Women with regular periods will have between 11 and 13 menstrual periods in one calendar year, which means that they will have up to 13 chances to conceive each year. On the other hand, women with irregular periods may have far fewer chances to conceive each year, potentially making the path to parenthood for them a longer, more tiresome journey.
If you do have irregular periods, it is certainly possible to become pregnant. Understanding the causes of irregular periods and how you can help to restore cycle regularity can help as you embark on your trying to conceive adventure.
Irregular or abnormal ovulation accounts for 30% to 40% of all cases of infertility. Having irregular periods, no periods, or abnormal bleeding often indicates that you aren’t ovulating, a condition known clinically as anovulation.
Although anovulation can usually be treated with fertility drugs, it is important to be evaluated for other conditions that could interfere with ovulation, such as thyroid conditions or abnormalities of the adrenal or pituitary glands.
What are irregular periods?
Your cycle length is the number of days between each of your periods.
A slight variation in cycle length is normal, but your cycles are considered irregular if you have more than five cycles a year that are more than five days longer or shorter than your average cycle length.
Cycles that are always shorter than 21 days, or longer than 36 days, are also considered irregular cycles.
How do I know if my periods are irregular?
To answer this question, it is helpful to talk about what a regular menstrual cycle might look like. (Note: the total length of your menstrual cycle is the number of days from the start of one period to the start of your next period.) It may be surprising to hear that you can be considered “regular” even if you don’t have a period every 28 days. According to anatomy and physiology textbooks, a woman with a regular menstrual cycle has a period every 23 to 35 days that are predictable in nature. This means that you can be considered regular even if your period comes every 23 days or every 35 days or anywhere in between, as long as your cycle length doesn’t typically vary by more than a couple days on either side.
On the other hand, an irregular period is defined as a menstrual cycle that is consistently shorter than 21 days or consistently longer than 36 days. You can also be considered “irregular” if your cycle length varies significantly from cycle to cycle, sometimes lasting 28 days, then 40 days, then 32 days.
What causes of irregular cycles make it harder to conceive?
As mentioned above, the cause behind irregular cycles has a lot to do with your chances of getting pregnant.
Sometimes, irregular periods are a sign of anovulation. Anovulatory cycles are menstrual cycles where ovulation doesn’t take place.
If you’re not ovulating, you can’t get pregnant.
Irregular periods may be a sign of polycystic ovarian syndrome (PCOS). Depending on whether you ovulate on your own or not, you may be able to get pregnant by yourself with PCOS.
Many women assume that irregular cycles and difficulty getting pregnant are always PCOS. This isn’t true. There are other possible causes of irregular periods and infertility, including a thyroid imbalance, hyperprolactinemia, low ovarian reserves, and premature ovarian failure.
A common cause of irregular periods and decreased fertility is obesity.
Being overweight (or underweight) can disrupt your menstrual cycles and make it harder to get pregnant.
Extreme exercise and extreme dieting are also potential causes of irregular cycles. Female athletes are more likely to experience infertility for this reason.
Sometimes, irregular cycles point to a more subtle hormonal imbalance. You may still be ovulating month to month. Just that your ovulation day varies greatly.
If you’re ovulating, you may be able to get pregnant without the help of fertility drugs.
Getting pregnant with ovulation problems
Once your doctor has ruled out other medical conditions, he or she may prescribe fertility drugs to stimulate your ovulation.
The drug contained in both Clomid and Serophene (clomiphene) is often a first choice because it’s effective and has been prescribed to women for decades. Unlike many infertility drugs, it also has the advantage of being taken orally instead of by injection. It is used to induce ovulation and to correct irregular ovulation by increasing egg recruitment by the ovaries.
Clomiphene induces ovulation in most women with anovulation. Up to 10% of women who use clomiphene for infertility will have a multiple gestation pregnancy — usually twins. (In comparison, just 1% of the general population of women delivers twins.)
The typical starting dosage of clomphene is 50 milligrams per day for five days, beginning on the third, fourth, or fifth day after your period begins. You can expect to start ovulating about seven days after you’ve taken the last dose of clomiphene. If you don’t ovulate, the dose can be increased by 50 milligrams per day each month up to 150 mg. After you’ve begun to ovulate, most doctors suggest taking Clomid for 3-6 months before referring to a specialist. If you haven’t gotten pregnant by then, you would try a different medication or get a referral to an infertility specialist.
These fertility drugs sometimes make the cervical mucus “hostile” to sperm, keeping sperm from swimming into the uterus. This can be overcome by using artificial or intrauterine insemination(IUI) – injecting specially prepared sperm directly into the uterus – to fertilize the egg. It also thins the endometrial lining.
Depending on your situation, your doctor may also suggest other fertility drugs such as Gonal-F or other injectable hormones that stimulate follicles and stimulate egg development in the ovaries. These are the so-called “super-ovulation” drugs. Most of these drugs are administered by injection just under the skin. Some of these hormones may overstimulate the ovaries (causing abdominal bloating and discomfort). This can be dangerous and require hospitalization; thus, your doctor will monitor you with frequent vaginal ultrasounds and blood tests to monitor estrogen levels. About 90% of women ovulate with these drugs and between 20% and 60% become pregnant.
How to find out if you are ovulating
Irregular periods often indicate that you are not ovulating, a condition clinically known as anovulation. Because you cannot get pregnant if you are not ovulating, it is important to confirm whether you are ovulating or not.
The simplest method is to chart your basal body temperature (BBT), by measuring and recording your body temperature first thing every morning. If you are ovulating, your temperature chart will show a shift from lower temperatures before ovulation to slightly higher temperatures after ovulation. If you can’t detect this two-phase pattern on your charts, you are probably not ovulating. Learn more about BBT charting
You can also ask your doctor or gynecologist for blood tests to confirm ovulation. You may be asked to take tests at different times in your cycle in order to measure the levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) before ovulation, and of progesterone after ovulation. Some doctors may also do a mid-cycle ultrasound to see if eggs are developing normally in your ovaries.
How to find your fertile periods with irregular cycles
If your temperature charts and/or your blood tests confirm that you are indeed ovulating, your most important task is to find out when ovulation happens so you can make sure to have intercourse during your most fertile period, which is the last 2-3 days before ovulation.
If you and your partner are making love three times per week or more, you will most likely have intercourse at least once during your most fertile days in any case. And if you are relaxed about how long it may take to get pregnant, you may want to leave it at that.
However, your probability of conception will increase with every intercourse in your fertile period. And if you are experiencing difficulties getting pregnant, or you just want to make sure you give yourself the best possible odds in every cycle, you will want to identify your most fertile days so you can time your lovemaking perfectly. Unfortunately, basal body temperature charting only identifies the ovulation day once ovulation is over, when it is already too late to conceive in that cycle. To predict ovulation and optimize intercourse timing, you need different methods.
The simplest tools are ovulation tests, or ovulation predictor kits. Ovulation tests detect the increased presence of luteinizing hormone (LH) in your urine which occurs 12 to 36 hours before ovulation. A positive ovulation test means that ovulation is likely to happen within the next day or two, and that it is time to take your partner to bed.
However, when your menstrual cycles are very irregular, it can be difficult to know when to start testing. You may also have to spend a lot of tests before you get a positive result. Many women with irregular cycles therefore prefer using a fertility monitor which predicts ovulation based on changes in electrolyte concentration (salinity) in saliva samples, rather than LH in the urine.
Getting pregnant when you have PCOS
If you have PCOS and you’re overweight, losing weight is one way to improve your chances of pregnancy. Your doctor also might prescribe medication to lower your insulin levels, since elevated insulin levels — caused by your body’s inability to recognize insulin — has been found to be a common problem among many women with PCOS. Chronically elevated insulin levels can also lead to diabetes. Women with PCOS may be at higher risk for developing heart disease, type 2 diabetes, and endometrial cancer, especially if PCOS is untreated.
PCOS can’t be cured, but there are treatments available to treat the symptoms of PCOS and the infertility associated with this condition. By stimulating ovulation, especially in women trying to conceive, and treating insulin resistance, regular ovulation and periods often are restored.
A procedure known as in vitro fertilization, or IVF, is another potential treatment for women with PCOS.
Stress and Fertility
For couples struggling with infertility, it’s a particularly cruel fact: Not only can infertility cause a lot of stress, but stress may affect fertility. It’s known to contribute to problems with ovulation. For many people, the longer you go without conceiving, the more stress you feel. Fears about infertility may also lead to tension with your partner, and that can reduce your chances of pregnancy even further. After all, it’s hard to have sex if one of you sleeps on the couch.
While it’s a fact that coping with infertility is stressful, that doesn’t mean you have to give into it. If your doctor can’t find a medical cause for your ovulation problems, consider finding support groups or a therapist who can help you learn better ways to cope with the anxieties that come with infertility.
The American Society of Reproductive Medicine offers these tips for reducing stress:
- Keep the lines of communication open with your partner.
- Get emotional support. A couples’ counselor, support groups, or books can help you cope.
- Try out some stress-reduction techniques such as meditation or yoga.
- Cut down on caffeine and other stimulants.
- Exercise regularly to release your physical and emotional tension.
- Agree on a medical treatment plan, including financial limits, with your partner.
- Learn as much as you can about the cause of your infertility and your treatment options.
Lifestyle changes to regulate ovulation for conception
Fertility drugs aren’t your only option.
You may be able to make lifestyle changes.
If you are overweight, losing some of the weight may be enough to jumpstart ovulation and help you conceive. And you may not have to lose all of the weight.
Research has shown that obese women who lose just 10% of their weight can start ovulating on their own again.
If extreme dieting is the problem, changing your diet to a more balanced plan, and even gaining some weight if you’re underweight, can help regulate your cycles.
When to talk to your doctor about irregular cycles
If you have irregular periods, the best thing to do is see your gynecologist.
Even if you weren’t trying to get pregnant, it’s a good idea to get checked out.
Usually, the recommendation is that you try to get pregnant for one year (or six months if you’re age 35 of older), and then, if you don’t conceive, to see a doctor.
However, this doesn’t apply if there are signs of a problem.
Irregular cycles is a risk factor for infertility. Your doctor can run some simple blood tests to see if you are ovulating or not.
If your blood work indicates that you are ovulating, and you’re not over 35, you might want to keep trying to get pregnant on your own for a bit longer.
Ovulation problems are a common cause of female factor infertility, with a pretty good treatment success rate.
There’s no shame in needing some help. Don’t be afraid to seek it out.