Fertility Health
Knowing Your Cycle
During puberty, periods start as part of your development and usually occur each month, with an average frequency of 28 days. The best method of calculating your menstrual cycle is counting between the 1st day of your period, to the next 1st day.
Usually, periods will last for around 4-7 days but each female (or person who bleeds) will differ. The number of oocytes (eggs) that any female has at birth is approximately 1-2 million. By the time of reaching puberty there are only 300,000 remaining for ovulatory processes!
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In reality, only between 400 - 500 oocytes (eggs) are produced throughout a lifespan.
There are four phases to the normal menstrual cycle:
The menstrual cycle is a natural process that typically occurs over 28 days, though it can vary from person to person. It consists of four distinct phases, each playing a vital role in reproductive health. Understanding these phases can help you track your cycle, recognize changes, and better comprehend how your body prepares for potential pregnancy each month.
1. Menstrual Phase
Duration: 3-7 days
This phase begins on the first day of menstruation. During this time, the thickened lining of the uterus (endometrium) is shed, along with blood and other fluids, as your body prepares for a new cycle.
2. Follicular Phase (Pre-Ovulatory)
Duration: From the end of menstruation to ovulation
After menstruation, follicles in the ovary start to grow and mature. Under the influence of FSH (follicle-stimulating hormone) and oestradiol (E2), one follicle will release a mature egg, which prepares for ovulation.
3. Ovulatory Phase
Duration: 1-2 days
Around day 11-14 of an average 28-day cycle, the release of luteinizing hormone (LH) triggers ovulation. A mature egg is released from the ovary, making this the most fertile time of the cycle.
4. Luteal Phase
Duration: 12-14 days
After ovulation, the follicle turns into a corpus luteum {CL}, producing progesterone (P4). If conception occurs, the fertilized egg will implant in the uterus within 6-12 days. If not, the progesterone drops, and menstruation begins again.
Ovarian Reserve:
Understanding Your Fertility Potential
Ovarian reserve is a key indicator of fertility reflecting the quantity and quality of your remaining eggs. There are several tests used to assess your ovarian reserve, helping you and your healthcare provider make informed decisions about your fertility and treatment options.
Anti-Müllerian Hormone (AMH) Test:
A serum blood test that measures AMH levels, produced by follicles in your ovaries. This test can be taken at any time during your cycle and gives a clear picture of your ovarian reserve. Higher AMH levels generally indicate a better ovarian reserve, while lower levels suggest fewer remaining eggs. However, it’s essential to note that while AMH reflects quantity, it doesn’t directly measure the quality of the eggs.
AMH Levels by Age:
30-35 years: 6.8 pmol/L - 47.8 pmol/L
35-39 years: 5.5 pmol/L - 37.4 pmol/L
40-44 years: 0.7 pmol/L - 21.2 pmol/L
45-50 years: 0.3 pmol/L - 14.7 pmol/L
Periods
Regular Periods: A Sign of Balance and Health
A regular period typically occurs every 28 days, though cycles can range from 21 to 35 days depending on the individual. On average, about 2 tablespoons of blood are shed during this time.
Common symptoms include cramps, slight temperature changes, and mood swings, which are all signs of your body responding naturally to hormonal fluctuations. Regular periods indicate that your hormonal balance and reproductive system are functioning as expected, providing reassurance of your overall reproductive health.​
However, not all menstrual cycles follow this regular pattern. Variations in frequency, duration, and flow can occur, and these may signal different things about your body. Understanding these changes can help you better navigate your reproductive health.
In the following section, we explore what irregular periods, light or missing periods, and painful periods may indicate.
Irregular Periods (Metrorrhagia)
Any cycle outside the average range can be considered irregular. Factors affecting this include excessive weight changes, stress, anxiety, hyperthyroidism, PCOS, and lack of sleep.
Irregular periods can indicate hormonal imbalances or other health issues that may need medical attention.
Light/Scanty Periods (Hypomenorrhea)
Normally, a period lasts 4-5 days. Light or scanty bleeding can result from changes in the womb lining, previous surgeries like myomectomy or 'Dilation and Curettage' (D&C), or lifestyle changes such as stress, excessive exercise, or rapid weight loss.
Persistent light periods may warrant further investigation to rule out underlying conditions affecting menstrual flow.
Missing Periods (Amenorrhea)
Primary Amenorrhea:
Delay in starting periods in young women.
Permanent Amenorrhea:
Often seen in women approaching menopause.
Temporary Amenorrhea:
Should be investigated to address possible fertility issues or underlying conditions like Asherman’s syndrome.
Painful Periods (Dysmenorrhea)
Painful periods can signal underlying issues like Endometriosis, where endometrial tissue grows outside the uterus, potentially affecting fertility and quality of life.
If menstrual pain is severe or persistent, it may be a symptom of a condition that requires diagnosis and treatment.
