The document provides an overview of women's fertility focusing on menstrual cycle irregularities, including types such as amenorrhea, dysmenorrhea, menorrhagia, oligomenorrhea, polymenorrhea, menopause, and dysfunctional uterine bleeding. It discusses the importance of recognizing these phases for fertility awareness and family planning, alongside common causes and symptoms for each type of irregularity. The document also outlines the diagnostic tests for menstrual disturbances leading to infertility.

1. Topic- Women's Fertility: Irregularities in the Menstrual Cycle
PRESENTED BY
Amit Prasad Rath
M.PHARM IN PHARMACOLOGICAL AND TOXICOLOGY
From Roland Institute Of Pharmaceutical Sciences, Berhampur, Odisha, India.

2. Introduction
Overview of the Menstrual Cycle:
 The menstrual cycle is a monthly process that prepares the female body for potential
pregnancy.
 It typically lasts about 28 days but can vary between 21 to 35 days in different individuals.
Importance of Understanding Fertility :
 Recognizing the phases of the menstrual cycle helps in identifying fertile days.
 Understanding how the menstrual cycle affects fertility is crucial for family planning and
reproductive health.
 Awareness of menstrual health can indicate underlying health issues and guide timely
interventions.

3. Common types of menstrual
irregularities
 Amenorrhea
 Dysmenorrhea
 Menorrhagia
 Oligomenorrhea
 Polymenorrhea
 Menopause
 Dysfunctional uterine bleeding

4. Amenorrhea
 Amenorrhea (uh-men-o-REE-uh) is the absence of menstruation,
often defined as missing one or more menstrual periods.
 Amenorrhea, medically known as the absence of menstruation, is
not a disease itself but may indicate an underlying condition.
CAUSES:
• Delayed puberty - delayed GnRH
• Hypothalamic&pituitarydysfunction
• Kallmann's syndrome
• Primary ovarian failure
• Resistant ovarian syndrome
• Galactosemia Enzyme efficiency ( 17 alpha hydroxylase deficiency also
knownas Congenitaladrenalhyperplasia)

5. “Dysmenorrhea” is the medical term for painful periods (menstruation) or menstrual cramps. In addition to cramping,
you might have other symptoms, such as nausea, fatigue and diarrhea. It’s most common to have menstrual cramps
the day before or the day you start your period. For most people, symptoms subside after about two or three days.
Types of dysmenorrhea
1. Primary dysmenorrhea:
Primary dysmenorrhea is the name for menstrual cramps that come back every time you have get period, but aren’t
due to another medical condition. Pain usually begins one or two days before you get your period or when the
bleeding actually starts.
2. Secondary dysmenorrhea:
If you have painful periods because of a condition or an infection in your reproductive organs, it’s secondary
dysmenorrhea. Pain from secondary dysmenorrhea usually begins earlier in your menstrual cycle and lasts longer
than typical menstrual cramps
Dysmenorrhea

6. Primary Dysmenorrhea
Prostaglandins: Hormone-like substances that cause the uterus to contract, leading
to pain.
Menstrual cramps: As the uterus contracts, it can result in pain in the lower
abdomen.
Secondary Dysmenorrhea
Endometriosis: A condition where tissue similar to the lining of the uterus grows
outside of it.
Fibroids: Noncancerous growths in the uterus that can cause pain.
Pelvic inflammatory disease (PID): An infection of the reproductive organs that can
lead to pain.Adenomyosis: A condition where the uterine lining grows into the
uterine wall.
Cause :

7. Menorrhagia refers to abnormally heavy or prolonged menstrual bleeding. It can result in the soaking of one or
more sanitary pads or tampons every hour for several consecutive hours or bleeding that lasts longer than seven
days.
Causes:
Hormonal imbalances: Often related to estrogen and progesterone levels.
Uterine abnormalities: Such as fibroids, polyps, or adenomyosis.
Medical conditions: Including thyroid disorders, liver disease, or bleeding disorders.Medications: Such as
anticoagulants or hormonal therapies.
Symptoms:
Heavy menstrual flow Blood clots larger than a quarter
Fatigue or shortness of breath (due to anemia)
Severe cramps or pelvic pain
Menorrhagia

8. Oligomenorrhea refers to infrequent or irregular menstrual periods. Specifically, it is characterized by cycles that
occur more than 35 days apart but less than six months between periods.
Causes:
Hormonal imbalances: Often related to conditions affecting the hypothalamus, pituitary gland, or ovaries.
Polycystic ovary syndrome (PCOS): A common condition that can disrupt regular ovulation.
Stress and lifestyle factors: Including significant weight loss, excessive exercise, or psychological stress.
Thyroid disorders: Hypothyroidism or hyperthyroidism can affect menstrual regularity.
Chronic illnesses: Such as diabetes or celiac disease.
Symptoms:
Fewer than six to eight periods a year. Irregular cycle lengths.
Possible symptoms of an underlying condition (e.g., weight changes, acne, excessive hair growth in PCOS).
Oligomenorrhea

9. Polymenorrhea refers to a condition characterized by frequent menstrual periods, typically defined as having
cycles that occur less than 21 days apart. This can result in women experiencing more than 12 menstrual cycles in
a year.
Causes:
Hormonal imbalances: Often related to issues with the hypothalamus, pituitary gland, or ovaries.
Uterine abnormalities: Such as fibroids, polyps, or adenomyosis that may disrupt normal bleeding patterns.
Medical conditions: Including thyroid disorders, chronic illnesses, or certain infections.
Stress: Psychological stress can impact hormonal balance and lead to more frequent periods.
Certain medications: Including anticoagulants or hormone replacement therapy.
Symptoms:
Frequent menstrual periods occurring less than 21 days apart.
Heavier or prolonged bleeding during periods.Possible symptoms of an underlying condition
Polymenorrhea

10. Menopause is the end of your menstrual cycles. The term is sometimes used to
describe the changes you go through just before or after you stop having your
period, marking the end of your reproductive years. Menopause usually happens
around age 50.
Menopause
Symptoms
Uneven or missed periods
Vaginal dryness
Sore breasts
Needing to pee more often
Trouble sleeping
Emotional changes
Dry skin, eyes, or mouth
Weight gain

11. Dysfunctional uterine bleeding (DUB) refers to abnormal bleeding from the uterus that is not caused by a structural
or organic condition, such as fibroids or polyps. It is often related to hormonal imbalances that affect the menstrual
cycle.Causes:Hormonal imbalances: Fluctuations in estrogen and progesterone levels, often seen in conditions like
polycystic ovary syndrome (PCOS).
Anovulation: Absence of ovulation can lead to irregular shedding of the uterine lining.
Age-related factors: Common during adolescence (due to immature hormonal regulation) and perimenopause (as
hormone levels fluctuate).
Stress and lifestyle factors: High stress levels, significant weight changes, or excessive exercise can impact hormonal
balance.
Certain medications: Anticoagulants or hormonal therapies may contribute to abnormal bleeding.
Symptoms:
Heavy or prolonged menstrual bleeding (menorrhagia).
Irregular periods or bleeding between periods (intermenstrual bleeding).
Spotting after sexual intercourse.
Dysfunctional uterine bleeding

12. Diagnosis test for menstrual disturbance which leads to Infertility
Pelvic exam
Rectal-vaginal exam
Pelvic ultrasound
Transvaginal ultrasound
Hysteroscopy
Hysterosalpingogram
Sonohysterography
MRI
Pap smear
Endometrial biopsy
Dilatation and curettage
Colonoscopy
Cystoscopy

13. (1) https://my.clevelandclinic.org/health/diseases.
(2) https://www.pacehospital.com
(3) https://www.webmd.com
(4) https://www.yourperiod.ca/abnormal-pain-and-menstrual-bleeding/exams-and-tests-used-to-investigate-menstrual-disor
ders/
References: