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Anovulation means that a woman is not ovulating - not releasing an egg each month. Just because a woman can have "bleeding" each month does not necessarily mean that she is ovulating. In anovulation, if bleeding occurs at the same time each month (making you think it is menstruation) it is actually break-through bleeding caused by low estrogen. Most women will have no bleeding.
Description of Anovulation
While anovulation and its role in infertility seems simple, the condition itself is quite complicated. Anovulation can arise from a number of causes, ranging from diet and exercise to complex disruptions in the relationships between tiny glands in the brain that control our most basic functions.
Anovulation can also be difficult to detect. Some women have seemingly normal menstrual periods even though they are not ovulating. Most often, women who do not ovulate also do not menstruate, a disorder known as amenorrhea, or do not menstruate regularly, a condition called oligomenorrhea. Because of this tendency, scant, erratic, short and/or painless menstrual cycles can sometimes alert a woman or her doctor to an anovulation problem. Physicians are now increasingly skilled at using modern diagnostic techniques and assisted reproductive technologies.
It is important to consider individual differences among women. Some, for example, have extremely sound and well-structured endocrine feedback mechanisms, and ovulate like clockwork each month no matter what happens. Others have endocrine systems that are much more sensitive to interruption. Moreover, anovulation can also be caused by underlying diseases that seem completely unrelated to reproduction.
Causes and Risk Factors of Anovulation
Some causes are relatively easy to identify, whereas others are much more difficult. A number of possible causes can be identified:
Excessive exercise and weight loss. A prolonged, strenuous program of exercise, such as running, can interfere with the ovulatory cycle by suppressing the output of hormones called gonadotropins from the hypothalamus in the brain.
This type of anovulation is generally accompanied by amenorrhea and normal menstruation returns when the woman adjusts her regimen so that it is more in since with her body's physiology.
Stress. Anxiety and other forms of emotional stress can take a their toll on normal ovulation. Some women can resolve the stress in their daily lives while others need the help of a psychiatrist or psychotherapist. Occasionally, through therapy or meditation, a woman will gain insight into a subconscious but significant reservation she has about becoming pregnant.
Drugs. Another possible contributor to anovulation is the long-term use of certain medications. Steroidal oral contraceptives (the Pill) are sometimes responsible. These drugs work by intentionally disrupting the hypothalamic-pituitary-ovarian axis, suppressing ovulation and thereby preventing pregnancy. For women using long-acting injectable steroid contraceptives (Depo-Provera), it appears likely that the longer the contraceptive is continued the more likely it is that amenorrhea will result.
Other causes. These might include eating disorders, estrogen and progesterone imbalances, a malfunctioning corpusluteum, congenital adrenal hyperplasia, hypothalamic dysfunction or tumors of the pituitary gland adrenal gland or premature ovarian failure, resistant ovary syndrome and autoimmune oophoritis, pituitary and thyroid problems, polycystic ovarian disease (PCOS) and hyperprolactinemia.
Diagnosis of Anovulation
The diagnosis of anovulation may require blood tests to measure the levels of prolactin, thyroid-stimulating hormone, adrenal function (DHEA), and male and female sex hormones (LH, FSH, and testosterone). It may necessitate use of ultrasound, MRI, CAT scan, and even laparoscopy.