Some women have specific disorders of ovulation because of a specific imbalance of reproductive hormones that is not associated with stress, weight loss or any of the other conditions explained below.

Polycystic ovarian syndrome (PCOS)
Some women are unable to develop eggs in a synchronised manner each month because of a hormonal imbalance. An ultrasound picture of the ovary often shows a number of small, immature eggs developing at different rates. It may be difficult for the ovary to develop any single egg to the point where it is mature enough to ovulate. Occasionally one or two of these developing eggs become cystic. For this reason women with this abnormality are said to have polycystic ovarian syndrome, or PCOS. Usually the cystic eggs disappear when the next period comes. The irregular growth of eggs in women with PCOS results in irregular and usually infrequent periods. Some women with PCOS may tend to be overweight and troubled with acne and hirsutism (excess hair growth).

Hyperprolactinaemia
Specific disorders of ovulation may also be due to an excess of another hormone produced by the pituitary gland called prolactin, which can cause infrequent or absent periods. Some women with excess prolactin also start to produce a small amount of milk from their breasts. Some of these women may have a small benign tumour in the pituitary gland that is causing the overproduction of the hormone.

Premature menopause
Specific disorders of ovulation may occur at any age. Although the average age for women reaching the menopause in Britain is 51, some women can develop a premature menopause. It is possible for this to happen as early as 20 years of age, but this is unusual.

When should you see a doctor?
Specific disorders of ovulation or infrequent periods during adolescence or approaching the menopause are normal and are nothing to worry about. If your periods are infrequent but not causing any inconvenience, and you are an adolescent or a woman in your 40’s, you can be reassured that there is nothing wrong and you need not see a doctor.

Heavy periods
If, as occasionally happens during adolescence and around the menopause, your period when it does come is particularly heavy and troublesome, you may need to consult your doctor.

When to consult a doctor.
You should consult your doctor immediately if you experience the following specific disorders of ovulation:

1. your periods have become infrequent or have stopped altogether and this is abnormal for you,
2. you have never established regular cycles with regular periods.

Remember that one of the first signs of pregnancy is an absence of periods. If pregnancy is a possibility you should see a doctor fairly soon – particularly if you do not wish to be pregnant. It will be helpful to the doctor if you keep a record of your periods so that any pattern may be obvious.

Trying for a family
If you are trying to start a family and you have irregular or absent periods, do not wait too long before seeking advice. You may find it more difficult to become pregnant than women who have periods once each month.

Need for contraception
If you do not want to have a baby, you should not rely on the fact that you are having no periods or only infrequent periods to prevent you from pregnancy. The system could correct itself at any time. If you do not want to become pregnant you must use a method of contraception. You may need to discuss an appropriate method with a doctor.

What will the doctor do?
The doctor may ask you some questions, examine you and perhaps take some blood or urine for tests. Sometimes it is then simply a matter of reassuring you that there seems to be nothing fundamentally wrong and waiting a little while longer for your periods to become regular. Often your periods will sort themselves out. Some women, particularly those who are trying to become pregnant, may need further investigations and treatment. Your doctor may refer you to see a specialist who will undertake some more investigations and tell you whether you need any treatment.

It does not matter if you have no periods for a few months. You are not storing up large amounts of blood that are waiting to come away at some time. It is simply that the system is either not working properly or is switched off completely. However, it is not good for you to live for years with very infrequent periods or with no periods at all. You should ask a doctor’s advice if you are worried.

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