IS MY PERIOD NORMAL? Understanding Your If You’re Trying to Conceive

More than 70% 11% 95% of women have or more of of U.S. women start irregular menstrual American women their periods by cycles as suffer from age 16. approaches. .1

10% 12% of U.S. women are of women have affected by PCOS trouble getting or (polycystic staying pregnant.3 syndrome).2

Fortunately, your menstrual cycle can tell you a lot about your if you know what to look for.

TYPES OF MENSTRUAL CYCLES

Only 15% of About Normal = women have 30% of women are fertile only during 21 to 35 days the “perfect” the “normal” fertility 28-day cycle. window—between days 10 and 17 of the menstrual cycle.

Day 1 Period starts (aka menses)

27 28 1 2 26 3 25 4 24 5 Day 15-28 23 6 Day 2-14 ; ; ** 22 WHAT’S NORMAL? 7 FSH released, (follicle- uterine lining 21 8 stimulating matures Give or take a few days, ) and a normal cycle looks like this: released, 20 9 * begins 19 10 18 11 17 12 16 15 14 13

*ovulation: the process of an ovum () being released from the ovary; occurs 10-14 days before menses. **progesterone: a steroid hormone that tells the to prepare for

At least 30% of women have an “irregular” cycle

either short, long or inconsistent.

Short = Long = < 21 days > 35 days

May be a sign of: May be a sign of: Hormonal imbalance Hormonal imbalance with fewer Lack of ovulation Approach of menopause Other fertility issues Reduced fertility4 Increased risk of

SIGNS TO WATCH FOR

Your menstrual cycle provides valuable clues about your body’s . Here are some red flags to look for.

Could mean: HEAVY Could result in: Hormonal imbalances BLEEDING Fibroids or polyps Difficulty getting pregnant Endometriosis Must change Increased risk of miscarriage Bleeding disorders pad/ every 1 to 3 hours

Could mean: Could result in: Irregular ovulation PROLONGED Disruptions to the uterine Iron-deficiency anemia lining BLEEDING Difficulty getting pregnant Problems forming blood clots More than 7 days Increased risk of miscarriage

Could mean: Could result in: gland irregularities Elevated hormone levels, such IRREGULAR Problems with ovulation as and androgens CYCLE Difficulty getting pregnant PCOS Increased risk of miscarriage Diminished Ovarian insufficiency Early signs of menopause

Could mean: Could result in: Ovulation isn’t happening NEVER Underdeveloped uterus HAVING A Difficulty getting pregnant or PERIOD without intervention Scar tissue inside the uterus Premature menopause Low BMI (body mass index)

WHAT TO DO

Understand your menstrual cycle and understand your fertility. If you are trying to conceive, consult with a fertility specialist if you’re experiencing any of these warning signs:

“Red flags” and early warning signs mentioned above

Abnormal periods

Heavy or prolonged bleeding

Irregular menstrual cycle

More than 3 months between periods

Under 35 and trying for more than 1 year to get pregnant

Age 35 to 39 and trying for 6 months or longer to get pregnant

Age 40 or older and trying for 3 months to get pregnant

Get educated about what’s normal vs. abnormal. Knowledge can save you time and heartache if you’re struggling to conceive.

1.888.761.1967 http://www.ShadyGroveFertility.com/appointment

Sources

1"Endometriosis." Womenshealth.gov. February 13, 2017. Accessed March 01, 2017. https://www.womenshealth.gov/a-z-topics/endometriosis.

2"Polycystic ovary syndrome." Office on Women's Health. Accessed March 01, 2017. https://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html#a.

3" FAQs." Centers for Disease Control and Prevention. February 16, 2017. Accessed March 01, 2017. https://www.cdc.gov/reproductivehealth/infertility.

4Wise, Lauren A., Ellen M. Mikkelsen, Kenneth J. Rothman, Anders H. Riis, Henrik Toft Sørensen, Krista F. Huybrechts, and Elizabeth E. Hatch. "A Prospective Cohort Study of Menstrual Characteristics and Time to Pregnancy." American Journal of Epidemiology. June 30, 2011. Accessed March 01, 2017. https://academic.oup.com/aje/article/174/6/701/88882/A-Prospective-Cohort-Study-of-Menstrual