Anovulation is a common cause of infertility. It means you’re not ovulating or releasing an egg. Hormonal imbalances typically cause it, and the main symptom is having irregular vaginal bleeding. Healthcare providers treat anovulation with lifestyle changes and/or medication to help balance your hormones.
Anovulation (also called an anovulatory cycle) happens when an egg doesn’t release from your ovary (ovulation). Ovulation only happens one time during your menstrual cycle. The egg that your ovary releases at ovulation has the potential to be fertilized by sperm and create a pregnancy.
Anovulation often happens due to a hormone imbalance. Since multiple hormones contribute to ovulation, there can be many causes of anovulation. Because ovulation is critical to pregnancy, anovulation is a common cause of infertility.
Being aware of your menstrual cycle length and understanding how your body changes throughout your cycle can help you identify signs of anovulation. It’s important to contact a healthcare provider if you notice irregular menstrual cycles or abnormal vaginal bleeding so they can determine an underlying cause and recommend treatment.
Ovulation typically happens on day 14 of a 28-day menstrual cycle. The exact day can vary and, depending on the length of your menstrual cycle, happen sooner or later.
The process of ovulation begins when your hypothalamus (a part of your brain) releases gonadotropin-releasing hormone (GnRH). GnRH causes your pituitary gland (a gland in your brain) to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
Between days six and 14 of your menstrual cycle, FSH causes follicles (small sacs of fluid in your ovaries that contain a developing egg) in one ovary to begin to mature. During days 10 to 14 of the cycle, only one of the developing follicles forms a fully mature egg. Around day 14 in the menstrual cycle, a sudden surge in LH causes the ovary to release its egg.
You can think of ovulation as an orchestra with your hormones acting as the instruments. When everything is playing in harmony, the song can flow from beginning to end effortlessly. But, if even one instrument is off-key, it messes up the entire song. The other hormones are completely thrown off and can’t do their part of the song. This is similar to what happens if one hormone is slightly off in the days leading up to ovulation.
Anovulation can affect anyone who has ovaries and is of child-bearing age, which, on average, is between the ages of 12 and 51. If any of the following conditions or situations apply to you, you’re more likely to experience anovulation:
Anovulation is a common condition and is the cause of approximately 30% of infertility cases.
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Being aware of the general signs of ovulation and keeping track of your menstrual cycles can help alert you to signs and symptoms of anovulation. It’s important to remember that having a period doesn’t necessarily mean you’ve ovulated. Signs and symptoms of anovulation can include:
Menstruation, or getting your period, happens because an egg wasn’t fertilized by sperm. When you don’t ovulate, there’s no egg to fertilize. Because of this medical definition, you technically can’t menstruate without ovulating.
However, you can still bleed — experience a “period” — without ovulating. This is known as abnormal uterine bleeding (AUB), or anovulatory bleeding. AUB is uterine bleeding that’s irregular and doesn’t follow a cycle. Abnormal uterine bleeding is common — approximately 30% of people assigned female at birth (AFAB) experience it at some point in their lives.
In general, the cause of anovulation is an imbalance of one or more hormones, especially the hormones involved in ovulation, which include:
However, even hormones that aren’t directly involved in ovulation, such as testosterone and prolactin, can impact the hormones your body needs for ovulation. The following hormone imbalances and conditions can cause anovulation:
Androgens are a group of hormones that help with growth and reproduction. Typically, androgens are thought of as male-specific hormones, but the female body produces a small amount of androgen hormones, too. Androgens include testosterone, androsterone and androstenedione. Your gonads (ovaries or testicles) and your adrenal gland produce androgens.
When a person with ovaries has a higher-than-normal level of androgen hormones in their blood, it’s called hyperandrogenism. The follicles in your ovaries contain eggs. A high level of androgens can cause these follicles to stay small instead of enlarging and maturing like they’re supposed to before ovulation. Conditions that can cause hyperandrogenism include:
Your pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are needed for ovulation. If your pituitary gland isn’t releasing enough LH and FSH, it can cause anovulation. Conditions and situations that cause your pituitary gland not to release enough LH and FSH include:
Prolactin is a hormone that your pituitary gland releases mainly for stimulating breast milk production (lactation). But prolactin also suppresses luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are needed for ovulation. Because of this, a high amount of prolactin in your blood can cause anovulation. Conditions and situations that can cause hyperprolactinemia include:
Your thyroid — the butterfly-shaped gland in the front of your neck — produces two hormones that are needed for many important bodily functions: triiodothyronine (T3) and thyroxine (T4). Having a low level of thyroxine in your blood can increase the amount of prolactin your pituitary gland makes. Prolactin suppresses luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are necessary for ovulation, so a low level of thyroxine can cause anovulation. Conditions and situations that can cause hypothyroidism include:
Your hypothalamus (a part of your brain) produces gonadotropin-releasing hormone (GnRH). GnRH triggers the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are needed for ovulation. Because of this, having low levels of GnRH in your blood can cause anovulation. Damage to your hypothalamus can cause low levels of GnRH.
Risk factors for having anovulation can include:
Anovulation can potentially cause complications. Not everyone will experience complications, though. Some possible complications include:
It can also increase your risk for the following health conditions:
In general, the diagnosis of anovulation is having irregular periods. Your healthcare provider can determine if you have anovulation by listening to your symptoms and noting that you don’t menstruate regularly.
However, your healthcare provider will want to investigate and determine the cause of your anovulation, which may lead to another diagnosis.
Tests for diagnosing anovulation depend on what your healthcare provider suspects are causing anovulation. It’ll mainly consist of hormone blood tests. Tests that can help diagnose anovulation include:
Many of the hormone imbalances that cause anovulation have other symptoms, so your provider may have you undergo other tests if you’re experiencing symptoms of a certain hormone imbalance condition.
Treatment for anovulation depends on correcting the hormonal imbalance that’s causing it, if possible.
In general, lifestyle changes that may treat your anovulation include:
Other treatments for anovulation include:
If fertility and pregnancy are your goal, and lifestyle changes and/or medication don’t help to treat your anovulation, there are still ways you may be able to experience pregnancy. Talk to your healthcare provider or a fertility specialist about in vitro fertilization (IVF) or intrauterine insemination (IUI).
You can’t prevent anovulation, but some of the reasons you have anovulatory cycles can be due to things you can manage. Things you can help manage include:
The outlook for anovulation depends on the cause of your anovulation. In most cases, lifestyle changes, fertility drugs or medication that treats the underlying health condition can treat anovulation. If you’re experiencing perimenopause, anovulation is more difficult to treat because hormonal changes are a natural and normal part of reaching menopause. Your healthcare provider can still help treat your symptoms, though.
Depending on the cause, anovulation can be temporary or chronic. It varies depending on your situation. Medication and/or lifestyle changes can often — but not always — treat anovulation.
Lifestyle changes and/or medication can often treat anovulation, which means you’ll have an opportunity to get pregnant. But there are many other factors that contribute to a successful pregnancy.
If you’re receiving treatment for anovulation and are still having a difficult time getting pregnant, your provider may recommend in vitro fertilization (IVF) or intrauterine insemination (IUI).
Contact your healthcare provider if any of the following apply to you:
If you’re receiving treatment for anovulation and still having issues conceiving, contact your healthcare provider or fertility specialist.
If you’re experiencing anovulation, it may be helpful to ask your healthcare provider the following questions:
A note from Cleveland Clinic
Experiencing anovulation can be a frustrating, disappointing and confusing time, especially if it’s contributing to infertility. While it’s natural to feel uncertain about your future or wonder if you’ll be able to conceive, try to put your trust in your healthcare provider. Even you’re not trying to get pregnant, you should still seek treatment because anovulation can contribute to health complications like osteoporosis or cardiovascular disease. Your healthcare provider can help you figure out the cause of your anovulation and suggest the right treatment for you. Remember, you’re not alone and there’s hope that your provider will get your menstrual cycles on track.
Last reviewed by a Cleveland Clinic medical professional on 02/14/2024.
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