Menstrual Cycles

Reproductive Problems

Polycystic ovaries (PCOS) Endometriosis
Pelvic inflammatory disease (PID) Ectopic pregnancy
Repoductive Problems


Reproductive Problems

The conditions below include the most common reasons for female infertility.

However, that is not to say that all women affected by them necessarily become infertile -
some women with small fibroids, say, may have successful pregnancies without treatment.
Treatment is an option in the case of most disorders.

Polycystic ovaries [PCOS] | Endometriosis | Pelvic inflammatory disease (PID)
Ectopic Pregnancy | Polyps and fibroids | Heavy bleeding [DUB]

Polycystic ovaries

This is a common condition in which many small cysts form in the ovaries. Polycystic ovary syndrome affects about one in ten women, Some of these women will encounter a variety of hormone-related problems, including infertility.

Women with Polycystic ovaries may have no symptoms - with the result that they only know that they have the condition when fertility tests are done. However, symptoms can include:
  • Obesity.
  • Excessive hair growth on the face or body.
  • Acne.
  • Infrequent or no menstrual periods.
  • Male-pattern baldness (from the temples, then the crown, gradually widening).
In women without polycystic ovarian syndrome, the ovaries begin to develop 20 eggs every month. These eggs mature in little sacs known as cysts. Over the course of the month, one egg will become dominant and draw most of the hormones being produced, eventually being released by the ovary to be fertilized or shed with your period. Women with PCOS, though, fail to produce the correct balance of estrogen necessary to help one egg become dominant. As a result, the 20 eggs develop but remain as cysts, which in turn results in the production of androgens, or male hormones, and little to no production of progesterone.

Because of the build up of androgens and lack of progesterone, women with PCOS may have irregular periods, fail to ovulate (anovulation), or fail to have a period (amenorrhea) entirely. When a period does occur, many women with PCOS note that their bleeding can be quite heavy. Those women dealing with irregular or heavy periods due to PCOS can use the birth control pill to help regulate their menstrual cycle.

Drug treatment is sometimes used to induce ovulation in women with polycystic ovaries. Otherwise, the cysts may be treated by being cauterized with a needle. This procedure is done by laparoscopy, in which a fibre-optic tube is inserted into the pelvic area through a small incision made just below the navel. This enables doctors to examine the womans reproductive organs, take samples and carry out some minor surgery. A general anaesthetic is given.



One in ten of all women referred for fertility testing turns out to be affected by endometriosis, making it a major cause of infertility. In this condition, cells similar to those of the lining of the uterus (the endometrium) become established outside it. They can grow any anywhere in the pelvic area - for example, on the ovaries, in the Fallopian tubes, bladder, uterus, bowel, peritoneum or the pelvic wall.

These stray endometrial cells respond to natural changes in hormone levels in the same way as those in the uterus. That is, they increase during part of the month and break down when the lining is shed (the period). However, because these cells are trapped inside the pelvic area, they cannot leave the body. Instead, they become inflamed and cause adhesions, which can cause one internal organs to become stuck to another. They may also form swellings which fill with dark blood - chocolate cysts.

Many women who are affected by endometriosis think that they merely have painful periods, with the result that the condition goes undetected for a long time - until fertility testing starts, in fact. The symptoms of endometriosis can include severe backache, abdominal pain and cramps during periods, and ovulation, during bowel movements and sex. The woman may sometimes also experience nausea and dizziness. Endometriosis is diagnosed by close examination of the pelvis, using a laparoscope.

The condition is usually treated by hormone therapy or by surgery. The procedure known as thermal coagulator treatment uses helium gas ionized by an electric current to dry out the endometrial cells. This procedure has had good results, and its other advantages is that it can be performed quickly.


Pelvic inflammatory disease (PID)

Infection can often cause inflammation in the uterus, Fallopian tubes and ovaries - a condition known as pelvic inflammatory disease. This is a common cause of infertility and other pregnancy related complications. It is estimated that women who have suffered with PID have a seven-fold risk of ectopic pregnancy.

The bacteria that causes gonorrhoea and chlamydia are thought to be the main causes of PID, although bacteria that normally exist harmlessly in the bowel or gut may also be the culprit. The bacteria enter the body through the vagina and then work up through the cervix into the pelvic cavity. The infection may occur as a consequence of sexually transmitted chlamydia, childbirth, miscarriage, termination or the fitting of an IUD.

In some cases, PID causes no symptoms other than the womans inability to become pregnant. It is therefore often not detected until fertility testing starts. The condition is also sometimes misdiagnosed as either endometriosis or appendicitis because it can cause similar symptoms. Where symptoms occur, they can include abdominal pain, exhaustion, high temperature and very heavy, painful periods. The pain has been described as a dull ache across the lower abdomen. In some cases it may be so intense that the woman is unable to move. The scar tissue caused by PID can cause pain during sex.

PID is diagnosed by means of an internal examination and a laparoscopy. It is usually treated with antibiotics. In severe cases, the woman may need to be admitted to hospital so that antibiotics can be given to her intravenously (directly into the veins).


Ectopic Pregnancy

An ectopic pregnancy is one that starts to develop in the fallopian tubes or, more rarely, in another site, on the cervix, in the abdomen, or on an ovary, rather in the uterus. Ectopic pregnancies occur with a frequency of 1 in 100 - 200 diagnosed pregnancies. It can cause permanent damage to the tube, leading to infertility. Doctors do not know why an ectopic pregnancy occurs. However, it is more common if the tube has already been damaged by infection, surgery or by a previous ectopic pregnancy.

An ectopic pregnancy can be extremely serious, even life threatening, and so the woman must get immediate medical treatment. The symptoms can include pain in the shoulder, spotty vaginal bleeding or intense pain in the abdominal area, sometimes initially diagnosed as appendicitis or miscarriage.

An ectopic pregnancy cannot develop normally. If diagnosed while the ectopic pregnancy is still small and has not ruptured the fallopian tube, methotrexate can be given to some patients to prevent further growth and avoid surgery. Once a fallopian tube has burst or ruptured, surgery is needed to remove the pregnancy. Sometimes, part of the Fallopian tube and part of the ovary may have to be removed as well, although doctors will avoid this whenever possible.

Women who have suffered one ectopic pregnancy are at a higher risk of experiencing another one. A subsequent ectopic pregnancy may occur in 10% - 20% of cases. However, many women who have had an ectopic pregnancy go on to have a perfectly healthy pregnancy. About 80% of the women who have experienced one ectopic pregnancy are later able to achieve a normal pregnancy.


Polyps and fibroids

Different forms of benign (non-cancerous) tumours or growths,polyps and fibroids can cause infertility in women. Doctors do not know why these grow.

Polyps have a stalk by which they attach themselves to the membrane lining the cervix or uterus. They may cause no symptoms, or the woman may experience a watery discharge streaked with blood between her periods and after intercourse.

Fibroids are bundles of muscle fibres that develop in the muscular wall of the uterus. They can vary in size from a small marble to a large ball. Fibroids are very common - one in five women over the age of thirty develops them. Like polyps, they may cause no symptoms. Where symptoms do occur, they may include long-lasting periods and heavy menstrual bleeding, including flooding and passing clots. The woman may also develop anaemia because of excessive blood loss, which can then lead to feelings exhaustion, breathlessness and depression, constipation and cystitis.

Polyps and fibroids are diagnosed by internal examination, ultrasound scan or laparoscopy. The woman may also be given a hysteroscopy, in which a viewing instrument is passed up the vagina into the uterus, or she may be offered a hsyterosalpingogram, in which a dye is injected through the cervix so that X-rays of the reproductive organs can be taken. Polyps and fibroids are usually removed surgically. Drug treatment may be recommended to shrink large fibroids before surgery.


Heavy bleeding or unusually long periods

Abnormal uterine bleeding - vaginal bleeding that is different from normal menstrual periods. It includes very heavy bleeding or unusually long periods (also called menorrhagia), periods too close together, and bleeding between periods. In adolescents and women approaching menopause, hormone imbalance problems often cause menorrhagia along with irregular cycles. Sometimes this is called dysfunctional uterine bleeding (DUB). Other causes of abnormal bleeding include uterine fibroids and polyps. Treatment for abnormal bleeding depends on the cause.

Early Menopause

The menopause usually starts in the woman's late forties but some women may stop having periods in their thirties or even their twenties. Women affected may at first think that they are pregnant. However, as well as the periods stopping, other symptoms can include hot flushes, night sweats,insomnia, vaginal drying, painful intercourse, loss of libido, genito-urinary infections, thinning of the skin, splitting of the nails, aches and pains, and incontinence. Women may also experience mood changes, anxiety, irritability, poor memory and poor concentration as well as subsequent loss of confidence.

If a doctor suspects premature menopause, the woman may be referred for a laparoscopy. In this procedure, the ovaries are examined by laparoscope (a fibre-optic tube), this allows the doctor to see if the woman's ovaries contain follicles with eggs. Women who experience premature menopause may still achieve a pregnancy, but only through assisted conception.

Early Miscarriage

The vast majority of women go on to conceive after a miscarriage with no problems.
It is recommended, though, that you wait anywhere from one to three months after miscarrying before you conceive again.

Even if you are physically ready to conceive, you may not be emotionally ready. Take your time and grieve if that's what feels right for you.



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