Is a 60 day menstrual cycle normal?

We all know that different people have different physical fitness and menstruation is also different. Some people even have very long menstrual cycles, which is beyond our imagination. Generally speaking, after a person reaches adulthood, the menstrual cycle is fixed and will not change at will. However, if it suddenly changes over a period of time, you should pay attention to whether there are substantial changes in your lifestyle habits. So, is a 60-day menstrual cycle normal?

1. Related diseases and treatments

1. The main cause of dysfunctional uterine bleeding is the dysfunction of the hypothalamus-pituitary-ovarian axis regulation. For adolescent functional uterine bleeding, because the regulatory function of the hypothalamus-pituitary gland is immature, stable cyclical regulation and positive feedback have not been established with the ovaries, FSH levels remain low, no LH peak is formed, and although the follicles grow, there is no ovulation. When the growth reaches a certain level, the follicles become atretic. Low estradiol (E2) cannot form positive feedback. During menopause, ovarian function declines and the number of follicles decreases significantly. The sensitivity of the follicles to gonadotropins decreases, E2 secretion is significantly reduced, and FSH levels increase. Because the positive feedback level of estrogen cannot be reached, there is no pre-ovulatory LH peak, and anovulatory functional uterine bleeding occurs. There are many mechanisms for functional uterine bleeding during childbearing age, such as the influence of physical condition and the uncoordinated feedback mechanism; the peripheral conversion of androgens to estrone increases the level of E2 converted from estrone, disrupting the cyclical changes of E2, causing FSH/LH ratio imbalance, no LH peak, and no ovulation. There is also an unexplained low FSH/LH ratio, which affects the maturation of follicles, and E2 is too low to cause positive feedback, resulting in no ovulation. The principle of treatment is to supplement estrogen and progesterone cyclically or sequentially to achieve the purpose of hemostasis or cyclical menstruation. Women of childbearing age can also undergo ovulation induction to establish a normal follicular development cycle.

2. Polycystic ovary syndrome (PCOS) is one of the most common gynecological endocrine diseases. The latest research estimates that the incidence of PCOS in women of childbearing age is approximately 4% to 12%. The main clinical features of PCOS are ovulatory disorders, irregular menstruation or amenorrhea, infertility, hirsutism, acne, obesity, etc. Its typical endocrine characteristics are: high LH/FSH ratio, hyperandrogenism, hyperestrogenism, hyperprolactinemia, insulin resistance, etc. The main treatment direction of PCOS is to reduce LH and androgen levels, improve insulin resistance, and induce ovulation at low doses to establish a normal development microenvironment for follicles.

2. Related clinical applications

The application of menstrual cycle regulation mechanism is of great significance to the improvement of ovulation induction program. Estrogen-progestin combined oral contraceptives starting in the follicular phase or estrogen supplementation starting in the late luteal phase can inhibit the increase of FSH and GnRH through negative feedback, avoid premature selection of dominant follicles, and improve the synchronization of follicular development in the ovulation cycle. In patients with diminished ovarian reserve, the selection of the dominant follicle may occur earlier. Under the stimulation of high-dose FSH during the ovulation induction cycle, the dominant follicle rapidly increases in size and then becomes atretic due to the large difference in diameter with other follicles. For such patients, the early application of hormone replacement cycles to inhibit the increase of FSH can not only increase follicle synchronization, but also enhance the responsiveness of granulosa cells to exogenous FSH due to estrogen supplementation, thereby increasing the number of mature eggs obtained. Clomiphene, the first-line ovulation-inducing drug, increases endogenous FSH secretion by binding to the pituitary estradiol receptor and inhibiting the negative feedback of E2 on FSH, thereby promoting follicle development.