Anovulation: What It Is, Symptoms, Causes And Treatment

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Ovulation is the process of egg release from one of the two ovaries (1). These eggs help you get pregnant, but some women may not be ovulating despite regular menstrual periods. But how can you get pregnant when you are not ovulating? This post helps you understand it better.

The egg not getting released from the ovaries is termed anovulation. Also called chronic anovulation, it continues for a year or longer and is a common cause of infertility. According to the National Institute of Health, problems associated with ovulation account for around 30% of infertility cases (2).

What Causes Anovulation?

Multiple hormones play a role in ovulation. Some of them include gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH). Any imbalance with these hormones can cause problems with ovulation.

Some other causes of anovulation are as follows (3):

1. Obesity

High body weight or BMI (body mass index) can cause a chemical imbalance in the body if there are excess androgens such as testosterone.

2. Stress

Excessive stress could cause imbalance in hormones

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Excessive stress can cause an imbalance in the hormones necessary for ovulation.

3. First and last periods

Anovulation can occur at any time during one’s menstrual cycle. However, it is more common when a girl first begins her menstruation or is approaching her menopause. Anovulation during this time may occur due to hormonal imbalance.

4. Low body weight or excessive workout

Excessive exercising or low body weight can negatively impact the woman’s pituitary gland leading to underproduction of LH and FSH.

5. Not consuming enough calories

A lesser bodyweight than usual can cause hormonal imbalance and may lead to issues with ovulation.

6. Hormonal birth control

The hormones in birth control pills prevent one from ovulating

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The hormones in birth control pills prevent one from ovulating (4).

7. Polycystic ovary syndrome (PCOS)

PCOS is a common condition affecting around one in ten women of childbearing age, causing anovulation. Small and painless cysts indicate the syndrome on the ovaries along with acne, or excessive male pattern hair growth, especially around the chin and upper lip. PCOS leads to an overproduction of male hormones or androgens such as testosterone. With increased androgen levels, the ovarian follicles that contain eggs remain small.

Point to consider
Obesity, adrenal gland issues, pituitary gland disorders such as Cushing’s syndrome and acromegaly, and medicines such as anabolic steroids may lead to increased levels of androgens in the body (11).

8. Abnormalities of TSH or prolactin

The imbalance of either of these hormones can cause issues with ovulation.

9. Hypogonadotropic hypogonadism (HA)

It is a condition in which the ovaries make little or no sex hormones (5) and is characterized by ovulation disorders (6).

10. Ovarian insufficiency

It is a condition wherein the ovaries stop functioning before a woman turns forty years and may lead to anovulation (7).

What Are The Symptoms Of Anovulation?

Irregular menstruation may cause anovulation

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Women with anovulation experience the following symptoms (8):

  • Extended or shortened menstrual cycles
  • Absent menstrual cycle
  • Irregular menstruation
  • Lack of cervical mucus
  • Irregular basal body temperature (BBT)

Many women with anovulation may continue to have normal periods. In such cases, your doctor may need other tools to diagnose anovulation.

How is Anovulation Diagnosed?

Doctor may run ultrasound test for irregular menstrual cycle

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If your menstrual cycles are regular and you still have trouble conceiving, the doctor may run the following tests to rule out any underlying problems (3).

  • Checking blood progesterone levels
  • Checking blood prolactin and thyroid levels
  • Ultrasound examination of pelvic organs
  • Uterine lining or other blood tests depending on the woman’s overall health and history

Is It Possible To Get Pregnant Without Ovulating?

Pregnancy is possible only when an egg is fertilized by male sperm. There is no egg to be fertilized without ovulation, and you can not get pregnant (9). However, with some lifestyle modifications and medications, anovulation can be managed.

Treatment Of Anovulation

Doctor may prescribe a treatment plan based on the results

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Your doctor may recommend the following lifestyle modifications to treat anovulation (3).

  • For women with high BMI or obesity, the doctors may ask them to lose weight. Losing weight can be difficult for women with anovulation, but you can achieve it with nutritional support.
  • For women with meager body weight, nutritional support can help them gain healthy weight.
  • For those who indulge in excessive heavy workouts, reducing the intensity and frequency can help.
  • Therapy is helpful for those experiencing stress and anxiety.
  • Sustainable diet plans can help attain a healthy weight and menstruation.

For severe cases where lifestyle modification does not help, the doctor may prescribe the following medications:

  • Clomiphene citrate
  • Aromatase inhibitors
  • Insulin-sensitizing agents
  • Gonadotrophins
Things to know
The doctor may also prescribe human chorionic gonadotropin (hCG), follicle-stimulating hormone (FSH), and gonadotropin-releasing hormone (GnRH) agonists and antagonist injections to regulate ovulation (11).

Even after all medical interventions, if you cannot conceive, the doctor may recommend other treatment options such as in-vitro fertilization (IVF) or intrauterine insemination (IUI).

Frequently Asked Questions

1. When does ovulation occur after the anovulatory cycle?

Some women may start ovulating in the subsequent menstrual cycle following an anovulatory cycle. However, others may continue their anovulation for months or years before they resume ovulating (10).

Anovulation is more common than it seems. Many women suffering from anovulation may not be aware of the condition if they have regular menstrual cycles. They might come to know if they cannot conceive even after having regular cycles. If you have anovulation, you should try all suggested lifestyle changes as they are sustainable ways to ensure good menstrual health. You can consult your doctor or nutritionist if you have any queries.

Key Pointers

  • Anovulation is a condition where the ovaries do not release eggs.
  • It can be temporary or chronic, whereas chronic anovulation could be one of the main reasons for infertility.
  • Anovulation can be managed by lifestyle modifications (such as diet, exercise, and self-care) or medications in most cases.

References:

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