Is it possible to fall pregnant when my menses are irregular?

Dear Doctor,

My menstrual cycle is getting me confused. It’s usually 28 days, but I can sometimes go up to 40 days without having a period. How then can I work out my fertile period as I’m anxious about delays in getting pregnant?

Lydia

Dear Lydia

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 periods are a bit of a challenge. The unpredictability of the cycles makes it difficult for you to have even the vaguest idea about when you might ovulate. 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.

Pretty irregular cycles mandate gynaecological review to work out the cause. This is especially so if the bleeding interferes with your other activities. If conception does not occur within six months in the background of irregular cycles, this also becomes another reason for getting a review. You will often need some hormone tests and pelvic imaging prior to getting a concrete diagnosis. For the majority a simple cause will be found, and simple remedies put in place.

Majority of women with prolonged menstrual cycle intervals, and consequent delay in conceiving will only need ovulation to be enhanced. This requires use of fertility medications, commonly tablets that are taken by mouth. It’s best not to self-medicate, as some basic monitoring is required to work out the optimal dose to be used. Once you start ovulating, you can expect to conceive within three to six months. Use of more potent fertility drugs may be required in some, while others may end up with advanced fertility treatment depending on their specific diagnosis.

You will easily find fertility apps that you could use to track your fertile intervals. The really good ones will even prompt you to get a gynaecological assessment depending on your cycle. Such apps can be supplemented with ovulation monitoring kits. But all these efforts may raise your stress levels, especially when there is a delay in conceiving. Nevertheless, seek help sooner if your cycles are very unpredictable.

- Dr Alfred Murage is a consultant obstetrician and gynaecologist