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A regular menstrual cycle typically displays two distinct estradiol peaks. The first peak occurs at ovulation, and the second peak coincides with the mid-luteal progesterone surge. However, your menstrual cycle isn’t always like clockwork. While some women get their periods right on schedule every 28 days, other women’s cycles aren’t so predictable. While an irregular cycle is not usually a problem, it can occasionally signal health complications; irregular or abnormal ovulation accounts for 30% to 40% of all cases of infertility.

There are a number of ways your cycle may be irregular and ways the irregularity may influence fertility. Here are a few to be aware of:

  1. Menstrual cycle length may affect fertility. For example, a woman whose progesterone peaks on day 14, rather than between days 19 and 21, may have difficulty conceiving because ovulation will also be earlier.
  2. Inadequate, early, or late progesterone surges in the luteal phase can affect the ability to conceive. As well, low estradiol levels may contribute to abnormal bleeding and difficulty conceiving.
  3. Heavy bleeding is usually associated with high estradiol levels, but may also occur as a result of low estradiol, a relative imbalance of estrogen and progesterone, anovulation or androgen excess.
  4. High cortisol can induce the enzyme aromatase, which speeds the conversion of testosterone to estradiol. High cortisol may elevate estradiol levels, especially when DHEAS and/or testosterone are also elevated.
  5. Low testosterone may be responsible for symptoms like low sex drive and vaginal dryness.
  6. Low DHEAS or high estradiol levels may be associated with impaired thyroid function, and/or contribute to erratic bleeding.
  7. Low estrogen and a delayed progesterone surge likely contribute to difficulty conceiving.

Women with abnormal bleeding (heavy, sporadic, light), amenorrhea, fertility issues or cycle-specific symptoms such as migraine headaches, hot flashes, or mood disturbances may benefit from a Month-Long Assessment. Other lab tests to consider include:

  • Adrenal Panel: a flat diurnal cortisol profile may contribute to hormone imbalance and difficulty conceiving.
  • Urine Steroids: may offer additional insights into hormone metabolism.
  • Urine Thyroid: insufficient thyroid hormone may impact the ability to conceive.

If irregular periods are a concern for you, or you are currently trying to conceive, talk to your healthcare professional about which testing and treatment options are best for you.

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