When a woman has irregular, infrequent (less than nine per year) menstrual periods or does not ovulate at all, she is said to have ovulatory dysfunction. Normally, one ovary releases an egg each month, which may be fertilized if it comes into contact with sperm. A woman with ovulatory dysfunction does not release an egg each month.
Ovulation is the release of an egg from the ovary. It must occur for pregnancy to be achieved naturally.
• Anovulation, means a lack of ovulation or absent ovulation. When a female is anovulatory, they cannot get pregnant because there is no egg to be fertilized.
• Oligo-ovulation ,When ovulation is irregular—but not completely absent.If a female has irregular ovulation, they will have fewer chances to conceive because they ovulate less frequently.
People with anovulation usually have irregular periods.2 Some do not get their cycles at all.
If your cycles fall within the normal range of 21 to 36 days, but the length of your cycles varies widely from month to month, that could also be a sign of ovulatory dysfunction. For example, if one month your period is 22 days and the next it’s 35, the variations between cycles could signal an ovulation problem.
A menstrual cycle where ovulation does not occur is called an anovulatory cycle.
• Polycystic ovarian syndrome, or PCOS (a complex metabolic syndrome that can be accompanied by resistance to insulin, impaired metabolism of glucose, and overproduction of androgenic, male, hormones)
• Hyperprolactinemia (increased production of the hormone prolactin from your pituitary gland)
• Hypothyroidism (underproduction of thyroid hormone)
• Hypothalamic dysfunction (underproduction of the pituitary hormones that stimulate egg development within the ovaries)
• Other conditions that can cause anovulation (eg, diabetes, depression, certain antidepressants, excessive exercise, use of drugs that contain estrogens or progestins)
• Menstrual history
• Sometimes basal body temperature monitoring
• Measurement of urinary or serum hormones or ultrasonography
Anovulation is often apparent based on the menstrual history.
The treatment for anovulation will depend on what is causing it. Some cases can be treated with changes to your lifestyle or diet. For example, if your low body weight or extreme exercise habit is the cause of anovulation, gaining weight or easing up on your workout routine might be enough to restart ovulation.
The most common treatment for anovulation is fertility drugs.
Commonly, chronic anovulation that is not due to hyperprolactinemia is initially treated with the antiestrogen clomiphene citrate.
Clomiphene is most effective when the cause is polycystic ovary syndrome (PCOS). Clomiphene 50 mg orally once a day is started between the 3rd and 5th day after bleeding begins; bleeding may have occurred spontaneously or have been induced (eg, by progestin withdrawal). Clomiphene is continued for 5 days.
Evidence indicates that in obese women with PCOS, letrozole (an aromatase inhibitor) is more likely to induce ovulation than clomiphene.
Letrozole, like clomiphene, is started between the 3rd and 5th day after bleeding begins. Initially, women are given 2.5 mg orally once a day for 5 days.
For women with PCOS, metformin (750 to 1000 mg orally twice a day) may be a useful adjunct in inducing ovulation, particularly if the patient is insulin-resistant, as many patients with PCOS are.
• Exogenous gonadotropins
For all women with ovulatory dysfunction that does not respond to clomiphene (or letrozole, when used), human gonadotropins (ie, preparations that contain purified or recombinant follicle-stimulating hormone [FSH] and variable amounts of luteinizing hormone [LH]) can be used.
Treatment of the underlying disorder
Underlying disorders (eg, hyperprolactinemia) are treated.
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