Researchers at Michigan State University have discovered that the cytoplasmic droplet in sperm is crucial for storing proteins vital for fertility, controlled by a protein trafficking system influenced by the SYPL1 gene. This breakthrough could have significant implications for fertility research and control.
Researchers at Michigan State University have unraveled the enigma of a lesser-understood sperm structure known as the cytoplasmic droplet (CD). The CD, characterized by an enlarged cytoplasm—a viscous, gelatinous substance encapsulated by a cellular membrane—is located near the sperm’s head, specifically at its neck. This phenomenon is observed in all mammals, humans included. This new genetic model is the first of its kind.
Despite being first discovered more than 100 years ago, it’s been unclear how the CD forms and what its function is due to the lack of molecular and genetic tools to study it.
Scientists have often disregarded it, but it can’t be ignored anymore said Chen Chen, an associate professor in the Department of Animal Science and the Reproductive and Developmental Sciences Program in MSU’s College of Agriculture and Natural Resources.
“Our new study using mice shows that the CD is indeed an actively forming organelle purposefully designed to regulate sperm maturation and fertility,” Chen said. “It acts as a ‘storage room’ to pack up critical proteins needed for sperm function before its long journey to reach the egg. It’s like packing for a trip to Mars — the spaceship needs to load up everything needed for the journey before leaving Earth.”
The Role of SYPL1 Gene in CD Formation
Chen and his research team discovered a novel protein trafficking system within the developing sperm that actively transports essential proteins via small membrane vesicles to the CD — the sperm storage room. This process is controlled by a gene called SYPL1. The SYPL1 protein resides on these membrane vesicles and plays a pivotal role in directing them to reach the CD. You can think of these vesicles as cargo trucks delivering protein cargos to the sperm storage room, Chen said.
Chen noted that when the SYPL1 gene is deleted in mice, this protein trafficking system collapses, and critical metabolic enzymes and essential proteins fail to be shipped to the CD, resulting in an empty CD devoid of vesicles — something he had never seen before. Consequently, without major CD contents, mutant sperm lose their motility and ability to cope with osmotic changes — they bend, leading to infertility.
“I believe this study represents a breakthrough in understanding the CD formation and its potential function,” Chen said. “At the cellular level, it helps us realize that there is a specialized protein trafficking system that actively transports cargo to the CD for future use by sperm for their journey to the egg.
“Fundamentally, this finding will change people’s misconception about this mysterious sperm structure. It will open new avenues for research on the CD as a biomarker for fertility in humans and animals and, possibly, on targeting this novel pathway for fertility control.”
Bacterial imbalances in the semen microbiome may cause a reduction in semen and sperm quality, according to a new study.
Semen has its own microbiome, and bacterial imbalances may impact sperm count and quality, according to a new study.
The researchers found unusually high levels of the bacteria Lactobacillus iners in males with low sperm motility.
The link between the health of the semen microbiome and gut microbiome remains unclear.
Experts say healthy lifestyle choices that promote a healthy gut could also support the health of the semen microbiome.
Globally, there is a reported decreaseTrusted Source in male sperm count or the number of viable sperm within semen.
Some research points toward pollution as a factor contributing to male infertility, but this does not explain why an estimated 30% of semen is considered abnormal.
A new reproductive study of semen examined the impact of the health of the semen microbiome on sperm motility, which is the sperm’s ability to swim successfully through the female reproductive system to reach and potentially fertilize an ovum or egg.
The study finds that high levels of the bacteria Lactobacillus iners (L. iners) are associated with low sperm motility.
This study represents the first time a distinct semen microbiome has been suggested and investigated, and the first in which L. iners has been linked to a lowering of sperm motility.
Along with “sperm helpers,” such as enzymes, fructose, and citric acid, there is a community of bacteria within semen.
In addition to L. iners, the most prominent bacteria found in semen include:
Enterococcus faecalis
Corynebacterium tuberculostearicum
Staphylococcus epidermidis
Finegoldia magna
For the study, the semen of 73 males seeking treatment for reproduction issues or vasectomies was analyzed.
The researchers found that 27 males with reproduction issues all exhibited higher amounts of L. iners compared to the 46 males seeking vasectomies who had already successfully reproduced and who had healthy semen.
The males with abnormal semen also had comparatively higher levels of the bacteria Pseudomonas stutzeri and Pseudomonas fluorescens. They had lower levels of Pseudomonas putida than those with normal semen.
The study’s first author, Dr. Vadim Osadchiy, an academic urologist specializing in men’s health and infertility, explained how the L. iners bacteria present in males and females may affect infertility:
In females, “this microbe can act as a symbiotic organism, meaning it helps maintain the healthy vaginal microbiome and prevents bad players from taking over,” Dr. Osadchiy said.
The relationship, if any, between the lesser-known semen microbiome and the gut microbiome is unclear, but experts have a few theories.
“I think the farther away you get from the reproductive tract, anatomically speaking, the more tenuous the relationship becomes between the semen microbiome and the various other microbiomes in our bodies,” Dr. Osadchiy suggested.
“We know there is an intimate relationship between the urinary and semen microbiome as the reproductive and urinary tract are interconnected [although] the two microbiomes are certainly distinct,” Dr. Osadchiy added.
Dr. Menka Gupta, a functional medicine doctor with NutraNourish, not involved in the study, suggested it may be possible to improve semen microbiome health but prioritizing gut health.
“I can potentially see a connection between the gut and the semen microbiome through lifestyle factors such as diet, level of stress, [and] exposure to toxins,” Dr. Gupta said.
Dr. Osadchiy noted it may be possible that a gut microbiome with inflammation could “result in conditions that favor a pro-inflammatory semen microbiome.”
“I’m not sure if there is too much definitive data on this yet, but that would be my hunch,” he said.
Dr. Gupta said further exploration of the role of the semen microbiome in fertility outcomes is needed, which could lead to “new treatments to improve sperm parameters and male fertility.”
Dr. Osadchiy agreed, noting there’s still much to learn about the body’s microbiomes in general, specifically the semen microbiome.
“We know that microbial community interactions can be just as important as the actions of individual players, so work to understand microbial communities in semen would help contextualize our findings. There are still so many questions related to the semen microbiome. More exploratory work but larger sample sizes and greater geographic diversity may help us better characterize what is expected variability since it’s likely there isn’t just one ‘good’ semen microbiome and not just one ‘bad’ microbiome.”
— Dr. Vadim Osadchiy, first study author
Dr. Osadchiy said a deeper understanding of the relationship between the semen microbiome and infertility is also needed, and researchers currently lack “a good sense of what sort of factors are under our control to positively (or negatively) impact the semen microbiome.”
“I wouldn’t be surprised if what is good for the body in general is also good for the semen microbiome,” Dr. Osadchiy added.
Despite the lack of understanding of the relationship between the semen and gut microbiome, both Dr. Osadchiy and Dr. Gupta recommended prioritizing healthy lifestyle choices to improve sperm quality and motility. These include:
Spotting before a period is typical and often means the period is about to start. It may last for around 1 or 2 days. However, sometimes spotting occurs for other reasons, such as pregnancy.
Spotting is light bleeding from the vagina that is noticeable but not substantial enough to soak a pad or liner. The blood is typically brown or dark red.
A 2020 studyTrusted Source of 116 women found that 41.7% experienced at least 1 day of spotting before a period. Other potential causes include hormonal birth control, perimenopause, or medical conditions.
This article explains the causes of spotting before a period, how to tell the difference between spotting and a very light period, and when to see a doctor.
Light bleeding or spotting can sometimes be an early sign of pregnancy. Doctors and other healthcare professionals call this implantation bleeding because they think it happens when a fertilized egg attaches itself to the lining of the uterus.
Implantation bleeding typically occurs 1–2 weeks after fertilization, which is often around the time that a person would expect to start their period. Although implantation bleeding is usually lighter than menstrual flow, some people may mistake it for a very light period.
People who think that they might be pregnant may wish to consult a doctor or take a home pregnancy test.
The birth control pill is a form of hormonal contraception that prevents ovulation and makes the cervix and uterus a less favorable place for fertilization. The pills contain synthetic hormones that can also help regulate a person’s menstrual cycle.
When someone starts taking birth control pills, they may experience some spotting before their period for the first few months. Healthcare professionals call this breakthrough bleeding. It signifies that a person’s body is adjusting to the hormones. This bleeding does not mean that the pill is not working.
Other types of hormonal birth control, such as the implant or hormonal intrauterine device (IUD), can also result in spotting because these methods provide a low, consistent dose of hormones. This may stop after a few months.
Spotting may also occur if a person misses a pill, takes a pill later than usual, or uses emergency contraception.
Ovulation is the point in the menstrual cycle when the ovaries release an egg, which then travels down a fallopian tube toward the uterus. This process usually occurs about halfwayTrusted Source through a typical menstrual cycle and can sometimes result in spotting.
Menopause is the time in a person’s life when they stop having periods. An individual reaches menopause when they have gone at least 12 months without a period. Perimenopause is the transition to menopause, and it can last for up to 10 years.
During perimenopause, hormone levels fluctuate, which can lead to irregular spotting and changes to the length and heaviness of a person’s period.
Other types of hormonal fluctuation may also lead to spotting before their period. For example, people only just starting their menstrual cycle during puberty may have some irregular spotting while their cycle becomes established.
People may also experience spotting after stopping birth control, when beginning their menstrual cycle again after childbirth, or after stopping breastfeeding.
Sometimes, sexual intercourse can irritate the delicate tissues of the vagina, which can sometimes cause a small amount of bleeding. A person may mistake this for spotting.
Lubricant may help to prevent this irritation from happening. However, if this bleeding occurs regularly, a person should speak with a gynecologist, as bleeding or pain after sex can be a symptom of some medical conditions.
A very light period can sometimes resemble spotting and vice versa. The duration and volume of the spotting may help people tell the difference.
Spotting before a period usually lasts 1 day or moreTrusted Source and occurs within several days of the period starting.
A light period usually produces enough blood to soak into a pad, whereas spotting may leave only tiny traces.
If spotting begins but then a period does not start, a person is likely having a very light period. It may help to track when bleeding begins and how much blood there is to see if there is a pattern.
Spotting before a period is not usually a cause for concern. However, if a person only experiences spotting and no period, or the spotting keeps occurring frequently throughout the menstrual cycle or after sex, they could consider speaking with a doctor.
It is also best to seek medical advice if any of the following symptoms accompany the spotting:
Spotting before a period may not require any treatment, as it is a typical partTrusted Source of the transition into menstruation. Wearing a panty liner or pad can usually protect a person’s underwear from staining.
However, if persistent spotting is due to a birth control method, a doctor may advise:
taking pills at the same time each day
if taking a continuous form of birth control, scheduling a period every few months
stopping smoking, if relevant, as this can help
changing to another method of birth control
For medical conditions that cause spotting or bleeding after sex, the treatment will vary depending on the cause.
Spotting before a period is commonTrusted Source and often means a period is about to begin. However, spotting can sometimes be an early sign of pregnancy. Spotting may also occur due to other hormonal fluctuations, such as starting a birth control pill or entering perimenopause.
Although spotting is not usually a cause for concern, a person should talk with their doctor if spotting is persistent or occurs alongside other symptoms, such as pain, irritation, and unusual discharge.
A ‘synthetic’ embryo could aid the understanding of human development during a ‘black box’ period |
STORY HIGHLIGHTS
The breakthrough is expected to further the scientific understanding of the development of human embryo and enhancement of the research into genetic disorders.
In a remarkable breakthrough that could revamp the existing understanding of In Vitro Fertilisation (IVF) in the area of human reproduction, scientists have created synthetic human embryos using stem cells. The development reportedly dodges the need for eggs and sperm for the creation of human embryos.
The work was reportedly described on Wednesday in a plenary address at the International Society for Stem Cell Research’s annual meeting in Boston. However, the full details of the latest work, from the Cambridge-Caltech lab, are yet to be published in a journal paper.
“Our human model is the first three-lineage human embryo model that specifies amnion and germ cells, precursor cells of egg and sperm,” Professor Magdalena Żernicka-Goetz, of the University of Cambridge and the California Institute of Technology, was quoted as saying by The Guardian.
“It’s beautiful and created entirely from embryonic stem cells.”
What is a ‘synthetic’ embryo like?
Created by stem cells, it does not have a beating heart or the beginning of a brain. However, they do have the cells which form the placenta, yolk sac and the embryo itself.
Why is a ‘synthetic’ embryo needed?
A report in The Guardian cites scientists saying that these sythetically created embryos could provide crucial information on the biological causes of recurrent miscarriages.
According to a paper published in The Lancet in April 2021, globally, an estimated 23 million miscarriages occur annually.
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At the same time, the basic need for the work is for scientists to understand the “black box” period of human development, which is referred to the duration between the 16 or 17 days after fertilisation and more than a week after the free-floating embryo anchors itself to the lining of the womb.
Scientists are currently allowed to cultivate embryos in the lab up to a legal duration of 14 days. Beyond that, they pick up on the course of the development by looking at pregnancy scans and embryos donated for research.
“The idea is that if you really model normal human embryonic development using stem cells, you can gain an awful lot of information about how we begin development, what can go wrong, without having to use early embryos for research,” Robin Lovell-Badge, the head of stem cell biology and developmental genetics at the Francis Crick Institute in London, was quoted as saying by The Guardian.
A TCM doctor shares a successful case of conception after three failures of artificial insemination.
A young couple who suffered from infertility for three years, finally became pregnant after a three-month acupuncture and Traditional Chinese Medicine treatment.
Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. According to the world health organization, infertility affects millions of people of reproductive age worldwide – and has an impact on their families and communities. Estimates suggest that between 48 million couples and 186 million individuals live with infertility globally.
Traditional Chinese medicine (TCM) offers countless ways to improve one’s health and well-being. The following story is one of many that illustrates the efficacy of TCM in treating infertility.
A couple had been married for three years. The woman, “Ms. W.” despite three attempts of artificial insemination, failed to become pregnant. Ms. W. suffered from insomnia, anxiety, and appetite loss. “Mr. W.” had problems with insomnia, bloated stomach, deficiency of stomach acid, and low back pain.
Dr. Jonathan Liu, a TCM practitioner with more than 26 years of professional medical experience, prescribed acupuncture and TCM for both of them. After a three-month treatment, the couple rejoiced at the announcement of conception.
Symptoms and Consultation
TCM treatment focuses on considering the body as a whole. The organs of the body are connected to other parts of the body which constitutes a whole-body system. The reproductive system is related to the kidneys, and the female reproductive system is also called the “lower elixir field,” located in the abdomen.
The pelvic cavity locates in the lower elixir field and includes the urinary and reproductive systems. Despite modern medicine’s ongoing research of the microcosm of the human body, the reproductive process remains complicated. Reproduction involves ovulation, fertilization, and implantation of an embryo into the uterus.
Ovulation disorder is the most common cause of infertility in women. Though modern medicine has a variety of treatment methods, the process of implanting zygotes into the uterus has not been fully studied.
A professor of obstetrics said that human science seems to be well-developed, but we still cannot recreate a uterus. After in vitro fertilization (IVF), also known as artificial fertilization, the fertilized egg still needs to be implanted in the uterus. If the implantation fails, no pregnancy occurs. The current IVF success rate is more than 95 percent and the chance of conceiving a child is around 30-40 percent, which is equivalent to the natural fertility rate of healthy couples.
In TCM, qi (vital energy), blood, essence, and body fluids are the essential substances for life activities, all originating from the internal organs and flowing constantly inside the body. Ensuring these essential substances are sufficient and circulating throughout the body is very important for health and well-being. Illnesses or other conditions are caused by the stagnation or lack of these substances.
The critical issue of this couple was the unsuccessful implantation of embryos into the uterus, failing to conceive a fetus. Strengthening the kidney and replenishing the “essence” is a method to facilitate the normal hyperplasia of the endometrium, and can ensure the fertilized eggs land on the endometrium successfully.
It is also necessary to disperse “qi” in a stagnated liver, relax the mind, and relieve emotional pressure for conception to occur. For this couple, ongoing infertility was causing them stress and discord. They were nervous—which affects the endocrine system, thus adding to the causes of infertility.
In the theory of TCM, the organs and emotions affect each other. The liver takes over the transformation of energy in the whole body—thus emotions such as anger or fear can damage energy in the liver.
Acupuncture and TCM
To increase their chances of conception, Liu recommended acupuncture to strengthen the kidney and facilitate pregnancy: Gate of origin (CV 4), Central Pole (CV 3), Return (ST 29), and Celestial Pivot (ST 25)—this group of acupoints is near the abdomen and can strengthen the kidney and replenish the essence, enhance the hyperplasia of the endometrium, and make fertile “the soil” so the implanted seed can grow thickly and steadily.
The other group of acupoints is in the back: Heart Shu (BL 15), Diaphragm Shu (BL 17), and Kidney Shu (BL 23), which can strengthen the yang energy in the body, and connect the heart above and the kidney below, resulting in warming yang and strengthening kidney.
In Chinese philosophy, energy in the universe can be divided into yin and yang, represented by the two colors on the Tai Chi diagram. Yin and yang are opposite to each other but can be mutually transformed. Both the universe and the human body contain yin and yang. For example, the day is yang, the night is yin, warm is yang and cold is yin, etc. The critical factor in treating diseases in TCM is balancing the yin and yang inside the body.
A warm environment and rich nutrient support are essential to fetal growth. It is all about energy in the lower elixir field—the replenishment of qi. Once the yang qi is sufficient, the sperm and ovum will have vitality and easily combine, and the hyperplasia of the endometrium will also be complete and adequate—conducive to the embryo’s growth.
Except for acupuncture, Liu prescribed TCM to regulate their bodies. The medicine for the woman was focused on strengthening kidneys, warming the uterus, nourishing qi, and dispersing the qi in the liver. The medicine for the man focused on dispersing the qi in the liver, strengthening his kidneys, and replenishing the essence. Healthy sperm and the health of seminal plasma secreted by gonads are essential factors for creating a healthy baby.
Fertility arises from your overall good health and these tips may help
Think you’re too old, too stressed out, or too busy to become pregnant? There are commonsense strategies and simple, everyday health habits that could make your dreams of parenting come true.
In the United States, 15 percent of couples are unable to conceive a biological child of their own, as reported by the University of California at Los Angeles Health in 2020.
Couples are considered to have an infertility problem when they have had regular and frequent unprotected sex for 12 consecutive months without conception.
“In the United States, about 10 percent of women, 6.1 million, aged 15 to 44 have problems getting pregnant,” a 2019 U.S. Department of Health and Human Services Office on Women’s Health report found.
The Office publishes an ovulation calendar on its website, womenshealth.gov, to help women target their most fertile days of the month, when they would be most likely to conceive.
Infertility, says the American Pregnancy Association (APA), is an equal opportunity health condition experienced by both men and women at nearly the same rate.
“Often, it’s assumed that the fertility difficulties are with the women,” says the APA on its website, “but in 40 to 50 percent of infertility in couples, (it) is due to male factors. Male infertility alone accounts for approximately up to 50 percent of all cases of infertility. It’s important for both partners to be tested.”
Male Fertility, Testing, Sperm Count, and Sperm Health
When a couple has not been able to conceive after consistently making the yearlong effort, both partners need to have a comprehensive physical and medical workup with their healthcare provider.
First, according to the APA, sperm is collected and inspected microscopically to assess their number, their shape, their appearance, and the speed of their movement. The more healthy and strong sperm are, says the APA, the better chance the couple has of conceiving.
“Normal semen contains 40 million to 300 million sperm per milliliter,” they write. “A low sperm count is considered to be anything between 10 and 20 million sperm per milliliter. Twenty million sperm per milliliter may be adequate for pregnancy if the sperm are healthy.”
If the sperm count is found to be low, a urinalysis can be performed to detect any signs of infection or the presence of sperm in the urine, where it should not be found.
If the sperm is adequate and healthy, then a lab will check the male’s testosterone levels and other hormones.
There are also many at-home sperm count tests available in stores and online at a range of price points.
If no abnormality is found, it’s on to testing the female, but not before taking a general health inventory so that the male can bolster his chances of conception with some simple lifestyle adjustments.
Some lifestyle habits that have been shown to lower the sperm count in men include:
Being overweight
Not exercising
Substance abuse including excessive alcohol
Not taking the vitamins D, C, E, and CoQ10, which are important for sperm health
Exposure to toxic environmental chemicals
Cycling more than five hours per week on a bike that is not fitted properly
Wearing constricting undergarments instead of loose boxers or cotton briefs that permit air flow and moderate temperatures for men. This has been found to be the optimum environment for sperm health.
Researchers found that, “Weight loss can significantly increase semen volume, its concentration, its mobility and percentage of normal morphology,” they wrote. “Consuming vitamin C significantly improves sperm concentration and mobility, but the semen volume and the percentage of normal morphology will not change significantly.”
In another study published in the journal Human Reproduction in 2014, researchers found engaging in reasonable exercise and having a generally healthy lifestyle can contribute to a higher sperm count. In particular, the researchers found that “weightlifting and outdoor exercise can help sperm health more than other types of exercise. Consider incorporating these kinds of activities into your routine. Exercise can also help you maintain or lose weight, which may have additional benefits for your sperm health.”
A less conclusive study published in Reproductive Biology and Endocrinology in 2015, found somewhat lower rates of pregnancy in couples where the man had low levels of vitamin D, but it was not significant. That said, couples with better vitamin D levels fared better, the researchers found.
“The pregnancy rates per patient and per cycle and delivery rates per patient and per cycle were all significantly higher (p< 0.05) in couples with normal vitamin D levels,” they wrote.
How can women promote their own fertility?
If the name of the game for men is sperm health, for women it is ovulation.
Once again, healthy lifestyle choices can increase your chances of becoming pregnant. The Mayo Clinic offers these suggestions:
The most common causes of female infertility include:
Problems with ovulation
Damage to fallopian tubes or uterus
Problems with the cervix
Age, as fertility naturally tends to decrease over time
An unhealthy weight because being overweight or significantly underweight can inhibit normal ovulation
Sexually transmitted infections such as chlamydia and gonorrhea
Regularly working a night shift and not sleeping enough can affect hormone production
Too much stress and a lack of effective coping strategies.
Smoking tobacco, which ages ovaries and depletes eggs
Drinking alcohol, which elevates a woman’s risk of ovulation disorders
Caffeine consumption of over 200 milligrams per day (three cups or more)
Heavy and vigorous physical activity over five hours a week may inhibit ovulation and reduce progesterone
Exposure to environmental pollutants and toxins
Fertility Lubricant
For couples who are trying to get pregnant, every lifestyle choice can impact your success in conceiving, and lubricants used during sexual activity are no exception.
That’s why the Food and Drug Administration has cleared a list of criteria required from lubricant manufacturers that ensures they are tested and confirmed to be safe for sperm, eggs, and embryos.
“Fertility lubricants are specifically tested to ensure that the lubricant has a similar pH and viscosity as semen and fertile quality cervical fluid so that it provides a protective environment for sperm and will allow sperm to swim into and through the lubricant,” according to the APA. “By matching the quality and consistency of cervical fluid, fertility lubricants supplement your body’s own natural lubrication.”
Consumers looking for conception-friendly lubricants should “avoid lubricants with a low pH, and that contain small penetrating chemicals (for example, glycerol) or paraben preservatives,” advises the APA website.
“They should also “avoid using a lubricant labeled as non-spermicidal with an FDA-cleared fertility lubricant.”
It’s well-established that sperm counts are plummeting in the Western hemisphere, dropping by more than 50 percent over the past 40 years. But while scientists agree that it’s a problem, they can’t yet agree upon the causes. This year, we learned that a low sperm count isn’t an issue singularly associated with infertility — it’s also linked to a multitude of other health concerns.
Sperm counts can indicate other health issues.
As Inverse reported in March, scientists speaking at the Endocrine Society’s 100th annual meeting in March presented research demonstrating that low sperm quality is associated with metabolic alterations, cardiovascular risk, and low bone mass. Lead investigator Alberto Felrin, M.D., Ph.D., of the University of Padova in Italy, announced that this means “infertile men are likely to have important co-existing health problems or risk factors that can impair quality of life and shorten their lives.”
Ferlin and his team studied 5,177 male partners in infertile couples and discovered that men with low sperm counts were 1.2 times more likely to have more body fat, higher blood pressure, less “good” cholesterol, and more “bad” cholesterol. The broadly accepted standard for a low sperm count is less than 39 million wiggly reproductive cells per ejaculate.
Declining sperm counts are an indicator of declining overall health, say endocrinologists.
They also found that this group of men was more likely to have “metabolic syndrome” — a cluster of conditions, including high blood pressure, that predisposes one to diabetes, heart disease, and stroke. These men, compared to men with higher sperm counts, also had a higher resistance to insulin, a symptom that can precede diabetes.
This revelation — that a man’s semen count is an extremely transparent marker of his general health — can actually serve to benefit men. Knowing that these ailments are linked to low sperm count can prepare doctors to holistically take care of their patients when they come in for fertility treatments. Fertility specialists, Ferlin stresses, should recommend that their patients additionally see a primary care doctor. A low sperm count doesn’t just mean it’s harder to have a baby — it means that dad needs some extra care too.
There are some period problems that are unfortunately par for the course, like cramps, irritability, and bleeding more than you would like to be bleeding from your vagina.
But there are also some period problems that you should bring up to your doctor—just in case—because they’re a bit outside of what’s normally expected during menstruation. Here are some things to keep an eye out for.
1. You soak through a pad or tampon in an hour or less, your period lasts longer than seven days, or both.
The clinical term for an exceedingly heavy or long period is menorrhagia. These are basically horror movie-style periods, but some people don’t even realize this kind of bleeding is abnormal. “One of the biggest problems is someone being so used to heavy bleeding that she underplays the amount,” Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. “She’ll come in and say her periods aren’t too bad, then say she has to change her tampon every hour.” Passing clots larger than a quarter is also a sign your bleeding is too heavy, according to the Centers for Disease Control and Prevention (CDC).
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It’s not just that bleeding way too much or for too long is messy and inconvenient. Losing more than the typical two to three tablespoons of blood during your period or bleeding for longer than seven days can lead to anemia, the CDC says. If you have anemia, you lack enough healthy red blood cells to get oxygen to all your tissues, so you may feel tired and weak, according to the Mayo Clinic.
Bleeding too much can also be a sign of various health issues, like uterine fibroids, which are benign growths in and on the uterus that can sometimes come along with problems like pelvic pain and frequent urination. Uterine polyps, which are growths on the inner lining of the uterus, can also cause heavy bleeding, as can cervical polyps, which are lumps that emerge from the cervix. Both types of polyps are typically non-cancerous but, in rare cases, may contain cancer cells.
The hormonal issue polycystic ovary syndrome (PCOS) can also cause heavy bleeding. Worse, this bleeding can strike after months of an MIA period. This gives your uterine lining a chance to build up over time, leading to an abnormally heavy period when it finally comes, Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale Medical School, tells SELF. PCOS can also cause symptoms like excess face and body hair or severe acne, thanks to high levels of male hormones.
Heavy menstrual bleeding could even be a sign of a disorder that causes you to lose too much blood, like idiopathic thrombocytopenic purpura (ITP). ITP usually comes along with other symptoms like easy and excessive bruising or a rash of reddish-purple dots on a person’s lower legs.
Clearly, figuring out what’s causing your heavy bleeding won’t be easy on your own, so you should see your doctor. They’ll typically ask about your other symptoms and perform exams to determine what exactly is going on, and treatment will depend on what you’re dealing with.
2. Your period brings days of pain that make it practically impossible to leave your bed.
Dr. Streicher’s rule is essentially that if you’re experiencing even an iota of period pain beyond what you’re fine with, it’s too much. The first step is typically to take nonsteroidal anti-inflammatory drugs, since they block hormone-like chemicals known as prostaglandins that cause uterine cramping. If that knocks out your cramps, you’re good to go. If you’re still curled up in the fetal position after a few hours, that’s a sign that you need evaluation, Dr. Streicher says. You’re dealing with dysmenorrhea (severe menstrual cramps), and doctors can help.
There are many different causes of overboard menstrual cramps. Fibroids are a common culprit. So is endometriosis, a condition many experts think happens when tissue lining the uterus travels outside of it and begins growing on other organs. (Other experts believe that tissue is actually different in that it can make its own estrogen, which can create painful inflammation in people with endometriosis.) In addition to causing extremely painful periods, endometriosis can lead to painful intercourse, occasional heavy periods, and infertility, according to the Mayo Clinic.
Adenomyosis, which happens when the endometrial tissue lining the uterus grows into the muscular walls of the organ, can also cause terrible menstrual pain, along with expelling big clots during your period and pain during intercourse.
3. You never know when your period is going to show up.
Pour one out for all the times you thought you’d have a period-free vacation, only for it to show up right as you hit the beach. Fun! Irregular periods could be due to a number of different things that are (at least somewhat) in your control, like stress and travel, Dr. Streicher says. But they can also happen because of various health conditions.
Take thyroid issues, for instance. Hypothyroidism, which is when your thyroid gland in your neck doesn’t produce enough hormones, can lead to an irregular period, according to the Mayo Clinic. It can also cause myriad other symptoms, like heavier than usual periods, fatigue, constipation, dry skin, weight gain, impaired memory, and more. Treatment typically involves taking medication that mimics the thyroid hormone.
On the flip side, hyperthyroidism, which is when your thyroid gland is overactive, can cause light or infrequent menstruation, along with issues like sudden weight loss, rapid heart rate, increased appetite, and more frequent bowel movements, according to the Mayo Clinic.
Irregular periods are also a sign of premature ovarian failure, which is when a person younger than 40 starts losing their normal ovarian function, according to the Mayo Clinic. It can also cause menopausal symptoms like hot flashes, night sweats, vaginal dryness, and difficulty conceiving. Doctors can offer estrogen therapy to relieve symptoms like hot flashes (typically in conjunction with progesterone to avoid the precancerous cells that may take hold if you take estrogen alone). They can also counsel you about the possibility of in vitro fertilization if you’d like to physically conceive and carry children in the future.
PCOS and uterine polyps be behind irregular bleeding, too.
4. Your period decides not to show up for a while.
While it’s true that you can sometimes randomly miss a period for reasons like stress, you shouldn’t just ignore a long-term missing period. Suddenly being period-free may feel blissful, but you’ll want to make sure there’s not a health issue going on, like PCOS, an eating disorder or excessive exercise affecting your menstruation…or, yes, pregnancy.
“If you’re menstruating normally then suddenly go months without a period, that’s not something to ignore,” Dr. Streicher says. If your period vanishes for three months or longer (this is known as amenorrhea), see your doctor for evaluation.
It’s worth noting that the use of some hormonal birth control methods—especially the hormonal IUD—can make your period basically disappear. Still, check with your doctor, just in case, when this happens.
5. You’re dealing with a lot of unexpected spotting between periods.
It could be something that’s ultimately pretty harmless, like a benign uterine or cervical polyp that’s causing bleeding between periods. But spotting is also a hallmark of pelvic inflammatory disease (PID), which is the result of sexually transmitted bacteria from infections like chlamydia and gonorrhea spreading to reproductive organs like your uterus, fallopian tubes, and ovaries. In addition, pelvic inflammatory disease can cause issues like fever, strange vaginal discharge that smells bad, and burning when you pee.
If you have PID, your doctor will first address the STI in question with antibiotics, says the CDC, then treat your partner for an STI if necessary. Pelvic inflammatory disease is a leading cause of chronic pelvic pain and infertility in women, so if you suspect you have it, treatment is of the essence.
More rarely, spotting in between periods can be a sign of cervical cancer, according to the Mayo Clinic. Cervical cancer can come along with watery, bloody discharge that might have a bad odor and pelvic pain, including during intercourse. Even though this likely isn’t your issue, you’ll want to get checked out, just in case. Treatment for cervical cancer may involve a hysterectomy, radiation, or chemotherapy.
6. You experience debilitating mood issues before your period.
When your estrogen and progesterone drop before your period, you may experience the typical mood swings that mark premenstrual syndrome (PMS). (Bear in mind that this may not be as drastic if you’re on hormonal birth control, which stabilizes your hormones throughout your cycle.)
But if you deal with severe mood swings, irritability, anger, a lack of enjoyment in things you usually enjoy, and other symptoms that affect your life, you may have premenstrual dysphoric disorder (PMDD). PMDD happens when you experience these symptoms in the week before your period, then they start getting better in the first few days of bleeding, and disappear in the weeks after your period. It’s listed in the DSM-5, the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, for good reason: This psychological issue can completely turn your life upside down.
“If you suspect you have PMDD, the one thing I would encourage is keeping a daily record of the severity of your symptoms,” Dr. Minkin says. If these symptoms only rear their head the week before your period, PMDD might be your issue. If you realize you’re constantly dealing with them and your period just makes them worse, it might be premenstrual exacerbation, which is another way of saying you have a mental illness like depression that gets worse during your period.
Either way, a doctor can help. If you have PMDD, your doctor may have you take antidepressants in the timeframe when you usually experience symptoms, then stop once your period starts, Dr. Minkin says. (If you have premenstrual exacerbation, they may recommend staying on the antidepressants through the month and potentially upping your dosage in the week before your period.)
Or your doctor may suggest you go on birth control using a synthetic version of progesterone called drospirenone, Dr. Minin says, like Yaz and Beyaz. These are FDA-approved to treat PMDD. Though experts aren’t sure why they can be so successful in this arena, it may be because drospirenone reduces a person’s response to hormonal fluctuations. It’s also a diuretic, meaning it can flush out liquids that could otherwise cause fluid retention and contribute to annoying issues like bloating.
7. You have excruciating migraines before or during your period.
If migraines had any home training, they’d at least leave you alone when you’re about to get your period. Unfortunately, period migraines are indeed a thing.
It’s not that menstruation will just randomly cause migraines in unsuspecting people who have never had one, but women with a history of migraines may experience them before or during their periods, according to the Mayo Clinic, which adds that this may be due to estrogen fluctuations. “They tend to get the headache right as they go into their periods, and it seems to get better after they have had their menses for a day or two,” Dr. Minkin says.
If you’re dealing with this, your typical migraine medication may work for you. As you probably know if you’ve grappled with migraines, the treatment options are legion. They include pain-relieving medications to relieve symptoms ASAP and preventive drugs to ward off migraines altogether, according to the Mayo Clinic. In the former camp, you have choices like anti-nausea meds and triptans, which constrict swollen blood vessels and block pain pathways in the brain. In the latter, you’ve got meds like tricylic antidepressants, which affect brain chemicals like serotonin that may be implicated in migraines.
No matter what your period problem may be, you don’t have to suffer in silence.
You have no reason to feel embarrassed about your period—or the myriad problems that can come with it. After all, celebrities are out here talking about menstruation! Some pad commercials even—gasp—use red “blood,” these days! What a time to be alive.
If you’re having period problems, see your doctor for help. If they aren’t committed to relieving your symptoms, that’s a sign you should try to find a more sympathetic medical professional who can help you find the best treatment.
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