In times when a woman decides to visit a fertilization clinic, it is because she has charted her own path to pregnancy. After different erroneous attempts, the only thing that passes through his confused mind is to discover the reasons for the failures. If you are one of them, we can understand how priority motherhood is in your life. Certain symptoms such as anovulation can externalize the cause of your infertility. Specifically in this case, the lack of ovulation is generated because the ovary does not expel the ovum. As you already know, there is no fertilization, if there is no embryo, therefore there is no pregnancy.
Polycystic Ovary Syndrome is considered another cause of anovulation, in this disorder there are high levels of androgens. Then the dysfunction in the ovary is produced by the appearance of multiple cysts in the ovaries.
It is undeniable that problems related to the ovaries represent one of the main causes of infertility worldwide in women, where certain disorders and conditions such as early menopause can complicate pregnancy. Anovulation is one of the conditions whose incidence is significant in women , so we offer in this post the related information you need to reveal what anovulation means, its causes, diagnosis and treatment.
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What is anovulation?
It is a gynecological disturbance, which causes your ovaries to not be able to release the eggs on a regular basis, generating in turn that the eggs cannot enter the fallopian tubes. If you suffer from anovulation, month after month you cannot release an egg for fertilization, on the contrary, this is done by your body in a discontinuous way. You should not confuse anovulation as a disease in itself, it is simply a sign about the malfunction of one of your organs in the body.
It represents one of the most common disorders, for which some women normally consult with their gynecologist. Irregular uterine bleeding, abnormal menstrual periods, infertility, and amenorrhea are the clinical signs that are frequently seen. What the doctor’s evaluation seeks is to highlight the causes of chronic anovulation.
Sporadic or circumstantial anovulation can occur at any moment in life, a phase of anovulation caused by the nerve, stress, nutritional deficiency, among others. Initially, anovulation is not serious and does not represent a concern, as long as it is circumstantial.
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Possible causes of anovulation
Although the probable causes of chronic anovulation or amenorrhea are quite extensive, in many of these cases they are related to certain conditions such as: functional hypothalamic anovulation, hypothalamic amenorrhea, hyperprolactinemine, Polycystic Ovary Syndrome, premature ovarian failure and thyroid disorders.
Anovulation by Hypothalamus-Pituitary
Any change that interferes with the release of gonadotropins at the pituitary level or the secretion of GnRH, can cause hypothalamic-pituitary anovulation . As there is a low concentration of gonadotropins due to the low systemic concentrations of estrogens, anovulation can occur at the level of the hypothalamus or pituitary.
In women with excessive stress, bulimia nervosa or anorexia, an alteration in the secretion of GnRH or a suppression in its production can be observed. There are also multiple less common neuroanatomic or genetic causes, which can appear to be chronic anovulation, such as: pituitary tumors, Acromegaly, Cushing’s syndrome, Empty sella syndrome, Sarcoidosis, Sheehan’s syndrome, Tuberculosis, Histiocytosis.
In addition, there are other acquired causes such as radiotherapy, trauma related to the hypothalamic-pituitary area, craniopharyngioma, chronic renal failure, Diabetes Mellitus, etc.
Anovulation and exercise
If you are a woman who engages in strenuous sports activities, delayed menarche, menstrual disturbances, and luteal phase dysfunction may occur. The duration, intensity and type of sport is a determining factor in the severity of anovulation . In general terms, anovulation related to sports training or exercise is caused by psychological stress, a low amount of fat tissue, the transformation of fat tissue into muscle, and insufficient nutrition.
Anovulation due to systemic diseases
If you are a patient with a chronic disease, it is possible that menstrual alterations and anovulation may be generated due to the effects of the condition, weight loss or the general condition at the level of the hypothalamic-pituitary axis.
Functional Hypothalamic Anovulation
Before making the diagnosis of this cause, a careful study should be performed on the patient. Generally, patients with functional hypothalamic anovulation are affected by secondary amenorrhea, without any other type of clear organic evidence. Although there is a set of factors such as depression, caloric restriction, excessive energy expenditure, as well as antidepressant, sedative, antipsychotic and stimulant medications, which can become triggers for functional hypothalamic anovulation.
Anovulation due to Polycystic Ovarian Syndrome
It represents one of the syndromes with the highest incidence of anovulatory infertility, at least 80% of cases. Polycystic Ovary Syndrome is quite a complex condition, apparently it is caused by different genes involved and multifactorial. Anovulation is one of the major complications related to fertility, the tendency to be overweight, irregular cycles, increased hair in unwanted areas, acne, among others.
HOW IS POLYCYSTIC OVARIAN SYNDROME DIAGNOSED?
To make the diagnosis it is necessary to present the following findings:
- Symptoms of hyperandrogenism: hair loss on the head, increased hair on the body and face, high levels of testosterone in the blood or acne (no other cause that causes the increase).
- Amenorrhea: the absence of menstrual periods or irregular cycles.
- Polycystic ovaries seen in an ultrasound: there are certain factors that can cause Polycystic Ovarian Syndrome, among them is weight gain, which can intensify the symptoms, generating a high tendency to anovulation.
Hyperprolactiemia is a pathology that is related to prolactin (a hormone connected with the synthesis of the hormone progesterone in the menstrual cycle during the luteal phase), it is characterized by an increase in prolactin in the blood. This variation in the normal rate of prolactin in females can cause alterations in your menstrual cycle, ovulation and infertility. One of the most frequent causes of infertility in women is generated by anovulation due to Hyperprolactinemia.
To preserve the proper functioning of your ovaries and egg maturity, hormones are related to estrogens, reproductive hormones, and progesterone. By releasing an exaggerated amount of thyroid hormones or vice versa, as a consequence the balance in your reproductive hormones is affected, along with the complications generated by the thyroid: irregular menstrual cycles, ovulation disorders, carrying a pregnancy to term or problems conceiving a child . Even if you have normal menstrual cycles, you are probably not ovulating.
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Symptoms of anovulation
The symptoms of anovulation are various, but these usually do not occur simultaneously, we will explain below:
- Absence of the menstrual cycle (amenorrhea): 20% of women with anovulation notice this symptom. Although there are also high possibilities of the opposite, that is, you can be affected with excessive menstrual bleeding.
- Irregular menstrual cycle: a woman may have periods for longer or shorter periods than normal during the year.
- Tenderness in the mammary glands or lack of pain: about 20% of women are affected by tenderness in their mammary glands or lack of tenderness in the breasts.
- Oligomenorrhea: women with anovulation suffer from light and infrequent menstrual cycles, this disorder affects 40% of females.
- Decrease in premenstrual symptoms: reduces constipation, headache, breast tenderness, bloating (premenstrual syndrome).
- Difficulty conceiving: Because the egg does not shed, you may have trouble getting pregnant.
Diagnosis of anovulation
Diagnosing your ovulation is very simple to determine. Initially on your fertile days you may observe a kind of thicker discharge than normal, you may even feel some discomfort in the ovary that is ovulating at the moment. Although it is also possible that you do not have any apparent symptoms, in this case just a basal body temperature test will be enough to reveal whether the ovulation process is occurring or not. You can also use commercially distributed tests, which have been developed to determine if your ovaries are ovulating.
Are there treatments for anovulation?
The treatments for anovulation strictly depend on the recommendations of the specialist and the origin of the problem. Treatment may include medications or, if the case is very complicated, even surgery . Regardless of your case, it is best that you go to a doctor to indicate the appropriate treatment for the origin of your problem. For example, if your problem is related to Polycystic Ovarian Syndrome, your doctor will probably prescribe a hormonal contraceptive treatment to normalize it. If you think you have an abnormal ovulation, it is important that you see a doctor immediately.
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Treatment for hypogonadotrophic hypogonadism
This treatment focuses on the main cause of ovarian dysfunction in your hypothalamic-pituitary system. In many cases, the patients have recovered the normal cycle, only by changing their lifestyle habits, without the need to resort to medications.
Patients with bulimia or anorexia, generally must treat their problem with group therapy and psychotherapy, control their weight, in this way they can ovulate spontaneously. If your case is that of an extreme athlete, your doctor will probably tell you to reduce training, change your eating habits and increase the fat tissue in your body.
The treatment of women with systemic diseases is based on treating their disease and preventing estrogen deficiency problems. It is essential that the patient receives an interdisciplinary evaluation, in this way the risks of the patient when conceiving can be studied . If from the doctor’s point of view the patient has acceptable results and the menstrual cycles are normal, then she will be able to conceive spontaneously or if ovulatory dysfunction persists, the patient can undergo ovulation induction.
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Treatment of functional hypothalamic anovulation
In these cases, the treatment is based on differentiating the main cause of the alteration in ovulation. Try to reduce work and daily stress, improve eating habits, as well as reveal the medications that are probably causing anovulation; with this, the treatment would begin.
If, when correcting the possible factors that affect ovulation, it does not occur spontaneously, the patient should undergo ovulation induction.
Treatment of Polycystic Ovarian Syndrome
To treat patients with Polycystic Ovarian Syndrome, it is necessary to correct the metabolic condition. If you need this treatment and you are overweight, you should know that you will need to combine exercise and diet. These changes can positively affect your endocrine profile, the likelihood of eventual pregnancy, and spontaneous ovulation. Even if you lose only 5% of your total weight, this can help you reduce fat tissue, restore your ovulation and improve insulin sensitivity.
If you also have insulin resistance, the use of Metformin can help correct part of anovulation, hyperandrogenism, early reproductive loss and infertility. If you have a body index <35, Metformin treatment is more effective. Although it is still essential to eat a healthy diet and carry out permanent physical activity.
In the treatment of anovulation due to Hyperprolactinemia, some widely used drugs such as Cabergoline or Bromocriptine are used. At the beginning of treatment, plasma prolactin values should begin to decrease and in about 6 weeks a reduction in tumor size. In the cases of patients with macroprolactinomas, surgery is indicated.
Treatment for thyroid disorders
The treatments focus on trying to regulate the circulating hormone cycles. Radioactive iodine treatment is used for hyperthyroidism, although you should know that this kind of treatment is contraindicated if you want to get pregnant after finishing the treatment. Hyperthyroidism can also be treated with propylthiouracil or carbimazole, although these drugs penetrate the placenta, increasing the risk of developing hypothyroidism in the fetus . Patients who cannot use medicinal treatment or it did not work for them, surgical intervention is recommended.
With regard to hypothyroidism, it is essential to regulate the level of circulating hormone, because during pregnancy, low levels can be related to premature births, spontaneous abortions, neurological dysfunctions, congenital malformations and low IQ.
Treatment for premature ovarian failure
The diagnosis of this complication in young people especially, is a bit complicated to carry and requires a multidisciplinary evaluation for the treatment of these patients. Women in amenorrhea are in danger of developing osteoporosis and therefore it is necessary to start hormone replacement therapy. In this therapy, climacteric symptoms will be treated for estrogen deficiency. Regarding the reproductive issue, patients will need “egg donation” as treatment.
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Complications that anovulation can produce
When anovulation is not detected early and treatment is not received, this can cause further long-term complications:
- Glucose intolerance and Diabetes Mellitus: hormonal alterations increase the chances of these diseases being generated in 40% of women with ovulatory conditions.
- Cardiovascular diseases: there is a high predisposition to high triglycerides, suffering from thrombosis, among others.
- Cancer: cancer is usually more common in patients with Polycystic Ovarian Syndrome, due to the increased predisposition to carcinoma and endometrial hyperplasia due to continuous stimulation by endometrial estrogens without progesterone (anovulatory cycles are generated).
- Sterility: it is the most obvious complication, because the non-existence of a normal menstrual period makes it difficult to conceive.
Anovulation and obesity
This complication is very common and usually has a positive solution in most cases. Similarly, in the rest of the cases it is possible to go to in vitro fertilization . As long as anovulation and its causes are diagnosed as soon as possible, in addition to performing the appropriate treatments.
When abnormalities such as overweight and obesity occur, fertility problems can originate in both women and men, further complicating the outlook for reproduction. Hence the importance of going to a specialist as quickly as possible.
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Alterations that affect reproduction
Anovulation has been reported between 30% and 60% of women with obesity. An obese woman has more trouble getting pregnant and her response to fertility treatments is also complicated, especially ovulation induction treatments. There are 3 alterations that are related to anovulation, which can improve when the patient loses excess weight: reduction of globulin levels linked to the sex hormone, generating an increase in testosterone and estradiol levels; increased levels of insulin, causing stimulation in the ovarian stroma for the development of androgens; increased immediate aromatization from androgens to estrogens.
In anovulatory women, their overweight is known as android obesity, their body fat distribution, which is the result of the visceral mesenteric location and the fat stored in the abdominal wall. Fat is less sensitive to insulin and with greater sensitivity to catecholamines, it is related to hyperinsulinism and is metabolically more active, diabetes mellitus, glucose intolerance and the increase in the adjustment of androgen production, resulting in a reduction in globulin elevations along with sex hormones, increased levels of free testosterone, SBHG and estradiol.
Kathie Sand always saw the world of beauty as the terrain on which to build her professional career, a goal that was clear to her when she was only 15 years old. Her great concern to expand knowledge led her to settle in Paris where she studied hand in hand with the best beauty professionals and with the most advanced techniques for skin care.