Introduction:
Anovulation is a disorder related to ovulation. Disorders of ovulation are related to irregular periods (oligomenorrhea) or the absence of periods (amenorrhea). The absence of ovulation can be called anovulation and causes infertility. This condition is characterized by difficulty releasing eggs from the ovaries.
What Is Anovulation?
Ovulation is the process of releasing eggs or oocytes from women's ovaries. Anovulation occurs when ovulation is skipped. Some women get their periods like clockwork or regularly on time, whereas some may experience irregular periods or unpredictable periods.
Ovulation occurs normally every 21 to 35 days until menopause. Irregular or absent periods are signs of anovulation, which occurs when the ovaries do not release an egg. When this occurs, the uterus does not regularly get the proper hormonal messages to shed the uterine lining.
Ovulation occurs on the 14th day of the 28-day menstrual cycle. The exact day may differ depending on the length of the menstrual cycle. It may occur early or late. This process starts when the hypothalamus (a part of the brain) secretes gonadotropin-releasing hormone (GnRH). This GnRH causes the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
During the sixth and 14 days of the menstrual cycle, FSH causes small sacs of fluid in the ovaries that consist of developing eggs. These sacs are called follicles and appear in one ovary and begin to mature. During 10 to 14 days of the menstrual cycle, one of the follicles matures to form a developed egg. Around the 14th day of the menstrual cycle, a sudden release of LH causes the ovary to release its egg.
Many hormones work to maintain the ovulation process. When one of the hormones does not work properly, it may affect the entire ovulation process.
Anovulation can be observed in young girls who have just started their menstrual cycle and those who are approaching menopause (perimenopause). This is considered normal.
Sometimes, women with regular menstrual cycles may also experience anovulation. When anovulation becomes chronic, it may lead to infertility.
In a normal menstrual cycle, the release of eggs from the ovaries produces progesterone, which is responsible for maintaining regular periods in women.
During anovulation, the progesterone levels drop, and this may lead to heavy bleeding. Women may mistake this bleeding for a regular period. This type of bleeding may be caused by endometrium. The endometrium is a buildup of the lining in the uterus. It does not withstand itself. The reason for the bleeding may be a drop in the levels of estrogen.
It was estimated that 10 to 18 % of couples in the United States (U.S.) face trouble getting or staying pregnant.
What Are the Causes of Anovulation?
The main reason for anovulation may be a hormonal imbalance. A disruption in hormone levels related to ovulation may result in anovulation. Anovulation is considered normal during pregnancy, breastfeeding, the perimenopause period, and adolescence.
The causes of anovulation include
1. Polycystic Ovarian Syndrome (PCOS): This condition affects one in 10 women of childbearing age in the U.S. This condition may result in anovulation. In this condition, excess levels of hormones like testosterone and androgen (male hormone) may be observed due to hormonal imbalance. Small, painless cysts and underdeveloped follicles in the ovaries may be seen. These may cause irregular periods, excess body hair, weight gain, and infertility.
2. Weight Problems: Variations in weight, like being overweight or underweight, may lead to anovulation. Women who are overweight tend to produce higher levels of estrogen. These hormones make the uterine lining grow and become more fragile. Underweight women produce lower levels of estrogen. This tends to cause the uterine lining to be thin and blood vessels to bleed erratically.
3. Over-Exercising: Excess exercise for lengthy periods may lead to anovulation. Intense physical exercise may cause the pituitary gland to not produce enough LH and FSH.
4. Disorders Related to the Thyroid and Pituitary Glands: The pituitary gland, located in the brain, releases thyroid-stimulating hormone (TSH) and prolactin. An imbalance of any one of these two hormones may lead to anovulation.
5. Medications: Medications like steroids, chemotherapy, antidepressants, antipsychotics, and hormonal medicines like birth control pills or progesterone can affect the ovulation process.
6. Stress: Increased stress or anxiety can cause an imbalance of hormones like GnRH, FSH, and LH.
What Are the Symptoms of Anovulation?
Anovulation may not always exhibit symptoms. Experiencing a normal menstrual cycle may not always mean a woman is ovulating.
Symptoms related to anovulation include
-
Not experiencing periods.
-
Experience decreased amount or not having cervical mucus.
-
Increased bleeding, along with periods, may be experienced.
-
Experience light bleeding with period.
-
Experience irregular basal body temperature.
How to Diagnose Anovulation?
The diagnosis of anovulation can be made by examining the regularity or lack of periods. This may not be the same for all women. Healthcare providers may ask about history and symptoms and may perform a physical examination. Tests advised to know about anovulation include blood tests for hormone levels.
Blood tests include
-
Progesterone levels in the blood.
-
Thyroid levels in the blood.
-
Prolactin levels in the blood.
Ultrasonography of the intravaginal area is performed to view the reproductive tract and its problems. An endometrial biopsy is performed to examine the endometrium.
How to Treat Anovulation?
The treatment of anovulation depends on the hormone imbalance to be corrected.
The treatment includes
1. Lifestyle Modifications: These include good sleep, nutritious food, and moderate exercise that may help regulate hormones. If stress is the cause, relaxation techniques such as meditation, yoga, and deep breathing should manage it. Weight problems, such as being overweight or underweight, must be treated accordingly.
2. Medications: Some medications are used to treat problems related to ovulation. Fertility drugs are generally used in the treatment to balance hormones and trigger ovulation. Clomiphene citrate is the most commonly used drug to treat anovulation.
3. Surgery: If other treatments do not work, surgery may be performed. Ovarian drilling, a minimally invasive procedure done laparoscopically, helps reduce the levels of testosterone produced in the ovaries.
What Are the Complications of Anovulation?
Complications do occur in anovulation, but not everyone experiences them.
These include
-
Infertility may result because of problems related to ovulation.
-
Amenorrhea (irregular periods).
-
Hormonal imbalance may lead to weight gain, hair loss, and acne.
Other complications include
-
Endometrial hyperplasia is when the thickening of the endometrium occurs.
-
A lack of estrogen causes osteoporosis. Estrogen helps maintain the strength of bones.
-
Cardiovascular diseases may result from low estrogen. This causes insulin resistance, leading to diabetes.
Conclusion:
Anovulation is a condition caused mainly by hormonal imbalance. This condition may be frustrating and disappointing to experience. This condition may result in infertility. Hence, it becomes important to know about this condition, its causes, symptoms, complications, and management. Knowing about the condition helps identify it early. Early diagnosis always leads to effective treatment, which further helps achieve a good quality of life.
