days to 35 days between cycles. Every month, the body prepares for a possible pregnancy beginning on day one of our menstrual cycle until an event known as ovulation occurs (roughly day 14 with a 28-day cycle). Ovulation is when the ovary releases an egg. If the egg becomes fertilized by sperm the embryo can attach to the uterine wall (known as implantation), and a pregnancy occurs. When no pregnancy occurs, hormone levels drop (estrogen and progesterone), the thick uterine lining of the uterus sheds, causing day one of bleeding, and the cycle begins again. Typically, bleeding occurs for three to seven days.
Irregular periods are when menstrual cycles are inconsistent, meaning they may come early or late, and may be less than 21 days or more than 35 days apart. Other symptoms of irregular periods may include:
- Bleeding or spotting between periods
- Amenorrhea which is the absence of menstruation
- Heavy bleeding during menstruation, known as menorrhagia
- Severe cramping pain, nausea, or vomiting
Common Causes of Irregular Periods
The most common cause of chronic irregular periods happens when ovulation fails to occur. Most commonly this occurs in polycystic ovarian syndrome, referred to as PCOS (Polycystic Ovary Syndrome). In this syndrome androgens are frequently elevated and to the ovaries have many cysts and do not produce an ovulatory follicle, no egg is released and the second half of the cycle does not occur and a predictable period does not ensue. PCOS may run in families, and it is not uncommon for a sister or mother to have a PCOS diagnosis as well. Often, an ultrasound visualizes PCOS by a distinct “string-of-pearls" appearance of small follicles (cysts) in the ovaries.
Other causes of irregular periods include stress or weight changes, thyroid issues, including levels that are too high or too low, hormonal imbalances, or hormone changes such as starting or stopping birth control pills, patches, or other supplements.
While irregular periods will not stop you from getting pregnant, achieving pregnancy is more challenging, depending on the cause. Irregular periods with no pattern lead to uncertainty in determining ovulation which is frustrating, especially when trying to find your fertile window (the peak time to conceive).
Diagnosis and Treatments of Irregular Periods
You know your body best and may want to seek testing to help determine the cause of chronic, irregular periods. In addition to a transvaginal ultrasound, hormone level testing is often used to detect underlying causes.
Period and Ovulation Tracking
The easiest tool to use to monitor ovulation is to mark your calendar on each day one, and record how many days your period lasts.
Tracking ovulation with irregular periods is tricky business. While you may ovulate, it may be highly unpredictable. Medication is one treatment option to reduce uncertainty around ovulation timing and optimize the best chances to try and conceive.
Letrozole (Femara) or clomiphene citrate (Clomid) are oral tablets, often used with injectable fertility medications to help stimulate ovulation. Femara and Clomid stimulate the production of hormones from the pituitary gland to recruit and mature an egg and prepare it for ovulation.
Another commonly used medication is hCG (human chorionic gonadotropin), a trigger injection used to optimize the precise timing of ovulation for timing intercourse or intrauterine insemination (IUI). Various fertility treatments and choices help people conceive every year with assisted reproductive technology (ART). The most known treatment is in vitro fertilization (IVF) which most frequently uses injectable medications to stimulate ovarian follicles.
Not all causes of irregular periods require treatment. Healthier lifestyle choices have many benefits, including lower stress levels which can improve the regularity of menstrual cycles. Looking for ways to make even minor modifications can significantly impact overall health and reproductive wellness and menstrual cycle regularity, such as:
- Increasing (or decreasing) the level of exercise
- Eating a well-balanced diet and making conscious healthier food choices
- Finding supportive family and friends
- Avoiding cigarettes, marijuana, or excessive alcohol intake. A correlation has been documented between cigarette chemicals, diminished ovarian reserve, and pregnancy complications.
- Staying active, such as a daily walk, can be a wonderful way to feel empowered and care for physical, mental, and emotional wellness when trying to conceive.
Ways to Achieve Conception with Irregular Periods
When trying to conceive with irregular periods, tracking your cycles and monitoring ovulation is essential. There are several methods to track ovulation, including basal body temperature tracking, ovulation predictor kits (OPKs), and monitoring cervical mucus.
Basal Body Temperature
Basal body temperature is tracked using a special thermometer to take your temperature every morning before getting out of bed. The temperature increase, primarily from progesterone after ovulation indicates the egg has already been released. It is important to have intercourse just before the temperature increases to be in your fertile window and optimize your chances of conception. Due to the timing sensitivity for sperm to be present before an egg is released, this is not an optimal family planning method, but it remains a useful and inexpensive indicator to confirm ovulation
Ovulation Predictor Kits
Ovulation predictor kits (OPK)are accurate tools to detect a surge in luteinizing hormone (LH), just prior to ovulation, to find the fertile window. Using an OPK (Ovulation Predictor Kits) involves a urine test strip. To identify the LH surge which signals that ovulation will occur soon. There are a variety of ovulation predictor kits advertising over 95% accuracy when properly used. The downside is OPKs can be costly, particularly when used over time, and may be less helpful if periods are irregular and baseline LH levels are already elevated
Monitoring cervical mucus involves observing changes in vaginal discharge throughout the menstrual cycle. The appearance and texture of the mucus will change as ovulation draws closer.
There may be no cervical mucus at the low fertility point of the month. Toward the intermediate fertile time of the month, mucus is observed to be thick, creamy, and may be white, yellowish, and sticky. In the peak fertile window (just before ovulation), cervical mucus becomes more watery, stretchy/elastic, and transparent. The sensation may feel wet, slippery, and smooth.
Although cervical mucus tracking can be an accurate marker to find your fertile window, some find it cumbersome to check cervical mucus and chart their findings. Others may find it confusing or mistake cervical mucus for other vaginal discharge. Uncertainty often remains about the best time to conceive.
Fertility Treatment Options for Irregular Periods
Seeking medical advice and support from a fertility specialist, obstetrician, or gynecologist is recommended if you are under 35 years old and have not conceived after twelve months of unprotected intercourse with a male partner. If over the age of 35, seeking a fertility specialist after six months is advised if conception has not occurred. If periods are irregular for several months, regardless of the desire to conceive, an evaluation is indicated.
A fertility specialist is a physician who practices in a specialty of gynecology and obstetrics known as reproductive endocrinology and infertility (REI). In the light of irregular periods or suspected infertility, a fertility doctor (REI) may evaluate and discuss:
- Hormone testing, often referred to as "Day 3's," obtained by providing a blood sample to evaluate your levels. Day 3 labs may include estrogen, progesterone, LH, FSH, AMH (Anti Müllerian Hormone) and thyroid and prolactin. This is an important part of a comprehensive infertility evaluation.
- Patient history with any pertinent background information that may be helpful, including a family history of infertility.
- Physical examination, which may include a transvaginal ultrasound (TVUS) which helps visualize the ovaries and uterus.
- Sexually transmitted infections (STIs) testing
- Genetic testing
- Hysterosalpingogram (HSG) to visualize the uterus and Fallopian tubes. This is a radiology test typically done menstrual cycle and before ovulation.
- Semen analysis, if appropriate.
In Vitro Fertilization (IVF)
One of the most known fertility treatments is IVF (in vitro fertilization). IVF involves daily injectable medications to stimulate ovarian follicles, retrieving eggs from those follicles once mature, fertilizing eggs with sperm in a lab, and then transferring the resulting embryos into a uterus. Hopefully, implantation occurs, and pregnancy is achieved.
In the U.S., fertility clinics report data to share their success rates (and influential factors) which can be referenced online through the Society for Assisted Reproductive Technology (SART). The most crucial factor that impacts success rates is age. Over the age of 40, success rates are lower. Another challenge that potential IVF patients may face is the financial burden. Patients may require several cycles of IVF, with each cycle averaging $10-15,000 in the U.S.
Help for Irregular Periods When Trying to Conceive
While irregular periods can make conception challenging, understanding causes, identifying symptoms, and seeking medical advice can help. It's important to remember that everyone's fertility journey is unique. It can feel isolating and uncomfortable to share the difficulties when facing challenges trying to conceive, but resources and treatments are available.
Remember that having irregular periods does not necessarily mean you will not be able to have a healthy pregnancy and baby. Seeking support from loved ones and medical professionals can make a difference. It's a good idea to see a fertility specialist to understand your best options and feel well-informed about your reproductive choices. Whether you are trying to start building a family now or in the future, connect with our team for compassionate care from globally recognized experts in reproductive health.