Understanding the menstrual cycle is an essential part any fertility journey, especially for those planning for pregnancy. Knowing when you’re ovulating can help optimize your chances of conception. But what if you have irregular periods? Does cycle irregularity equal infertility? 

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The menstrual cycle is one of nature’s most widely misunderstood bodily functions, and irregular periods and infertility are topics that can be tough to talk about openly. However, when you know the facts and understand your options for conceiving with irregular cycles, your goals will feel much more manageable.

What’s the connection between irregular periods and infertility? In short, it is simply more difficult to determine when you’re ovulating each month, or if you’re ovulating at all. When you’re unsure about the timing of ovulation, trying to conceive becomes difficult.

So, what can cause such erratic behavior in menstrual cycles?

There are many factors that can contribute to cycle irregularity, making them longer or shorter, or causing your body to skip cycles altogether. We’ll explore four of the most common reasons for irregular periods below.

The good news is that even with irregular periods, it’s very likely you can still get pregnant! However, it will likely make planning a pregnancy more challenging.

That’s where the fertility professionals come in. We’re here to help you understand why this might be happening, what you can do about it, and what your options are.

Before we dive in, let’s briefly recap what happens during a typical menstrual cycle.

Fertilization occurs when the egg meets and is fertilized by a sperm, resulting in pregnancy. Contrary to what you may have learned in health class, your chances of getting pregnant (even without known fertility issues or period irregularity) in any given cycle are much lower than you might expect – only around 20-25%.

Those chances of success also decrease with age.

Menstruation

When the egg doesn’t meet or get successfully fertilized by a healthy sperm, the egg will be discarded through the process of menstruation, where the lining of the uterus is shed. More commonly referred to as a “period,” this process causes bleeding for about four to eight days every month, signaling the end of the cycle.

Navigating menstrual cycle irregularity when trying to conceive can be quite frustrating, often leaving hopeful parents wondering, “What’s wrong with me?” Before we go on, it’s important to acknowledge that in nearly all cases, there is nothing you’ve done to cause this. 

So, what causes irregular periods? There are four common conditions that can lead to cycle irregularity or anovulation (the technical term for the absence of ovulation). Let’s talk about these four possible causes and how you can still get pregnant in spite of them. 

One of the most common causes of irregular periods, affecting 1 out of every 10 people assigned female at birth, is called Polycystic Ovary Syndrome (PCOS). 

PCOS is an imbalance of the hormones involved in the reproductive process. These imbalances can cause problems at various points in the ovulation cycle – affecting the development of an egg or even impacting when that egg is released into the uterus.

This, in turn, causes irregular or “missed” periods.

Unfortunately, there isn’t a definitive cause of PCOS, however, it often appears alongside an unusually high presence of androgens (testosterone) or excess insulin. Sometimes, an inflammation of the ovaries is to blame.

How to Get Pregnant with PCOS

Fortunately, symptoms of PCOS can be managed through lifestyle changes or with the aid of medications. Those who struggle with excess weight or have a family history of diabetes have a higher chance of developing PCOS.

Focusing on improving your overall health is one of the best lines of defense when it comes to this challenging, complex condition. Working with an experienced nutritionist can also be helpful as you learn to navigate PCOS. 

Birth control can help regulate your menstrual cycle, while other medications can enhance or block various hormone levels. If these steps do not work, in vitro fertilization (IVF) treatment has a very high success rate for those with PCOS.

Intense and unusual pain during the menstrual cycle, during intercourse, or general pain in your pelvic area can be due to a condition called endometriosis.

Endometriosis occurs when the endometrium (the tissue that lines the uterus) attaches and grows outside of the uterus. It can grow in the ovaries, fallopian tubes, outer surface of the uterus, or anywhere inside the lower abdominal region.

And it’s more common than you might imagine…an estimated 11% of women of childbearing age have this condition. (Including all of these celebrities!) Although we don’t know why some people develop endometriosis, researchers have some hunches.

What causes endometriosis?

During your period, the lining of the uterus can get “backlogged” instead of shedding normally. In other cases, the immune system may not be strong enough to fight off leftover tissue before it attaches elsewhere. The disease also seems to run in families, suggesting a genetic link. Hormonal imbalances, too, are thought to possibly play a role.

How does endometriosis impact fertility?

These growths are typically benign, but can significantly impact your ability to get pregnant. For instance, if one of these abnormal tissue growths blocks your fallopian tubes or impacts the lining of the uterus, it could block your ability to ovulate or make it impossible for an embryo to successfully implant.

There are many reasons why this condition might endanger the path to pregnancy at various points within the process. While there is no cure for endometriosis, there are successful treatments.

How to Get Pregnant with Endometriosis

While endometriosis can be quite painful and complex, your chances of pregnancy are still quite high, as long as you receive proper treatment and support.

For those trying to conceive, temporarily halting ovulation by means of a gonadotropin-releasing hormone (GnRH) agonist can stop endometrial growth and allow for a healthy pregnancy once ovulation is resumed. In severe cases, surgery to remove the abnormal tissue can be an option.

Controlling the frequency of periods with hormonal birth control can offer pain management.

One of the more serious conditions that affects the menstrual cycle and a person’s ability to conceive is called Diminished Ovarian Reserve (DOR). This rare condition occurs when ovarian function is impaired in women under the age of 40.

Ovaries that don’t function well tend not to release eggs. It also often leads to a decrease in estrogen, which not only impacts your ability to become pregnant but it can cause other health problems, such as osteoporosis.

Symptoms of DOR mimic those of early menopause, such as:

• Hot flashes
• Decreased libido
• Irritability

Sometimes this ovarian dysfunction can be traced back to chromosomal anomalies, autoimmune responses, or genetics, but more often than not, the cause is simply unknown.

Women with DOR sometimes have an ovulation cycle and release an egg, which can lead to pregnancy in about 5-10% of cases. But the frequency and predictability of ovulation is severely impacted, which makes planning a “natural” pregnancy highly difficult.

Unfortunately, there’s no cure or treatment proven to restore ovarian function.

How to Get Pregnant with Diminished Ovarian Reserve

Learning you may never be able to conceive due to diminished ovarian reserve can be extremely difficult news to receive. It will take time to process all of the information and grieve the vision you’ve held of being pregnant and bearing a child with your genetics.

However, if experiencing pregnancy is important to you, there are alternatives.

Many couples facing DOR expand their families by seeking out an egg donor and pursuing IVF treatment. Talk to your fertility clinic about your options. Be sure to have a strong support network in place as you explore the possibilities (a fertility counselor can be helpful too).

A healthy body has the highest chance of getting pregnant, and this is the case whether or not you are struggling with irregular periods. However, in the case of an unpredictable menstrual cycle, improving your overall health and wellness can especially helpful for getting your periods back on schedule.

Nutrition & Movement

Those who struggle with excess weight or nutritional deficiencies have an increased risk for conditions that cause irregular cycles. With this in mind, we recommend eating a balanced, nutritious diet and starting an exercise routine that’s right for your body. 

This is also a great opportunity to consult with a nutritionist, who can offer expert guidance and support around any nutrition and lifestyle modifications you’re considering making.

Note: Be cautious and don’t overdo it on the workouts. Extreme physical activity can also cause irregular cycles, as often seen in professional athletes. Make sure to take the time to build up your fitness appropriately.

Stress Reduction

Menstrual cycles are also highly impacted by emotional stress. It isn’t uncommon for stress to trigger your period or cause your body to skip a cycle. Finding ways to reduce stress – perhaps through techniques such as meditation, yoga, taking breaks from work, or even by prioritizing sleep – may help restore your cycle.

When facing irregular periods, consider your overall wellness, as it is an enormous factor in hormonal imbalances and focusing on things holistically often makes a real, positive impact.

Stress, exercise and other factors can sometimes impact your cycle in the short term, so some fluctuation can be normal and not a cause for major concern. However, you should reach out to a doctor if you’ve had irregular (or missed) periods for more than three months.

When the menstrual cycle is upset for a sustained period of time, there may be an underlying issue that needs attention. Unusual or deep pain is also a sign that it’s time to get checked out.

Should I see my OB/GYN or a fertility specialist?

You can always start by speaking with your OB/GYN about your concerns, or opt to go straight to a board-certified reproductive endocrinologist, who can monitor your overall health and test for various conditions that may be impacting your cycle and ability to conceive.

When you meet with your doctor, be sure to discuss your full medical history and any recent changes to your health, including any of the following:

• Weight loss or gain
• Unusual hair growth
• Intensity and length of your periods
• Changes to your sleep patterns
• Prior pregnancies and surgeries
• Mental health issues, such as depression or anxiety
• Known reproductive problems in genetically-related family members

Feeling uncertain about when (or if) you’re ovulating, experiencing cycle irregularity, or just wanting to rule out any fertility issues? It’s never too early to reach out to a fertility specialist. By working with a reproductive endocrinologist, you can feel confident that you’ve left no stone unturned and have all the support you need on your journey to parenthood.