Not every menstrual cycle in women is ovulatory. In some cycles, ovulation does not occur, while menstruation remains regular, and many ladies do not even realize that there is no ovulation until they are faced with the impossibility of conceiving a baby. Why this happens and what to do, this article will tell.
Anovulation - what is it?
Ovulation is important, because it is she who gives a woman the opportunity to continue the birth, to conceive a child. In the process of ovulation, a mature egg appears from the follicle on the surface of the sex gland (ovary), which is an obligatory participant in the process of conception. This significant event usually occurs in the middle of the cycle.
Ovulation is completely hormone-regulated. In the process of maturation of a follicle with an egg inside, the hormone FSH acts, and after it reaches a large size, the hormone LH begins to be produced, which leads to rupture of the membrane and the release of the egg. A woman's reproductive cell lives from 24 to 36 hours, and during this time, with a successful coincidence, it can be fertilized by a male cell - a sperm.
Lack of ovulation is called anovulation. Within certain limits, this phenomenon can be considered normal, every woman has barren neovulatory cycles, and there is no getting around it. The only question is how often this happens. It is considered normal to have no more than 1-2 such cycles per year in women in the prime of their fertile period - 20-30 years. And after 35 years, the number of anovulatory cycles normally increases and can reach 5–6 per year, which is why, with increasing age, it is more difficult for a woman to conceive a child, even if she and her sexual partner are healthy.
If the number of "empty" cycles exceeds these norms, they speak of pathological anovulation, which is a consequence of disruption of the ovaries and hormonal imbalance. It is impossible to conceive a child without an egg, and therefore the absence of ovulation is identical to the concept of "infertility".
Why does this happen?
Age-related changes in the ovulatory process are due to the depletion of the ovarian reserve and a smaller amount of sex hormones produced than before. A woman is given about 450 germ cells for her entire life. Their consumption will occur not only during ovulation - some cells die under the influence of unfavorable external and internal circumstances. And when the reserve starts running out, the number of anovulatory cycles increases.
If the hormonal balance is disturbed, the delicate and delicate interaction between the hypothalamus, pituitary gland, ovaries can be disrupted, which also leads to the fact that there is no ovulation in the cycle, but menstruation remains regular.
This can be caused by dysfunctions of the hypothalamic-pituitary system, which often occur after cranial injuries, concussions, neuroinfections, in which the membranes of the brain were affected.
The reason for the lack of ovulation due to incoherence in the work of the pituitary gland and hypothalamus may be tumors, high levels of prolactin in the blood (this hormone, which is involved in breastfeeding and provides it, blocks the production of FSH, and follicles do not mature).
The ovaries can be immune (resistant) to the effects of sex hormones, and ovulation can also be mechanically hampered with a thickened ovarian capsule, in which the rupture itself does not occur. Disorders of the thyroid gland, obesity can also be the reasons for the absence of the ovulatory phase in the menstrual cycle.
The interaction of the pituitary gland and hypothalamus with the ovaries can be disrupted due to the fact that a woman is constantly experiencing severe physical exertion, taking antidepressants, anticoagulants, blood thinners. The work of the gonads is also influenced by stress: if a woman is experiencing a difficult emotional state, she is depressed, in fear, then the production of stress hormones is activated, which reduce the synthesis of sex hormones.
If a woman was protected by oral contraceptives, and then decided to plan conception, you should know that after such drugs, temporary anovulation often occurs - for 2-3 months. In this case, there is menstruation, but no ovulation.
Deficiency of estrogen leads to the fact that the follicles do not mature, as a result of which ovulation does not occur.
Symptoms
The absence of ovulation has no symptoms, which is why it is so difficult to understand whether it is happening or not, has already passed or it did not exist at all. Therefore, the main sign that indicates that a woman does not ovulate is the absence of pregnancy with unprotected intercourse throughout the year. Of course, the cause of infertility may lie in something else, but statistics say that it is ovulatory problems (or a factor of endocrine infertility) that are most common in women: it is revealed in every third infertile female in Russia.
If anovulation is repeated every month for a year or more, it is likely that hormonal imbalance will be reflected in manifestations at the physical level... Such women may experience a coarsening of the voice, increased growth of hair on the body, sooner or later, irregularities in the cycle appear - menstruation becomes not only irregular, but also different in terms of the volume of fluid secreted. The condition of the skin may deteriorate (a profuse acne appears), sexual desire decreases, a woman may begin to dramatically gain weight for no apparent reason.
It should be noted that in almost 35% of women with no ovulation, their periods are normal, on time, the cycles are regular. But it is not entirely accurate to call them monthly, therefore, for such monthly bleeding, the term "menstrual discharge" is used.
Diagnostics and treatment
To understand whether there is ovulation or not, a woman needs to start keeping a basal temperature chart. It is measured in the rectum or vagina in the morning immediately after waking up, trying to make fewer movements. Anovulatory cycles are indicated by a graph in which there are no significant rises and falls in the temperature curve, as well as a chaotic graph, which does not show the division of the cycle into two phases (at the time of ovulation, the temperature rises and remains elevated in the second half of the cycle). Additionally, it is advisable to do ovulation tests starting about 4-5 days before the expected ovulation. Observations and graphs for three cycles should be shown to an obstetrician-gynecologist who can understand exactly whether pathological anovulation is taking place.
The doctor may prescribe blood tests for sex hormones, as well as folliculometry - an ultrasound of the ovaries in dynamics, which helps to track how the follicle grows and whether the follicular membrane ruptures at the appointed time. Sometimes there is a need for tests, in which case the woman is given hormonal agents and monitors whether there is a response from the ovaries.
Its absence indicates resistance, in this case the simulation of ovulation is meaningless - IVF will be offered. Be sure to do an MRI of the brain to assess the state of the pituitary gland and hypothalamus.
Treatment consists of hormone therapy. Various hormones can be prescribed, the task of which is to normalize the stages of a woman's menstrual cycle. It should be noted that in most cases this helps well, in any case, after treatment, pregnancy occurs naturally in about 80% of women. Those who have not been helped are offered IVF treatment protocols, sometimes with a donor egg, if it is not possible to get your own quality one.
Treatment requires a woman to be diligent and responsible. Hormonal drugs need to be taken at the same time, without breaking the scheme, without forgetting about the next pill or injection. You need to normalize nutrition, monitor your physical form and weight. Treatment courses are usually not well tolerated - hormonal treatments for anovulation have many side effects, such as headaches, bloating, nausea, low and even depressed mood.
A visit to a psychologist or psychotherapist is often indicated, since only these specialists can help in eliminating psychogenic anovulation and reducing stress levels. As soon as stress hormones cease to be produced in large quantities, the endocrine background normalizes itself, without the use of hormonal therapy, and the woman becomes pregnant.
