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Infertility problems are increasing day by day and it is very common today. It is estimated that as many as one in six couples may experience difficulties in conceiving. It is advisable to seek fertility specialist help if you have not been successful despite trying for 12 months. Sometimes it may be better to act sooner (for example if there is a per-existing problem such as irregular/absent periods). Infertility problems in women may be the result of blocked tubes, ovulation disorders, STDs, or age.
Abnormalities of the hormones that control the menstrual cycle and/or abnormalities of the uterus itself can lead to absent, frequent or irregular menstrual periods. In order to successfully diagnose the cause of the abnormal menstrual periods, several tests may be suggested.Irregular periods are a common condition in women and can be caused by many things. Most of the time the irregular periods are related to a condition called “anovulation”. This is a medical term for an imbalance between the hormones of the pituitary gland, the ovaries and the hypothalamus.
Menstrual cycle disorders can cause a woman’s periods to be absent or infrequent. Although some women do not mind missing their menstrual period, these changes should always be discussed with the doctor because they can signal underlying medical conditions and potentially have long-term health consequences. A woman who misses more than three menstrual periods (either consecutively or over the course of a year) should see either the doctor or the gynecologist.
Amenorrhea or Missed Periods: The term amenorrhea is used by doctors to describe the absence of menstruation. Primary amenorrhea (in which a woman does not begin menstruating) is very rare, while secondary amenorrhea (when menstrual periods are absent for more than three to six months in a woman who previously had periods) is much more common.
Oligomenorrhea or Infrequent or Irregular Periods
Oligomenorrhea is the medical term for infrequent menstrual periods (fewer than six to eight periods per year).The causes, evaluation, and treatment of amenorrhea and oligomenorrhea are similar.
CAUSES OF IRREGULAR PERIODS
Menstrual cycle disorders can result from conditions that affect the hypothalamus, pituitary gland, ovaries, uterus, cervix, or vagina.
Primary amenorrhea–The most common causes includes
1) Conditions that are present at birth, but may not be noticed until puberty. These conditions include genetic or chromosomal abnormalities and abnormalities of the reproductive organs (eg, if the uterus is not present or developed abnormally).
2) All of the conditions that lead to secondary amenorrhea can also cause primary amenorrhea.
Secondary amenorrhea— Pregnancy is the most common of secondary amenorrhea. Other common causes include the following:
1} Ovarian conditions, such as polycystic ovary syndrome and ovarian failure (early menopause).
2) Hypothalamic amenorrhea. This occurs when the hypothalamus slows or stops releasing GnRH (gonadotropin releasing hormone),
a hormone that influences when a woman has a menstrual period.
3) Prolactin-secreting pituitary tumors are another common cause of secondary amenorrhea.
Oligomenorrhea — Many of the conditions that cause primary or secondary amenorrhea can also cause a woman to ovulate irregularly (oligomenorrhea). However, most women who develop infrequent periods have polycystic ovary syndrome.
EVALUATION OF IRREGULAR PERIODS
The evaluation of amenorrhea/oligomenorrhea includes a complete medical history and physical examination.
The woman’s personal and medical history reveals the clues about the cause of amenorrhea.Any problems during infancy or childhood,the date of first period and its frequency and the history of irregular menstrual periods shold all be accounted for.Physical examination includes the examination of the face, neck, breasts, and abdomen. A pelvic examination will also be performed.Because pregnancy is the most common cause of secondary amenorrhea, a pregnancy test is usually recommended for women whose menstrual periods have stopped. Blood tests to measure hormone levels is also recommended.
TREATMENT OF IRREGULAR PERIODS
The goal of the treatment is to correct the underlying condition. For a woman who is trying to become pregnant, restoring fertility may be another goal.
Polycystic ovary syndrome — Polycystic ovary syndrome (PCOS) is a chronic condition that causes infrequent periods and an excess of androgens (male hormones). PCOS treatment is recommended to reestablish normal menstrual cycles and prevent
long-term complications. For women with PCOS who want to become pregnant, hormone pills or injections are often needed to help women ovulate. Ovulation occurs in almost all women with PCOS who use gonadotropin therapy; approximately 60 percent of these women become pregnant.
Hypothalamic amenorrhea — Women with hypothalamic amenorrhea are sometimes able to resume normal menstrual periods after making certain lifestyle changes, such as eating a higher-calorie diet, gaining weight, reducing the intensity or frequency of exercise, and reducing emotional stress.Some doctors recommend estrogen and progesterone hormone replacement (or a hormonal contraceptive, such as a birth control pill) for women with hypothalamic amenorrhea. These treatments can reduce the risk of developing osteoporosis later in life.
Ovarian failure — Normally, a woman stops ovulating around the age of 50; this is called menopause. If a woman stops ovulating before age 40, this is called premature ovarian failure.With most types of ovarian failure, pregnancy can be achieved using injectable fertility medications and donor eggs.
High prolactin — Women with amenorrhea and hyperprolactinemia can usually have normal menstrual periods and become pregnant when treated with medications under the supervision of the doctors.
Hypothalamic or pituitary conditions — Some hypothalamic and pituitary gland conditions that cause amenorrhea, such as a
congenital deficiency of gonadotropin-releasing hormone (GnRH), are irreversible.
Endometrial adhesions (Asherman syndrome) — The doctor may recommend surgery to remove the scarred tissue, followed by
estrogen treatment to stimulate regrowth of the lining.
Anatomic problems — Surgery is often an effective treatment if amenorrhea is caused by a blockage in the reproductive tract.
If you’ve skipped a period, try to relax. Restoring your life to emotional and physical balance can help. Many women miss
periods now and then. Unless you are pregnant, chances are your cycle will return to normal next month.
Facing the diagnosis of infertility (the reason for which may or may not be known) is a difficult and complex task. A lack of awareness compounds the anxiety caused from the inability to conceive and the uncertainty about the future.In most cases of female infertility, doctor can do a fertility workup. Through a physical examination and tests, doctors may determine the problem. Then, treatment with medications and/or surgery or high-tech procedures may help you get pregnant.
Good news for people wanting to start family with IVF and moving first step towards the parenthood.No matter what is causing infertility, there are answers. Talk with your fertility specialist.
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