Even a perfectly healthy woman sometimes has menstrual irregularities. Especially often deviations occur in puberty, as well as after the onset of menopause. Usually, a woman knows her feelings when ovulation occurs, feels the approach of menstruation. But sometimes the cycle is atypical: menstruation comes later, there are no characteristic pains in the lower abdomen and in the chest. Most likely, in this case, the cycle is anovulatory. Not always worth the worry and go to the doctor. If this is a pathology, then other symptoms of gynecological diseases appear.
- Features anovulatory flow of cyclic processes
- Causes of cycles without ovulation
- Physiological causes
- Pathological causes
- Signs and symptoms of lack of ovulation
- Diagnosing the causes of lack of ovulation
Features anovulatory flow of cyclic processes
In the normal cycle, there are 2 phases (follicular - the egg matures in the follicle) and lutein (the phase of formation in the ovary of the corpus luteum, producing progesterone). Ovulation occurs between them, that is, the release of a mature egg from a ruptured follicle.
In phase 1, the functional layer of the endometrium increases under the influence of estrogens. If the egg is fertilized, then progesterone strengthens the endometrium and contributes to the successful development of the embryo in it. The corpus luteum continues to exist until the formation of the placenta. If fertilization does not occur, the yellow body is absorbed by the end of phase 2, progesterone production is stopped, the surface layer of the endometrium is exfoliated and removed, that is, menstruation occurs.
There is only one phase in the anovulatory cycle. Estrogen production does not correspond to the norm, therefore, although the follicle grows, the egg cell remains in it, after which the opposite development occurs (follicle atresia). The corpus luteum is not formed, the luteal phase does not occur. However, as with normal menstruation, the endometrium has time to mature, and in due time it exfoliates. Bleeding occurs, which is called menstrual.
The peculiarity of such a cycle is that, in principle, it cannot be completed with the onset of pregnancy. Monthly to eat, and a woman is not capable of conceiving a child.
Anovulatory menstruation can alternate with the usual in women of different ages. Common causes of physiological failure in the nature of menstrual cycles are:
- Age-related changes in the hormonal background in the body. For example, in adolescence, when the development of the reproductive organs is not yet complete, menstruation comes irregularly, the intensity of bleeding varies. In this case, quite often there is such a problem as an anovulatory cycle. Due to hormonal disruption, women also experience a similar deviation during menopause, when, on the contrary, reproductive function wilts and the work of hormone-forming organs is disturbed.
- The onset of pregnancy or the postpartum breastfeeding period. In the first months of pregnancy, some women continue to experience weak regular bleeding, similar to menstruation, but the cycles are completely anovulatory. Lactating women after childbirth restore hormonal levels that have changed dramatically during pregnancy. After the resumption of menstruation, approximately half of them have anovulatory cycles.
- Temporary disruption of the functioning of the reproductive system. Even at a mature reproductive age and in normal health, approximately 3% of cycles pass without ovulation.
Hormonal background may temporarily change if a woman falls into a stressful situation (for example, changes her place of residence or work, loses a loved one, becomes overworked, quickly gains weight).
Pathology is the lack of ovulation, leading to infertility associated with the appearance of uterine bleeding and other symptoms of severe menstrual disorders. The anovulatory cycle of a pathological nature arises due to a disruption of the pituitary gland or ovarian dysfunction.
The pituitary glands produce hormones that regulate the production of female sex hormones, estrogen and progesterone. His work may be disrupted due to the occurrence of tumors, inflammatory diseases, brain injuries, congenital developmental pathologies, circulatory disorders. Anovulatory abnormalities occur due to insufficient production of follicle-stimulating hormone (FSH), which is responsible for the maturation of follicles. Lack of luteinizing hormone (LH) leads to the absence of phase 2 of the cycle, the impossibility of ovulation and the formation of the corpus luteum.
In the anovulatory cycle, the deficiency of these hormones arises due to the increased production of prolactin (hyperprolactinemia), which can be caused by diseases of the thyroid gland and other endocrine organs, as well as the liver. Hormonal failure occurs after long-term use of contraceptives and drugs based on estrogen.
One of the most common causes of anovulatory cycles is the appearance of benign and malignant neoplasms in the ovaries. Dysfunction becomes a consequence of their infectious and inflammatory diseases. With hypoestrogenic follicle maturation is impossible.
Factors provoking anovulatory processes, are also intoxication of the body harmful industrial waste and chemical additives to food, the effects of radiation, starvation, vitamin deficiency. Anovulatory cycles occurring with various other disorders may occur as a result of hereditary diseases or congenital pathologies of the development of reproductive or endocrine system organs, disorders of sexual development.
Signs and symptoms of lack of ovulation
A woman, even without going to the doctor, in most cases realizes that she had an anovulatory cycle.
It is difficult to determine the moment of ovulation, as the symptoms accompanying the release of the egg from the follicle (pain at the moment of rupture of the membrane, pink staining of secretions) are very weak and hardly noticeable. There is a more accurate way to establish the time of ovulation: many women make a special schedule showing the change in basal temperature during the cycle. By the onset of ovulation, it increases by about 0.5 °, and then keeps at this level until the onset of menstruation.
If the temperature remains constant (below 37 °) throughout the entire cycle, this indicates that the cycle is anovulatory. Basal temperature is measured rectally in the morning, immediately after waking up, preferably at the same time.
There are other signs of lack of ovulation. During the month, the nature of vaginal discharge is constantly changing. Before ovulation, they liquefy, are abundant, viscous, resemble egg white in appearance, and by the onset of menstruation it becomes scarce and thick. If there is no ovulation, then there is no change in the nature of the discharge.
With a slight deviation of estrogen production from the norm, even during anovulatory cycle, menstrual periods can come more or less regularly and with normal intensity. Too high estrogen levels (hyperestrogenic) leads to heavy and prolonged bleeding, which can cause iron deficiency anemia. If during a normal cycle during menstruation a woman feels a pulling pain in the lower abdomen, then with anovulatory pain is absent. Long periods of menstruation may occur (from several days to several weeks). During examination, the doctor detects an increase in the size of the uterus, the sealing of its walls, and the swelling of the cervix.
With hypoestrogenism (reduced estrogen production), menstrual-like bleeding in the anovulatory cycle is scant and short-lived. The uterus, on the contrary, decreases.
The consequence of the lack of ovulation is infertility.
Diagnosing the causes of lack of ovulation
If an abnormal cycle is suspected, a woman should consult a gynecologist and endocrinologist. To diagnose the absence of ovulation in a cycle is possible in the following ways:
- Determination of basal temperature changes. In order for the result to be reliable, measurements are made within six months (at least 3 months).
- A cervical smear test will show infection and inflammation.
- Scraping the uterine cavity on the eve of menstruation, carrying out a histological analysis of the material obtained is necessary to detect characteristic changes in the structure of the endometrium in phase 2 of the cycle. If they are missing, then the cycle is single phase.
- Blood tests for sex hormones. They are made in different periods of the cycle, watching the changes taking place.
- Blood tests are also performed to determine the level of pituitary and thyroid hormones.
- Ultrasound of the uterus and ovaries. It is carried out to monitor changes in the thickness of the mucous during the cycle, as well as the growth of follicles.
- Conducting laboratory tests for ovulation.
The presence of ovulation or the occurrence of the anovulatory cycle can be judged by the characteristic changes in the composition of vaginal mucus, which depends on the production of estrogen and progesterone throughout the cycle. The laboratory uses the method of crystallization of mucus from the cervical canal. Since its consistency in the 1 and 2 phases of the cycle, as well as during ovulation, is significantly different, a different picture is observed when the sample is applied to a glass slide, when the sample is dried on a glass microscope. The closer to the time of ovulation, the clearer the picture. At the time of ovulation, you can see that a sheet of fern crystal appeared on the glass (“fern phenomenon is positive”). In the following days, the picture blurs (“the phenomenon is negative”).
Another test for ovulation is the phenomenon of "pupil". The method is based on the fact that during the cycle the state of the cervix changes. By the time of ovulation, the production of mucus is enhanced, the cervix opens up and glitters as much as possible, so when viewed from mirrors it looks like a “pupil”. In the 2nd phase of the cycle, the mucus thickens, its amount decreases. The neck closes and the effect disappears.
Note: In the anovulatory cycle, the nature of the discharge is almost unchanged, and there are no positive results from these tests.
In the anovulatory cycle of menstruation, treatment is carried out only when a serious pathology of the reproductive or endocrine organs is found. First of all, drugs are prescribed or surgeries are performed to eliminate the underlying disease that caused the hormonal failure.
To stimulate ovulation, hormone therapy is carried out using progestins (duphaston, utrogestan, desogestrel), as well as oral contraceptives with a high content of progesterone (ovidone, triziston). Their action is based on the suppression of estrogen production in the ovaries.
Klostilbegit and its analogues are also prescribed as anti-estrogens. Ovulation stimulation in the anovulatory cycle is also performed with the help of preparations containing gonadotropins (hormones of the pituitary FSH and LH). Among them - menogon, menopur, pergonal.
Drugs based on human chorionic gonadotropin (hCG) stimulate the breaking of the follicle membrane and the release of the egg from it. These include pregnil, ovitrel, prophase.
In case of hypoestrogenism (ovarian insufficiency), estrogen preparations (hexestrol, folliculin) are prescribed to stimulate the maturation of the follicles and the growth of the endometrium in the presence of anovulatory cycles. Bromocriptine is used to eliminate hyperprolactinemia.
A warning: All drugs are taken solely on doctor's prescription, since their use is unsafe due to very serious side effects.
In anovulatory cycles, physiotherapeutic methods of stimulating ovulation are used, such as electrophoresis of the pituitary-hypothalamus region. If treatment does not lead to the successful elimination of infertility, women are advised to resort to using the IVF method.
The causes that led to the pathological condition are dependent on the subspecies. For example:
- The basis of the physiological anovulatory cycle are the causes of a natural nature. This is a normal condition at a certain age that does not require specialized therapy or surgery. Moreover, it is inherent in almost all women twice a year. The presence of adolescent girls menstrual bleeding without ovulation, in medical practice is considered a normal natural phenomenon.
- The pathological anovulatory cycle is characterized by the presence of a background in the form of organ malfunctions, such as the hypothalamus, pituitary, ovaries, thyroid, adrenal cortex, responsible for the production of certain hormones important for stable and complete regulation and functionality of the female reproductive system.
Among the factors of pathology, in which there is no ovulation, can be identified:
- improper operation or the presence of pathological processes in organs that produce hormones,
- ovarian dysfunction,
- the presence of inflammatory processes, with localization in the uterus and appendages,
- genetically determined underdevelopment of the genital organs,
- delayed puberty (late)
- underweight or overweight,
- chronic intoxication with a different nature,
- excess production of prolactin.
Why is hormone production disrupted leading to a cycle in one phase? There are a number of reasons for this:
- excessive physical labor, power sports, unbalanced recreation planning with an excess of work,
- constant stress,
- improper metabolism and fasting
- past infectious diseases
- the presence of injuries with severe pain,
- climate change.
These are all the most diverse factors, based on various processes and deviations in the functions of the female body.
Symptoms of pathology
Anovulatory cycle has symptoms that cannot be classified as unnoticed, and there are only two:
Any woman planning a pregnancy, monitors the slightest changes in the body, the onset of ovulation, the absence of which can be determined by the following symptoms:
- White discharge appears in the middle of the cycle,
- lumbar region painful, dull pain,
- discomfort appears in the ovaries,
- always want to eat
- increases sexual desire.
If there are two of the listed symptoms, urgent medical consultation is required.
Proceeding from the fact that the anovulatory cycle is a pathological condition with no obvious symptoms of progression, the main for the patients are considered complaints about the deterioration of health in general. Monthly bleeding is relatively regular and normal, sometimes there is a slight shift towards early or late, but without much discomfort.
Deviations from the norm are in the duration and profusion of menstruation, or a reduction in the number of days and the volume of discharge. The reason for the delay is most likely that the hormonal background is malfunctioning, and if you postpone the visit of a specialist, then there may be no monthly periods for several months, which is fraught with progression and aggravation of the pathological process.
Moreover, women can take their absence for dysfunction under the influence of negative factors such as hypothermia or overheating, past illnesses or stress.
Diagnosis plays an important role in the anovulatory cycle, ensuring the correctness of treatment. Only with the help of a comprehensive examination is the correct diagnosis. One of the main indicators of pathology is basal temperature, which helps to control the cycle and make a graph. What you need to know:
- In the absence of pathologies and the passage of all phases of the cycle, the rectal temperature in the first phase is at the level of thirty-seven degrees, and after ovulation it rises sharply by an average of half a degree, returning to normal when menstruation occurs.
- If a woman has a progressive pathological process and a cycle in one phase, the rectal temperature is always unchanged, with rare unnatural jumps in indicators, when there is no clear line of rise and fall and the graph is unstable.
Among other possible additional tests and examinations, by the decision of the doctor are appointed:
- Transvaginal ultrasound, which helps in a short time to get information about the presence or absence of the yellow body.
- A clinical study of biomaterials in the form of blood and urine, to determine the level of concentration of certain hormones.
- Gynecological examination according to an individual scheme.
- Taking the contents of the vagina for analysis.
- Гистологическое исследование соскоба, взятого со слизистой оболочки в предменструальный период.
In order for the diagnosis to be accurate, it is required to perform all medical appointments for half a year, because the anovulatory cycle sometimes tends to alternate with the normal one.
What to do if pathology is diagnosed? In case of progression of the anovulatory cycle, infertility can occur, so treatment is necessary. It aims to achieve ovulation stimulation and arrest the growth of the endometrium, and is carried out by a gynecologist, in tandem with which the endocrinologist acts.
Hormonal therapy is prescribed according to a special scheme, with regular medication and a course break to control the level of saturation of the body with the necessary hormones. If necessary, phased stimulation of the menstrual cycle, first do the curettage of the endometrium, and then gonadotropic hormones are written out. The treatment period lasts from three months to six months.
Daily injections of progesterone are prescribed, and with excessive tissue proliferation, synthetic progestins are administered. In case of insufficiency of ovarian function, small dosages of estrogenic agents are used, which favorably affects the mucous layer of the uterus, the functioning of the ovaries and the development of follicles.
If the pathology is caused by chronic uterine inflammation, electrostimulation is performed in the form of cervical electrophoresis. Treatment of the physiological subspecies is not made when the disease coincides with age-related changes in the body such as puberty or menopause, pregnancy or breastfeeding.
As a supplement to drug therapy, folk remedies are widely used in the form of infusions made from herbs of adonis, Adam's root, sage, plantain, cuff.
Anovulatory cycle is single-phase, because it lacks a successive phase change characteristic of a normal menstrual cycle. Virtually the entire anovulatory cycle is occupied by the proliferation phase, which is replaced by desquamation and regeneration of the endometrium. At the same time, the secretory phase, usually occurring after ovulation due to the development of the corpus luteum, is completely absent. In contrast to dysfunctional anovulatory uterine bleeding, the anovulatory cycle is characterized by cyclical menstrual-like bleeding.
Causes of anovulatory cycle
In practically healthy women at reproductive age, the anovulatory cycle is relatively rare (1-3%) and can alternate with the ovulatory cycle. Anovulation can be caused, for example, by a change of climate when moving to another geographic region. The most frequent physiological causes of the anovulatory cycle are the processes of age-related changes in the female body — puberty and the extinction of reproductive function (menopause). As a physiological process, anovulation in combination with amenorrhea is characteristic of pregnancy and postpartum lactation. In the case of the resumption of rhythmic bleeding in 40-50% of lactating women, the cycle has a single-phase anovulatory character.
As a pathology requiring correction, the anovulatory cycle is considered by gynecology for infertility or uterine bleeding caused by a violation of folliculogenesis, lack of ovulation and the luteal phase. The causes of the pathological anovulatory cycle, as a rule, are disorders of the hypothalamic-pituitary regulation of the menstrual cycle, as well as ovarian dysfunction. Violations of the hypothalamic-pituitary regulation are manifested by a lack of FSH production, leading to follicle mismatch and its inability to ovulate, LH deficiency, a change in the ratio of sex hormones, and sometimes excessive production of prolactin by the pituitary gland.
Anovulatory cycle may be associated with inflammation of the ovaries or appendages (adnexitis), impaired enzymatic transformation of sex steroids in the ovaries, functional disorders of the thyroid gland or the cortical layer of the adrenal glands, infections, neuropsychiatric disorders, intoxication, vitamin deficiency or other disorders of alimentary disorders. Often anovulatory cycle is observed in congenital malformations of the reproductive system, genetic pathology, impaired sexual development.
Pathogenesis of anovulatory cycle
In the process of anovulatory cycle, periods of growth and reverse follicular development can be observed in the ovaries. The short-term rhythmic persistence of the mature follicle is accompanied by hyperestrogenism, the atresia of the nevzurevnogo follicle - relative monotonous hyperestrogenism. The excess effect of estrogens, not replaced by the effect of progesterone gestagenic hormone, is most typical for the anovulatory cycle. In some cases, the anovulatory cycle proceeds with hypoestrogenism. Depending on the level of estrogen influence, changes in the endometrium of a different nature develop - from hypoplasia to excessive proliferation - hyperplasia and polyposis.
The development of menstrual bleeding in the anovulatory cycle is usually due to a decline in the hormonal influence caused by atresia of the follicles. In the functional layer of the endometrium, phenomena of extravasation, hemorrhage, and areas of necrosis develop. The surface layers of the endometrium partially disintegrate, which is accompanied by bleeding. In the absence of rejection of the endometrium, bleeding develops as a result of erythrocyte diapedesis through the walls of blood vessels. Sometimes there is no decline in hyperestrogenism, and estrogen excretion in the urine remains relatively stable throughout the anovulatory cycle (from 13 to 30 μg / day).
In puberty, when the formation of menstrual function occurs, the anovulatory cycle is caused by the absence of the necessary level of luteinizing and luteotropic hormones, the synthesis of which reaches a peak by 15–16 years. Similar changes, but in reverse order, develop with the extinction of reproductive function: there is a violation of cyclic secretion and an increase in gonadotropic influence. The alternation of ovulatory and anovulatory cycles in menopause is replaced by a change in the duration of the cycle and the nature of menstruation.
Manifestations of anovulatory cycle
Clinically, the anovulatory cycle may manifest itself in different ways. The menstrual bleeding that arises during the anovulatory cycle may not differ from a normal menstruation in regularity and the amount of blood lost.
In hyperesterogenia, bleeding is accompanied by prolonged and abundant secretions of blood such as menorrhagia. In this case, a two-handed study reveals an enlarged uterus of a dense consistency with a softened neck and ajar internal throat. Excessive bleeding ultimately leads to the development of anemia.
For hypoestrogenism, on the contrary, are characterized by shortened and scanty menstrual bleeding. When vaginal examination is determined by the reduced uterus, which has a long conical neck, closed internal pharynx, narrow vagina. Anovulatory cycle in women of reproductive age is accompanied by the impossibility of pregnancy - hormonal infertility, in connection with which patients usually turn to a gynecologist.
Diagnosis of anovulatory cycle
The simplest method of differentiating between ovulatory and anovulatory cycles is the determination of rectal (basal) temperature (BT). An increase in BT in the progesterone phase is characteristic of the normal ovulatory cycle. In the anovulatory cycle, a single-phase temperature is determined.
A pronounced estrogenic effect in the case of an anovulatory cycle is detected using functional tests (a positive fern phenomenon and a pupil symptom during the whole cycle), colpocytological data. A sign of anovulatory menstrual cycle with dynamic ultrasound of the ovaries is the absence of a dominant follicle.
The decisive criterion for determining the anovulatory cycle is a diagnostic curettage of the uterus before the menstrual period with a histological examination of the scraping. The absence of endometrial secretion changes in the scraping confirms the presence of anovulatory cycle.
To clarify the etiological background of the anovulatory cycle, the hormones of the hypothalamic-pituitary system, the thyroid gland, the adrenal cortex are studied, and inflammatory changes in the genital area are detected. Given the possible alternation of anovulatory and ovulatory cycles, for the final diagnosis, dynamic monitoring is carried out within six months.
Treatment of anovulatory cycle
Since a persistent anovulatory cycle is accompanied by infertility and pronounced proliferative changes in the endometrium, the main task of treatment is to stimulate ovulation and suppress excessive proliferation. The gynecologist-endocrinologist deals with the treatment of the anovulatory cycle.
Hormonal therapy of the anovulatory cycle is carried out in intermittent cycles, depending on the degree of estrogen saturation. For the step-by-step stimulation of the correct menstrual cycle after preliminary curettage of the endometrium, preparations of gonadotropic influence are prescribed (choriogonin for 3-6 months from 11 to 14 days). For 6-8 days before menstruation, intramuscular injections of 1% p-ra progesterone are connected, taking norethisterone. When anovulatory cycle occurs with hyperestrogenic and excessive proliferation, synthetic progestins are shown for several cycles (from 5th to 25th day of the cycle).
In case of ovarian insufficiency and hypoestrogenism, estrogen preparations are used in small doses (estradiol or folliculin, hexestrol), which stimulate the transformation of the uterine lining, ovarian function, growth and development of the follicle. If the cause of the anovulatory cycle is chronically occurring inflammation of the appendages, complex treatment of adnexitis is carried out, vitamin C is prescribed, which is involved in the synthesis of steroids and contributes to the restoration of ovulation.
In order to induce ovulation in the anovulatory cycle, indirect electrostimulation of the hypothalamic-pituitary area is prescribed by endonasal electrophoresis, cervical electrostimulation, etc. Hormonal stimulation is performed using clomiphene. When hyperprolactinemia prescribed bromocriptine. Treatment of physiological anovulation during periods of menstruation, lactation, menopause is not required.
Prognosis and prevention of the anovulatory cycle
With properly designed and ongoing treatment of the anovulatory cycle, pregnancy occurs in 30-40% of women. If it is not possible to achieve pregnancy, women are encouraged to resort to assisted reproductive technologies under the IVF program. If the patient does not have her own mature eggs, artificial insemination is performed with the donor egg, after which the embryo is transplanted into the uterine cavity. Use of a donor embryo is possible.
For the prevention of the anovulatory cycle, it is necessary to pay increased attention to the health of adolescent girls, good nutrition, a rational mode of activity and rest, timely treatment of genital and extragenital pathology, prevention of infections, toxic effects in the workplace.
Will there be later periods
After a period with no ovulation, menstrual bleeding is observed. Monthly with anovulatory cycle may begin in the same period as the usual, but often fails the occurrence of discharge. Independently, it is almost impossible to find differences between normal menstruation and bleeding after anovulatory cycle.
Most often, this period is accompanied by hyperestrogenic, which can lead to excessive proliferation of the endometrium. Bleeding after such a cycle is abundant, with a two-handed examination, an increase in the uterus and a soft, loose neck with a parted mouth can be noted. Hypoestrogenism is less common. Here, on the contrary, scarce bleeding, small uterus size and elongated neck of conical shape will be observed.
How to understand if there was ovulation
Signs of the anovulatory cycle are not always easy to detect; indirectly, a woman may notice the following symptoms:
- the absence of pain in the mammary glands, tingling, abdominal pains from the side of one of the ovaries approximately in the middle of the menstrual cycle (provided that the woman used to feel how ovulation occurs)
- earlier or late onset of menstruation and change in the period of bleeding.
In order to know exactly whether the maturation and release of the egg occurred, we need to turn to a more serious diagnosis of the anovulatory cycle:
- Folliculometry. On the 10th day of the menstrual period, an ultrasound scan is performed to identify the presence of a dominant follicle. If one is not found, then there will be no ovulation in this cycle. The specialist may also notice polycystic (multiple, slightly enlarged follicles, but none of them are ready for maturation). Another survey needs to be done on the 15th or 16th day, when you can detect a corpus luteum, appearing in the place of a ruptured follicle, from which a ripe egg came out, or to confirm the absence of ovulation. The doctor will measure the thickness of the endometrium in order to detect hypoestrogenism, which will help in further treatment.
- Scheduling basal temperature. It is held at home alone. Every morning at the same time, without getting out of bed, it is necessary to measure the rectal temperature. From the obtained values, a graph is compiled. On it you can find out the presence of ovulation, in front of which there is a decrease in temperature, and at the time of release of the egg, it rises by about 0.5 degrees.
- Diagnostic curettage of the endometrium on the eve of menstruation with subsequent histological analysis.
After confirming the absence of ovulation, studies of the hormones of the hypothalamic-pituitary system, which affect the menstrual period, thyroid hormones, and a number of gynecological tests, are conducted.
The reasons for the lack of ovulation
The causes of the anovulatory cycle may be different:
- hormonal disorders of the hypothalamic-pituitary system,
- disorders of the thyroid gland,
- diseases of the pelvic organs,
- multiple ovarian cysts,
- early menopause
- endometrial and cervical inflammatory processes,
- reception of previously incorrectly chosen contraceptives,
- unbalanced nutrition, vitamin deficiency,
- overwork, stress, lack of sleep,
- excessive physical exertion.
Another reason for the lack of ovulation may be hormonal changes in the reproductive organs associated with puberty or menopause, as well as with pregnancy and lactation. Lack of ovulation for such reasons, gynecologists do not consider as a pathology.
In healthy women, 1–2 anovulatory cycles per year are allowed within the normal range, with no apparent cause or associated with climate change (for example, a vacation trip).
Anovulation as a cause of infertility
In the anovulatory cycle there is no rupture of the follicle with the release of a mature egg ready for fertilization. After such a cycle, menstruation still begins, which means that the presence of menstruation is not at all an indicator of fertility.
One of the manifestations of infertility in women is the pathological absence of ovulation. Therefore, it is extremely important to contact a gynecologist as soon as there is a suspicion of a problem.
One of the ways to treat a lack of ovulation is to prescribe oral contraceptives in order to rest the ovaries. After several months of taking the pills and their subsequent cancellation, the reproductive organs begin to work with double strength, sometimes both ovaries even ovulate at the same time.
Another way is to stimulate ovulation by taking hormonal drugs. The treatment is carried out according to the following scheme:
- Before the onset of menstruation, endometrium is scraped.
- From the 2nd day of the cycle, gonadotropic drugs (choriogonin) are used.
- On day 6–8, intramuscular progesterone shots are prescribed. Control of therapy is performed using folliculometry. The doctor may increase the dose of hormones or stop treatment in this cycle, depending on the presence and size of the dominant follicle and the state of the endometrium.
If hormonal therapy succeeds after ovulation, the gynecologist may prescribe progesterone (Duphaston, Utrogestan) to support the function of the corpus luteum. Further abolition of the drug occurs after the tests and the decision of the doctor.
In case of a lack of ovarian function, estrogen therapy is carried out. If the reason lies in the inflammation of the appendages or chronic adnexitis, then complex therapy is prescribed with the use of vitamin C.
When several unsuccessful attempts to conceive a child should not be delayed with a trip to the doctor. The specialist will help to understand the cause of what is happening and prescribe timely treatment, the result of which will be the desired pregnancy.
How to determine whether ovulation was
It is possible to determine whether the regular monthly cycle is complete. But to do this, trying to find the external signs of the anovulatory cycle, is not worth it. Иногда женщины прислушиваются к внутренним ощущениям или рассматривают содержимое прокладок, надеясь выявить патологию. Некоторые утверждают, что с точностью до минуты засекают процесс овуляции и даже видят остатки яйцеклетки в менструальной крови. Однако подобные способы — не более чем заблуждение.The change in health and the violation of the internal environment of the vagina occurs for many reasons, and the structure of the discharge is almost always heterogeneous. It contains clots of mucus and blood, fragments of the epithelium.
Indirect symptoms of the manifestation of anovulation can be considered completely homogeneous semi-transparent periods without endometrial residues. Morphologically, such secretions resemble metrorrhagia - bleeding that occurs during the intermenstrual period. They may be more scarce or maintain their usual intensity.
With elevated estrogen levels, prolonged bleedings lasting over 7 days are observed. Dizziness, weakness, changes in taste sensations, severe swelling are likely.
All physiological changes in the ovaries are accompanied by fluctuations in rectal temperature. Track them with a normal thermometer:
- Every day in the morning, immediately after waking up, without getting out of bed, a prepared thermometer is placed in the anus. You can lubricate the tip of vaseline oil. It should be inserted to a depth of 2-3 cm in the position on the side and slightly pulling up the legs.
- For several minutes you should lie still with your eyes closed. You can not fall asleep.
- After removing the device, the resulting value is recorded.
Normally, during the first phase of the cycle, the temperature is about 37 ° C ± 0.2 ° C. Immediately before ovulation, it drops sharply to 36.2–36.5 ° C, and the next day also increases sharply, reaching 37.6–37.8 ° C. Then until the end of the luteal phase is kept at the same level, gradually decreasing by the end of the cycle.
Specific indicators for different women differ, but one moment is necessarily present: a peak in the form of a decline and a rise in temperature. That he points to what happened ovulation. The absence of fluctuations or slight temperature fluctuations up and down throughout the entire cycle indicate anovulation.
The temperature must be measured at the same time, and the indicators should be recorded in a notebook. For clarity, it is recommended to depict the results as a solid curve - draw a graph. It must be carried on for at least 2-3 months.
The method allows to detect the absence of ovulation and determine the time period during which the failure occurs. In addition, the diary of basal temperature is used to determine the pathogenesis of amenorrhea, activity of the corpus luteum, the likely occurrence of pregnancy.
Will there be menstruation after it?
Detection of such a violation does not mean the absence of menstruation. "Barren" cycles in duration may not differ from normal and alternate with them. With anovulatory cycle, you can wait for menstruation at the usual time or several days later.
The expanding endometrium peels off and comes out without the participation of progesterone, therefore, less mucus is usually present in these secretions. With regularly repeated anovulation, scanty but prolonged bleeding is likely. Characteristic clinical picture: the appearance of a large number of brown clots at the beginning of menstruation.
When combined with adnexitis or polycystic discharge, discharge may come with a delay of 1.5–2 months. In such cases, talking about dysmenorrhea.
Menstruation with anovulatory cycle is not an indicator of reproductive system health. Incomplete rejection of the endometrium often leads to the formation of areas of dysplasia, necrotization, increases the risk of endometriosis.
The state of pathological anovulation is assumed in women when they visit a doctor for prolonged menstrual flow, weakness, and unsuccessful attempts to get pregnant. In the course of preliminary diagnostics, the data of the basal temperature graph are studied, a visual examination is carried out, a smear is taken on the microflora and cytology. The gynecologist notes a thickening or loosening of the cervix, ajar throat.
To clarify the reasons, a number of surveys are prescribed:
- blood test for hormonal profile: sex, gonadotropins,
- transgenital ultrasound,
- PCR study on infectious pathogens,
- diagnostic curettage of the endometrium,
- histological examination.
After clarification of all factors provoking anovulatory cycles, the gynecologist-endocrinologist prescribes a comprehensive treatment. It is based on directed hormone therapy. With an excess of estrogens, antagonists are used, stimulate ovulation and inject drugs that reduce proliferation - excessive growth of the endometrium. Drugs are used for 5 days, then control ultrasound is performed. With the successful maturation of the follicle, the therapy is supplemented with progestogens to ensure normal endometrial secretory activity.
With reduced ovarian function, estradiol analogues are used to stimulate the activity of the pituitary and hypothalamus. The treatment is supplemented with physiotherapeutic procedures. Reception of medicinal plants containing phytohormones is shown: sage, adonis, boron uterus.
Can anovulation cause infertility
The presence of a mature, viable egg in the fallopian tube is a prerequisite for conception. Pregnancy after the anovulatory cycle is quite likely if the following take place normally. The success of the implantation of the embryo is also influenced by the condition of the uterus and the thickness of the functional layer of the endometrium.
In situations where most or all of the cycles are anovulatory, hormonal infertility develops. You can get pregnant only after restoring the normal mechanism of ovulation.
There are no specific precautions against the flow of anovulatory menstrual cycle. Prevention in this case is considered general medical examination and regular visits to the gynecologist. To promote health, it is necessary to eat properly and balanced, avoid stressful situations, and hypothermia. It is undesirable to take a great interest in extreme sports, to visit hot saunas, to abuse solariums and non-traditional cosmetic procedures, for example, cryotherapy.
Persistent impairment of reproductive function is one of the main negative consequences of pathological cycles with an unripe egg cell. In addition to infertility, anovulation is often threatened by debilitating uterine bleeding. Their regular repetition leads to hypotension, iron deficiency anemia, physical exhaustion.
Opinion of doctors
The poor functioning of the pituitary, hypothalamus and ovaries leads to an imbalance of sex hormones. The consequence is often the emergence of anovulation - failure of the process of maturation and release of the egg from the follicle. When such suspicions are concerned, it is useful to regularly measure basal temperature to track probable pathology. This is an easy way to identify a violation and take action on time.
In most cases, anovulation is treatable and has a favorable prognosis. Often, women have to resort to hormone replacement therapy to preserve the possibility of getting pregnant and carry out the child. If it is impossible to conceive, it is naturally recommended to use the IVF method with donor or own eggs.
Studying the anovulatory cycle, it is impossible to properly understand the issue, without delving into the concept of normal menstruation.
The menstrual cycle is divided into two phases. The first (follicular) - the period of maturation of the egg. The process is concentrated in the dominant ovarian follicle. Next comes ovulation, when the follicle breaks and the cell enters the fallopian tube, from where it passes into the uterus. Ovulation point - the place of formation of the yellow body, producing progesterone. The normal functioning of the systems ensures a successful pregnancy. After ovulation, the second (luteal) phase of the cycle begins, which ends with menstruation.
Pregnancy is possible if a mature fertilized cell is fixed on the uterine wall, and the corpus luteum generates hormones, passing into the placenta. Under adverse conditions, the corpus luteum disappears, and after 2 weeks, menstruation resumes.
The second phase is characterized by the proliferation of the endometrium of the uterus, as the body prepares for fertilization and cell adoption. Bleeding during menstruation - rejection of the uterine lining.