What Does My Weird Cycle Mean?

Question - What Does My Weird Cycle Mean?:

"I've had this problem for some time now that doctors have tried to help regulate my cycle with birth control pills. At times (more so than not) my cycle runs about every two weeks, and logic tells me that I can't be ovulating properly with this going on. I could be wrong, and am not looking to have children in the next year but look very forward to it in the future!

I never had a problem of this nature until I got off the Depo shot, and I'm not a big fan of the pill. The pill is the only solution the doctors that I have asked can come up with, and I would be grateful to receive your insight. I do love children so and would like to know how this cycle of mine reflects on fertility."

Answers:

Your concerns are valid, and you're wise to look into it now, before you are trying to conceive. It would be helpful in answering this question to know your age, as that has quite an impact on a woman's menstrual and ovulatory cycles, but I'll try to answer as generically as possible.

To clarify, by saying your cycle "runs every two weeks," I presume that you're referring to your entire menstrual cycle -- in other words, from Day 1 of menstrual Period A to Day 1 of menstrual Period B is a length of about 14 days. This is not within a normal range.

That said, I will add that the old adage that a "normal menstrual cycle" is 28 days in length can be very misleading. There's actually a pretty wide range of time that's considered normal, from about 24 days to about 35 days in length. So, even with that wide range in mind, your 14-day cycle is pretty short.

Occasional variances in a woman's period, such as differences in length of cycle, associated pain, or amount of bleeding, are also normal. It is when these "variances" become regularities, that is, happen over several cycles, that concern is warranted.

In your case, your time on Depo Provera, a time-released contraceptive drug, may indeed be having an impact. Again, some specifics would make answering this question a little easier, since the lasting effects of Depo are generally said to subside over time.

It has been the case, however, that some women who believed they were of average fertility later became concerned about some of Depo's lasting effects. That does not mean that Depo causes infertility -- while you may hear some very unhappy patients claim that as fact, it has not been proven. It helps to think of fertility in non-absolute terms.

We tend to think of ourselves (and others) as either fertile or infertile; in fact, there is a huge range of fertility, from very fertile to subfertile to sterile. The lasting effects of Depo, as with some other hormonal contraceptives, may indeed promote subfertility in women of normal fertility. Those effects should, however, last no longer than a few months at most after stopping the contraception.

If, however, a woman who never "tested" her fertility (that is, never attempted or achieved conception) before trying a hormonal contraceptive then later goes on to experience subfertility after ceasing the medication, it is very possible that a problem existed at some undetected level prior to beginning the contraception.

It's a hard call, and possibly one that doesn't even need to be made. The bottom line is this -- regardless of the involvement of Depo or other agents in your current fertility issues, your goal should be adequate assessment of current and future fertility and, even more importantly, reproductive health in general.

Now, for some possible reasons as to why you may be having such short cycles, and I'll be keeping the possibility of Depo effects out of these answers:

PCOS - Polycystic ovarian syndrome can sometimes result in shorter cycles.
Thyroid disease - Improperly regulated thyroid can also disrupt menstrual cycles.
Other hormonal dysfunction - There are a number of structural, environmental, and biochemical causes that will throw a woman's normal hormone levels off, causing menstrual/ovulatory irregularity.
Age - As women's bodies age, their cycles change, sometimes gradually and sometimes swiftly.

Using oral contraceptives, or birth control pills (BCPs), is a very common way of helping a woman regulate her cycle. Even women who are trying to conceive may benefit from a short time on BCPs, so long as she is being adequately monitored by a specialist. However, to simply place a woman on "the pill" without trying to first assess the initial cause of her cycle's disruption may be hasty. Menstrual irregularity can signal that a number of health problems exist, and not just infertility. Leave no stone unturned in your assessment.

Endocrinology (study of hormonal systems) is the field of expertise to which you should turn with your question. The medical specialty that is most closely related with questions of menstrual cycle regularity and its affects on fertility is reproductive endocrinology (RE). REs are endocrinologists who further specialize in conception and early pregnancy maintenance. If you have not yet consulted with an RE, you might want to consider it -- not for fertility treatment, per se, but for accurate assessment and then regulation of your cycle in an effort to protect future fertility.

There may also be a number of non-medical or alternative medical therapies that might assist you with regulating your cycle. However, I do not recommend that you self-treat without further assessment of a possible cause. Your best bet is to fully understand how the menstrual and ovulatory cycles are related, and about all of the various things that can impact those cycles. Then, take your knowledge to a specialist and discuss what these cycles may mean for you.