Chronic Anovulation

Overview

Chronic anovulation means the ovaries regularly fail to release an egg (ovulate) over many menstrual cycles. Ovulation is the step in the cycle when an egg is released and can be fertilized, and it also drives the hormonal changes that produce a regular period. When ovulation does not happen, periods become irregular, infrequent, or absent, and becoming pregnant naturally is difficult.

Chronic anovulation is a common reason for irregular periods and is one of the leading causes of difficulty conceiving. It is usually a sign of an underlying hormonal imbalance rather than a disease on its own, so finding and treating the cause is the focus of care. Beyond fertility, regular ovulation and the hormones that go with it help keep the lining of the uterus healthy, so long-standing anovulation can also lead to a thickened uterine lining over time. This is another reason that ongoing irregular or absent periods are worth investigating, even for women who are not trying to become pregnant.

Symptoms

The main signs relate to the menstrual cycle and hormones.

• Irregular, infrequent, or absent periods
• Very light or unusually heavy bleeding
• Difficulty becoming pregnant
• Lack of the usual signs of ovulation, such as predictable cycle timing
• Other hormonal signs depending on the cause, such as acne or extra hair growth in polycystic ovary syndrome

Because cycles are unpredictable, some people first notice the problem when trying to conceive. Periods that are consistently irregular or absent are worth discussing with a doctor.

Causes

Anovulation results from a disruption in the hormonal signals between the brain and the ovaries. Common causes include:

• Polycystic ovary syndrome (PCOS): The most common cause, involving hormonal imbalance that disrupts ovulation.
• Thyroid problems: An overactive or underactive thyroid can affect the cycle.
• High prolactin: Elevated levels of the hormone prolactin can stop ovulation.
• Stress, weight changes, or intense exercise: Significant low body weight, rapid weight gain, or heavy training can suppress ovulation.
• Ovarian causes: Conditions such as premature ovarian insufficiency reduce ovarian function.

Risk Factors

• Polycystic ovary syndrome
• Thyroid disease or high prolactin levels
• Very low or very high body weight
• Intense physical training or significant emotional stress
• The years just after first periods begin and approaching menopause, when cycles are naturally more variable

Diagnosis

Diagnosis confirms that ovulation is not occurring and looks for the cause.

• Menstrual history: A pattern of irregular or absent periods is an important clue.
• Blood tests: Hormone tests, including those measuring progesterone (which rises after ovulation), thyroid hormones, and prolactin.
• Ultrasound: A pelvic ultrasound can show the ovaries and the lining of the uterus.
• Tracking ovulation: Home ovulation kits or charting can help show whether ovulation is happening.

Treatment

Treatment depends on the cause and on whether the goal is to regulate periods, manage symptoms, or become pregnant.

• Lifestyle measures: Reaching a healthy weight, balanced nutrition, and moderating intense exercise can restore ovulation in some people.
• Treating the cause: Managing thyroid disease, lowering high prolactin, or treating PCOS.
• Hormonal birth control: Used to regulate periods and protect the uterine lining when pregnancy is not the goal.
• Ovulation-inducing medicines: For those trying to conceive, medicines can help trigger ovulation, usually with specialist guidance.

Because the right treatment depends so much on the cause and on personal goals, care is individualized. Many women see their cycles become more regular and their chances of pregnancy improve once the underlying problem is addressed.

Prevention

• Maintain a healthy, stable body weight
• Balance intense exercise with adequate nutrition and rest
• Manage stress where possible
• Treat thyroid and other hormonal conditions as advised
• Seek evaluation early for ongoing irregular or absent periods, especially if planning a pregnancy

When to See a Doctor

See a doctor if you have:

• Periods that are consistently irregular, very infrequent, or absent
• Difficulty becoming pregnant after several months of trying (or sooner if over 35)
• Signs of a hormonal imbalance, such as new acne, extra hair growth, or unexplained weight change
• Very heavy or prolonged bleeding

Identifying and treating the cause can restore more regular cycles and improve the chance of pregnancy when that is the goal.

Related Topics

Frequently Asked Questions

References

1. Office on Women's Health, U.S. Department of Health and Human Services. Menstrual cycle and ovulation.
2. Mayo Clinic. Female infertility and ovulation disorders.
3. MedlinePlus, U.S. National Library of Medicine. Absent menstrual periods.
4. American College of Obstetricians and Gynecologists. Ovulatory dysfunction.