A Break in Her Cycle

Nearly every woman at some time in her life will miss her menses. There is a myriad of other reasons for this to happen. Take, for example, my patient, Lindy. "I'm late again. Should I be worried?" she chirped as she perched herself on the end of the exam table and swung her legs back and forth nervously. Nurses General Nursing Article

A Break in Her Cycle

"Before we start to worry, let's talk", I reply then query about her menstrual history:

  • Last menses 7 weeks ago
  • First menses - age 13
  • Irregular 28-39 day cycle
  • 5-day menses - moderate flow
  • "missed" menses twice a year
  • And take her sexual history: Single lifetime sexual partner (male)...Consistent use of condoms

We are careful with a capital C, I'm telling you", she asserts confidently. I guess that's why I'm not too worried...but then you never know."

As I probe further I learn she has recently been experiencing discomfort during intercourse. "Sort of like a dull, pulling feeling on my left side, down low."

With this information, I now have an idea what may be the cause for her missed cycle, as well as past missed cycles, but we'll need to do an exam to see if I'm on the right track and also check for pregnancy by doing a urine test.

On exam, I find that her left ovary is enlarged to almost twice its normal size. This, along with a negative pregnancy test, lead me to conclude that Lindy has an ovarian cyst, It is probably a "follicular cyst". This is the cause of both her late menses and the discomfort she's been experiencing with intercourse.

"So how did I get it?" she asks in a straightforward manner.

"That is an excellent question," I reply as I launch into an explanation. "One of the most important things we women can do for our health is to understand our cycles. Remember those middle school health classes and the drawing of a woman with arrows running back and forth between her brain and her reproductive parts?"

"Ya, but I don't remember that stuff too well. I guess I didn't pay too much attention", she grins.

I smile too as I tell her she isn't alone. That most of us didn't pay that much attention because it was all so confusing and embarrassing for us at the time.

"Okay now, so here it goes again so pay attention," I direct her, smiling. "Here's the simple version. It starts with the shedding of your uterine lining - menses. By the end of this shedding process, two very important hormones, estrogen, and progesterone - we'll just call them E and P - are very low in your body. When E and P get low, it sends a signal to your brain to release another hormone - "follicle-stimulating hormone" (FSH) FSH does just what it sounds like it would do. It stimulates your ovary to produce a follicle, sort of a "bubble on your ovary." Actually, several follicles begin to develop, but usually, one follicle will dominant and the others just wither away. This follicle causes your ovary to release more and more E into your system and that makes your uterine lining begin to thicken. It also helps cause an egg inside the follicle to mature.

Your ovary is pumping more and more E into your system and when the E level reaches a critical mass, it signals the brain to release another hormone called the luteinizing hormone (LH). This one tells your ovary it's time to give up the egg. That's when ovulation occurs. Once your ovary releases its egg, the empty follicle does a miraculous thing. It turns into a little power plant that releases both E and P. This helps to prepare your uterus even more.

Your egg dances through your fallopian tube in a slow-motion ballet hoping to meet a sperm that will penetrate it. If that happens, it goes on to your uterus and buries itself in the thick lining and Voila - You are pregnant! But, if fertilization doesn't happen, your uterus begins to shed it's lining and we're back at the start of your cycle - menses. Any break in this cycle, controlled by hormones, will cause a change in your menstrual cycle.

Your menses is late because your ovary is hanging on to your egg. The follicle keeps getting bigger and bigger and is disrupting the pattern of your cycle. Does any of this make sense?" I ask.

"Ya and way cool! I think I get it. Okay, so what can I do? I don't want to be worrying about being pregnant and besides it's a pain in my side," she remarks.

"Literally," I reply then recommend that she consider one of the hormonal methods of contraception that suppresses ovulation such as the injection or the pill. Either of these will prevent follicular cysts from developing in the future. Most healthcare providers recommend the pill for ovarian cysts suppression. After a discussion of both methods she chooses to begin oral contraceptive pills (OCPs)

Most follicular cysts will resolve spontaneously, but I ask her to return in 6 weeks for another exam to assure that her cyst has resolved. I review with her the signs and symptoms that would warrant immediate evaluation with extreme pain being the main one. Although rare, ovarian cysts can become large and twist or rupture causing severe pain.

Follicular cysts are fairly common and easily controlled with OCPs, I assure as I prepare to leave the exam room. "Is there anything else that I can do for you today?"

Lindy grins mischievously, "Ya, now can you make algebra simple to understand?"

"No way!" I chuckle as I head for the door. "I've been looking for "X" my entire life and I still haven't found it! See you back in 6 weeks."

Retired women's Healthcare Nurse Practitioner - worked largely in MCH in USA, Belize and Kosovo

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WOW!!! You really need to be my A & P instructor! :yeah:

Specializes in Hospital - Home Health - Public Health -.

Thanks! :-) I see your speciality is 'veins' - me? I can't satrt an IV to save my soul! Merry Christmas!

Wow thanks for explaining this to me. I just went in to my OBY/GYN for the same reason today. Missed period and on day 55 of my cycle. Had an ultrasound and he found a 5 cm cyst on my left ovary. I think that it was a follicular cyct. I didnt' understand quite what caused it or when it would resolve but your explaination eased my worrying :) He too put me on oral contraceptives.

Specializes in Maternal Child Health - specialty in wom.

Rachael - I'm happy to hear tht my rambling made sense. I'm sure your cyst will resolve on it's own with the oral contraceptives. follicular cysts nearly always do.

Specializes in Med/Surg, Home Health.

Wow, you know your stuff! I had a cyst that kept growing, it reached the size of a grapefruit (along with more smaller ones). My ovary just wouldnt let go, lol. I had them removed, they kept coming back. I finally had to have a hysterectomy. :( That was the turning point in my life, I will never be the same again.

Specializes in Maternal Child Health - specialty in wom.

chenoaspirit - Thanks for the kudos! I hope you mean that your life has changed in a good way. If you'd like to 'talk' more privately just sent me a private message.