OVULATION

IMPORTANCE OF MENSTRUAL HISTORY

A normal menstrual history and a normal physical examination do not mean that a woman is fertile, but an abnormal history definitely tells about probable problems. The clues to a woman’s infertility may appear years before she plans a family. At menarche, the periods are naturally very irregular. However, within 2-3 years they should have stabilized so that they come about every twenty-eight days, are four to five days duration and tend to be bit heavier the first or the second day, tapering off to just a little spotting on the last day. There is precise hormonal balance, which regulates all this. If these intricate hormonal events are out of tune, the periods may be irregular.

In a fertile woman, the normal buildup of a firm, thick lining in the uterus, followed by softening of that lining in the second half of the month, leads to an even and neat flow of menstrual blood and the uterus has a fresh start with each new cycle. However, if there is no ovulation, the lining of the uterus builds up unevenly, and the bleeding can occur irregularly.

Great variation in number of days between menstrual periods, is a sign of an error somewhere in the hormonal axis and is usually associated with lack of ovulation. Certainly women with irregular periods can ovulate and get pregnant, but if they are ovulating, they are either ovulating late or are not ovulating each month. Some women may ovulate only twice a year and have mixed up periods in between. If the husband has a very high sperm count, the woman may very well get pregnant the one time she does ovulate.

Irregular periods indicate a step-by-step peeling off the lining rather than a heavy shedding of its entire thickness.

Some women get a sharp, crampy pain lasting several hours at the time of ovulation, on the side, where ovary is extruding the egg. For reasons not understood, most women do not feel this pain but those who do feel this pain can exactly tell when they are ovulating.

Using contraceptive pills will generally make irregular periods regular, because they artificially control the hormonal axis but is a temporary respite.

There is a definite increase in male hormone (yes! male hormone) output in women who are not ovulating regularly and small amount of hair on the breast and/or slightly denser than usual amount of hair around the anus, or even hair on the great toe are all subtle signs of elevated male hormone production.

Another sign of excess male hormone, which often turns up in the late teens and whose significance is not realized until ten or fifteen years later when a woman is unable to get pregnant, is acne. Very frequently acne, which persists beyond the mid-teens in a girl, is a sign of elevated male hormone production associated with lack of ovulation. Oily skin has similar connotations. Thus menstrual irregularity, excessive pain, abnormal body hair distribution, oily skin, and acne can be clues to an ovulatory disturbance. However, to pinpoint the ovulatory pattern accurately requires more than just guesswork?