Anovulation is a common cause of infertility. It’s caused by hormonal imbalances, and the main sign of it is having irregular periods. Anovulation can often be treated with lifestyle changes and/or medication.
Anovulation happens when an egg (ovum) doesn’t release from your ovary during your menstrual cycle. An egg is needed to have a pregnancy. Since multiple hormones are involved in ovulation, there are many causes of anovulation. Chronic anovulation is a common cause of infertility.
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Ovulation is the release of an egg (ovum) from your ovary. Ovulation is part of the menstrual cycle. On average, it happens on day 14 of a 28-day menstrual cycle. There are multiple hormones involved in ovulation.
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 the menstrual cycle, FSH causes follicles (small sacs of fluid in the 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. This is called ovulation.
After ovulation, the egg begins its five-day journey through your fallopian tube to your uterus. As the egg travels through your fallopian tube, the level of progesterone, another hormone, in your body rises, which helps prepare your uterine lining for pregnancy.
In the medical world, menstruation happens when an egg that's released from your ovary isn’t fertilized, so the uterus sheds its lining. Because of this, you cannot technically 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 non-cyclic uterine bleeding that is irregular. Abnormal uterine bleeding is common — approximately one-third of people who have a uterus and are of child-bearing age experience it.
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 25% of infertility cases. Approximately 1 in 10 people with ovaries who are of child-bearing age experience anovulation at some point in their lives.
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:
In general, the cause of anovulation is an imbalance of one or more certain 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 that are needed for ovulation. The following hormone imbalances and conditions can cause anovulation:
High levels of androgens (hyperandrogenism): Androgens are a group of hormones that help with growth and reproduction in both men and women. 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:
Pituitary gland dysfunction (hypogonadotrophic hypogonadism): 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 to not release enough LH and FSH include:
High levels of prolactin (hyperprolactinemia): Prolactin is a hormone that’s released by your pituitary gland that’s mainly known for stimulating breast milk production (lactation). 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:
Low levels of thyroid hormones (hypothyroidism, or underactive thyroid): 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 needed for ovulation, so a low level of thyroxine can cause anovulation. Conditions and situations that can cause hypothyroidism include:
Low levels of gonadotropin-releasing hormone (GnRH): 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.
In general, the diagnosis of anovulation is having irregular periods. However, if you’re trying to conceive, 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 your anovulation. 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).
Risk factors for having anovulation can include:
The prognosis (outlook) for anovulation depends on the cause of your anovulation. In most cases, anovulation can be treated with lifestyle changes, fertility drugs or medications that treat the condition that’s causing your anovulation. If you’re experiencing perimenopause, anovulation is more difficult to treat.
Lifestyle changes and/or medication can often treat anovulation, which means you’ll have an opportunity to get pregnant. However, many other factors are involved in successful conception and pregnancy.
If you’ve been treated for anovulation and are still having a difficult time becoming pregnant, be sure to reach out to your healthcare provider. They may recommend in vitro fertilization (IVF) or intrauterine insemination (IUI).
Depending on the cause, anovulation can be temporary or chronic. Medication and/or lifestyle changes can often — but not always — treat anovulation.
If you’re experiencing irregular, heavy or excessively painful periods that are disrupting your life, be sure to see your healthcare provider for treatment.
If you’re having issues conceiving, reach out to your provider. You may be experiencing anovulation.
If you’ve been treated for anovulation and are 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 while trying to get pregnant can be frustrating and upsetting. The good news is that many causes of anovulation can be treated. If you’re experiencing signs and symptoms of anovulation, be sure to reach out to your healthcare provider. They can help you figure out the cause of your anovulation and suggest treatment.
Last reviewed by a Cleveland Clinic medical professional on 08/25/2021.
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