If fertility is a puzzle, menstruation is a piece that is often overlooked — or avoided.
Shame and stigma surround menstruation in cultures around the world, with some women made to feel unclean and unwelcome during their periods. Even those who accept that menstruation is normal and healthy aren’t always willing to talk about it. A recent survey found one in five women don’t even feel comfortable discussing menstruation with their healthcare providers.
Even though reproductive challenges are common, we’re reluctant to share them because talking about menstruation and fertility is uncomfortable. But your menstrual cycle offers key insight into your fertility, and it’s important to understand the link between the two, which likely means overcoming your reluctance and discussing the topic with a healthcare provider.
“Periods are nature’s way of helping us figure out ovulation,” said Dr. Cindy Duke, clinical assistant professor at the University of Nevada, Las Vegas School of Medicine, and a member of HealthyWomen’s Women’s Health Advisory Council. Ovulation is the release of an egg from the ovary into the fallopian tube, where it can be fertilized by sperm, which results in pregnancy.
Put simply, a person is considered to have better chances of being fertile if they’re menstruating regularly. “There are exceptions, but for the most part, if someone is having periods at regular intervals (28-35 days), the assumption is they are ovulating about 14 days before their period,” Duke said.
A person with an irregular period, on the other hand, is not ovulating regularly.
“There’s the assumption that if you have a period, whether it’s regular or not, you’re fertile. But people may be bleeding for reasons other than ovulation, which is why I emphasize regular intervals,” said Duke. While people with irregular periods may still ovulate sporadically, irregular menstrual intervals are generally an indicator that ovulation is not occurring on a regular basis, she explained.
There’s no question that irregular periods affect your fertility, according to Duke. Given the critical role menstruation plays in fertility, why aren’t more people aware of the connection? Duke points to cultural pressure that prevents people from seeking information.
“There’s a sense that talking about infertility means admitting that you’re broken, that you’re cursed, that you’re not fulfilling your basic human contract with society,” Duke said. “People have fear and misconceptions about how they will be judged.”
Racial disparities can also factor into misinformation about menstruation and fertility. Social determinants of health associated with institutionalized and interpersonal racism, including poverty and residential segregation, may make Black women more vulnerable to disparate outcomes when it comes to their sexual and reproductive health.
And years of mistreatment have led the Black community to be skeptical of the medical community.
“There’s a distrust within the Black community when it comes to doctors and reproductive health, a fear that doctors might harm you rather than help you,” said Duke.
She hopes that raising awareness about the link between menstruation and fertility will help give voice to people who may be suffering in silence.
“There are so many women out there who know their periods aren’t regular and still try to conceive for years before seeking professional help,” she said.
If your periods aren’t regular and you’re trying to conceive (or thinking about it), now is the time to talk to your doctor. Addressing potential problems early on may prevent struggles down the road. “Don’t wait,” said Duke. “You’ll save yourself a lot of time and tears.”