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Long menstrual intervals are associated with delayed conception

Dear doctor,
I have a long menstrual cycle; I can go up to 3 months without having a period. How then can I work out my fertile period as am anxious about delays in getting pregnant?

Most women have a regular menstrual cycle. This means they can predict fairly accurately when the next period is expected. Some will have irregular periods for various reasons. Still, regular periods could change into an irregular pattern, causing a bit of anxiety. Regular periods imply regular ovulation, and high chances of conception. Irregular periods on the other hand imply unpredictable ovulation patterns, and often a delay in conception.

The average regular menstrual interval is 28 days. You can expect to ovulate around the mid-cycle, give or take a few days either way. Having sex around the ovulatory period therefore gives you a high chance of conception. But you don’t necessarily need to have sex timed around your mid-cycle. Regular intercourse, about two to three times a week will still catch you at the right time. Irregular and prolonged period intervals however mean ovulation is unpredictable, or it may not be happening at all. But still, a proportion of women with irregular periods will still conceive spontaneously. Again regular intercourse helps, with conception occurring as and when an egg gets released, even though somewhat unexpectedly.

Prolonged period intervals mandate gynecological review to work out the cause. Majority of women will have a condition called polycystic ovarian syndrome (PCOS). The diagnosis will be confirmed following hormone tests and pelvic imaging. A minority may be diagnosed with rarer causes. A specific and definite diagnosis must be made prior to any recommendations on treatment options.

Once a diagnosis for irregular periods has been confirmed, fertility enhancing treatment can then be offered. Those with PCOS can be advised on lifestyle adjustments that may promote resumption of spontaneous ovulation. Treatment with ovulation tablets is often necessary. It’s best not to self-medicate, as some basic monitoring is required to work out the optimal dose. Once you start ovulating, you can expect to conceive within three to six months. If a rarer diagnosis has been made, the most applicable and appropriate remedy will be recommended.

If you do not conceive shortly after the correction of ovulation, there may be additional fertility issues that may not be immediately apparent. A comprehensive additional fertility evaluation is warranted in these circumstances. And this must include testing of the male partner as well. Some women with irregular periods and ovulation disorders will eventually require advanced fertility treatment in order to conceive.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist.

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