Do Infertile Women Menstruate?

It is a common belief over decades that women with normal menstrual cycle pattern are fertile, and those with abnormal menstrual pattern are infertile. But, this is not true always as women even with normal menstrual cycle can have difficulty to conceive.

INTRODUCTION

Normal menstrual cycle length is variable from 21 days to 35days. Normal volume of bleeding is 80ml lasting from 3 to 7 days. In women with normal menstrual cycle the cause of infertility can be tubal factor, poor egg quality, uterine or male factor. Inappropriate timing of sexual intercourse may also contribute to infertility.
Menstrual cycle consists of regular cycling of the hormones which are responsible for the egg to grow starting from day 1 of the cycle. Average, after 12-14 days egg is released from the follicle and after 14 days if pregnancy does not occur, due to fall of estrogen and progesterone hormone menstruation occurs.

Abnormal menstrual cycle patterns are associated with infertility, they can be less than 21 days (polymenorrhoea), delayed cycles more than 35days( oligomenorrhoea,), heavy prolonged bleeding lasting more than 7days ( menorrhagia), scanty bleeding (hypomenorrhoea).

Disturbances in the hypothalamic pituitary ovarian axis are associated with unpredictable menstrual cycles. The length of the menstrual cycle is determined by length of the follicular phase length. Longer cycles have longer follicular phase and shorter cycles have shorter follicular phase.

Age is the important predictor of cycle length. As the age increases, the egg reserve decreases , quality of egg decreases, cycles become shorter due to hormonal imbalance. Anovulation is more frequent in menstrual cycles that deviate from normal cycle length.

Duration and amount of bleeding also indicate chances of fertility in certain conditions. Scanty bleeding is associated with thin endometrium which indirectly can affect the implantation rates. Prolonged and heavy bleeding is associated with anovulation disorder(PCOS).

ETIOLOGY

CAUSES OF ABNORMAL MENSTRUAL CYCLES ASSOCIATED WITH INFERTILITY

1. PCOS
2. Premature ovarian failure
3. Menopause
4. Thyroid disorders
5. Genital tuberculosis
6. Stress and eating disorders.

PCOS-This endocrine disorder is most common cause of anovulatoryinfertility. It is characterised by more than normal levels of androgens. This hormonal imbalance interfere with the growth and release of eggs from ovaries. In PCOS menstrual cycles are irregular heavy or scanty depending on hormones.

Premature ovarian failure– It is a primary ovarian defect characterised by absent menarche( primary amenorrhoea) or premature depletion of ovarian follicles before the age of 40yrs (secondary amenorrhoea). In this case women does not have menstruration.

Thyroid disorders– Hypothyroidism in women is associated with infrequent menstruation( oligomenorrhoea) that is cycle length more than 35days. Hyperthyroidism that is excess thyroid is associated with short periods with little flow. Abnormal levels of thyroid hormone can interfere with ovulation causing anovulatory cycles and infertility.

Genital tuberculosis– It usually affects fallopian tubes and endometrium leading to infertility. Most patients are asymptomatic or they can present with scanty menstrual cycle. Tubercular endometritis can also affect the menstrual cycle ,decreasing the implantation rates.

Stress and eating disorders, sedentary life style leading to increase weight are also associated with irregular cycles and infertility.

MANAGEMENT

1. Life style modification.
2. Pharmacotherapy with ovulation induction drugs in anovulatory cycles.
3. Correction of hormonal problems like thyroid and prolactin.
4. Anti tubercular drugs in TB endometritis.
5. In case of premature ovarian failure , HRT( hormone replacement therapy) is advised .
Disorders in menstrual cycle should be evaluated and treated accordingly.