Irregular Periods & Miscarriage History: Evaluation & Pregnancy Planning

Irregular cycles and prior miscarriage warrant systematic evaluation to optimize future reproductive outcomes.

Irregular Menses: Differential

• Ovulatory dysfunction: PCOS (most common), thyroid (hypo/hyper), hyperprolactinemia, hypothalamic amenorrhea (stress, weight, exercise).
• Structural: Polyps, fibroids, adhesions (Asherman's).
• Perimenopause: >40 with changing patterns.
• Iatrogenic: Hormonal contraception, antipsychotics, chemotherapy.

Miscarriage Context

• Prevalence: 10–20% of recognized pregnancies; 1% recurrent (≥2 losses).
• Etiologies: Aneuploidy (50–60%), anatomic (uterine septum), antiphospholipid syndrome, endocrine, thrombophilia, genetic (balanced translocation).
• Prognosis: After 1 loss: 80–90% next pregnancy viable; after 2: 70–75%; after 3: 60–65%.

Recommended Workup

1. Cycle tracking: BBT, OPKs, app — confirm ovulation, luteal length.
2. Basic labs: TSH, prolactin, FSH/LH/estradiol (day 3), AMH, testosterone, DHEAS, 17-OHP.
3. Anatomic: Saline infusion sonohysterogram (SIS) or HSG.
4. RPL panel (if ≥2 losses): Karyotypes (both), antiphospholipid antibodies, HbA1c, uterine cavity eval.
5. Genetic counseling: If parental translocation suspected.

Treatment Targets

• Ovulation induction (letrozole > clomiphene for PCOS).
• Thyroid normalization (TSH <2.5 mIU/L preconception).
• Metformin (insulin resistance/PCOS).
• Progesterone supplementation (luteal phase defect — controversial).
• Low-dose aspirin + prophylactic LMWH (antiphospholipid syndrome).
• Hysteroscopic septum resection / polypectomy.

Timing Next Pregnancy

Physically: 1–3 cycles for endometrial recovery. Emotionally: individual. Evidence doesn't support mandatory wait. Optimize health factors first.