While some women’s periods are like clockwork, for other women, however, they can be completely unpredictable. A woman normally ovulates every 21 to 35 days until menopause, but if you’re experiencing irregular periods, or no periods at all, this may be a sign of anovulation.
“Anovulation is when your ovaries don’t release an egg,” said Megan Cheney, MD, an OBGYN at Banner – University Medicine Women’s Institute. “When this happens, your uterus doesn’t get the right hormonal messages to shed the uterine lining at regular, expected intervals.”
Anovulation isn’t unusual for young girls who have just started their periods or women who are approaching menopause (perimenopause). Even women who typically have regular menstrual cycles can experience it from time to time. However, chronic anovulation is one of the most common causes for infertility.
If you’re trying to get pregnant or are experiencing irregular menstrual cycles, read on to learn more about the causes, symptoms and treatment options for anovulation.
What causes anovulation?
If you’re experiencing anovulation, you’re probably wondering why it’s happening. Anovulation occurs when the body’s hormones are out of balance. To trigger ovulation, your hormone levels must reach a certain level for the release of an egg to occur. Any disruption can lead to anovulatory cycles.
Anovulation is normal when you are pregnant, breastfeeding, perimenopausal, or during adolescence. Other potential causes of anovulation include:
Polycystic ovary syndrome (PCOS): This condition is one of the most common causes for anovulation, affecting nearly 1 in 10 women of childbearing age in the U.S. PCOS causes small cysts or underdeveloped egg-containing follicles in the ovaries, which can cause irregular periods, excess body hair, weight gain and infertility.
Weight issues: Having a low body mass index (low body weight) or being overweight can also prevent you from ovulating.
“Women who are overweight often produce higher levels of estrogen which causes the uterine lining to grow and be more fragile,” Dr. Cheney said. “Women who are underweight often produce lower levels of estrogen, making the uterine lining thin and the blood vessels underneath more likely to bleed erratically.”
Over-exercising: Too much intense exercise for an extended period of time can cause ovulation to stop.
Thyroid and pituitary disorders: Thyroid-stimulating hormone and prolactin are two hormones released by the pituitary gland in the brain. Imbalances in these, such as hypothyroidism or hyperthyroidism, can lead to anovulation.
Certain medications: Some medications, like steroids, chemotherapy, antidepressants or antipsychotics and hormonal medications, such as birth control pills or progesterone, can sometimes interfere with ovulation.
How do I know if I am experiencing anovulation?
Unless you’re tracking your ovulation, you may not even notice. However, there are a few things to look out for that could indicate you’re having an anovulatory cycle: Your period is heavy, you experience irregular bleeding or you have no bleeding at all.
“Often, women with anovulation will have no periods for two to three months, and then a very heavy, prolonged episode of bleeding,” Dr. Cheney said. “In other words, having vaginal bleeding that is unpredictable in timing, duration and amount of flow.”
How is anovulation diagnosed?
The first step to diagnosing anovulation is becoming familiar with your menstrual cycle. “Menstrual cycle tracking is the most helpful tool to make the diagnosis,” Dr. Cheney said.
In addition, talk to your doctor about any concerns you have about your menstrual cycle and share any additional symptoms. They may recommend a blood test to measure progesterone, thyroid hormone, prolactin levels and other hormones.
How is anovulation treated?
Because there are many factors that can influence your hormones and menstrual cycle, there is no single solution for anovulation. Often, the underlying cause of anovulation is resolved with treatment.
“For example, if you’re overweight, weight loss can definitely help to regulate your periods without having to take any medications or make other changes,” Dr. Cheney said. “If you’re underweight, increasing caloric intake and/or decreasing exercise intensity can help.”
In other cases, fertility drugs may be prescribed when anovulation is confirmed, lifestyle changes have failed to correct the problem and you’re otherwise healthy to conceive.
“When there is a substantial reserve of eggs in the ovaries, and conditions like perimenopause are not the cause of your anovulation, the potential for inducing ovulation with medication is very good,” Dr. Cheney said. “On the other hand, when there are only a few eggs present in the ovaries, inducing ovulation is sometimes more difficult and often requires the assistance of a fertility specialist.”
Can I get pregnant with anovulation?
Treating conditions like PCOS and hypothyroidism can increase your odds of pregnancy. However, this may not always be the case and may require the assistance of a fertility specialist.
To find a Banner Health specialist near you, visit bannerhealth.com.
