How to Recognize, Prevent, and Treat an Anovulatory Cycle
A menstrual cycle involves dedicated dynamics of hormone levels. To ovulate, your hormone levels have to rise and fall precisely at the right time.
Ovulation happens when the ovary releases an egg into the fallopian tube, setting up the foundation for pregnancy. In order to get pregnant, you must ovulate.
You may assume that menstrual bleeding is a sign that you ovulated normally — but that’s not always the case. Sometimes, you can have what’s called an anovulatory cycle, which is a menstrual cycle where you do not ovulate, yet may still have a menstrual period.
What is an anovulatory cycle?
An anovulatory cycle is a menstrual cycle characterized by the absence of ovulation, and the inability to get pregnant.
In a regular, ovulatory cycle, hormone changes drive the ovary to release a mature egg. If the egg meets sperm in the uterus, fertilization can happen and prenatal development starts. In an anovulatory cycle, menstrual bleeding can still happen, even without ovulation. So, you may have experienced one and not even noticed.
In an ovulatory cycle, progesterone levels rise, leading to ovulation. In an anovulatory cycle, an insufficient level of progesterone can lead to anovulatory bleeding. You may mistake this for normal menstrual bleeding, but it is technically not the same as a “real” period.
Anovulatory or uterine bleeding can also be caused by the buildup of the uterine lining, which is known as the endometrium. When the endometrium can’t sustain itself anymore, it sheds and leads to bleeding, even if you have not ovulated.
What are the signs of an anovulatory cycle?
In the United States, one out of every six couples has trouble getting pregnant or sustaining a pregnancy. Anovulation is a common reason for infertility.
Unless you track your ovulation, you are most likely not aware that you have experienced an anovulatory cycle. The signs of an anovulatory cycle are easy to miss if you do not know what you are looking for.
If you have regular periods every 24 to 35 days, you are likely ovulating regularly. Signs you may not have ovulated include:
- Irregular cycles that are shorter than 21 days or longer than 35 days
- Getting your period 10+ days late
- Having a menstrual cycle that is much shorter than usual
Tracking your period alone will not tell you if you ovulated or not. Mira’s fertility tracker tracks your actual hormone concentrations to detect when ovulation does (or does not) occur. The only other way to pinpoint your ovulation with this level of accuracy is with a laboratory test at your doctor’s office.
With Mira, you can see your unique hormone curve so you know exactly when you are fertile or non-fertile. Mira’s algorithm learns your cycle. Your test data is automatically synced and managed by the Mira App.
Another way to detect ovulation is by ultrasound. It confirms the follicle growth and the characteristics of endometrium and corpus luteum formation that signify ovulation. To do this, you will need multiple hospital appointments that are at least two to three days apart to monitor your cycle.
During your follicular phase, doctors often measure the levels of your follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estrogen. In the middle of your luteal phase, progesterone level is checked as well.
If ultrasound discovers a fully developed corpus luteum, and hormone tests find that a progesterone peak has occurred, full ovulation is confirmed. If one or more of these factors are not true, the cycle is called anovulatory.
Causes of anovulation
Anovulatory cycles are most common in girls who have just started menstruating and women who are close to menopause. In both these groups, anovulatory cycles are considered normal and nothing to worry about.
Besides normal changes throughout the life cycle, other potential causes of an anovulatory cycle include:
- Polycystic ovarian syndrome (PCOS)
- Using hormonal contraception
- Certain medications
- Extreme exercise
- Unhealthy lifestyle
- Low body weight
- Severe stress
If you are trying to conceive or avoid pregnancy naturally, be sure to track your hormone levels and ovulation with a fertility tracker such as Mira. If you believe you may have a reproductive health problem, visit a doctor as soon as possible.
Treatments for anovulation
Your doctors will often recommend a treatment plan if you have frequent anovulation. In addition, there are some natural ways to encourage your body to ovulate.
All of the following factors are important in ensuring healthy ovulation:
- Good nutrition
- Healthy lifestyle
- Moderate physical activity
- Well-managed stress levels
If you are overweight, losing weight may also encourage ovulation to restart.
You cannot control factors like PCOS or menopause, but you can control your lifestyle. Try to stick to a healthy diet and moderate exercise plan and manage your stress for a few months. Then, check if ovulation returns and becomes regular by measuring your hormone concentrations with Mira.
If the above changes don’t seem to make a difference, you should talk with your doctor. Your OB/GYN may give you medication to support the ripening of follicles, increase estrogen levels, and/or stimulate the ovaries to release eggs.
What anovulation can mean if you’re trying to get pregnant
Anovulatory cycles can feel like a death sentence if you are trying to conceive (TTC). While it’s true that you can’t get pregnant if you do not ovulate, you should know that anovulatory cycles are a treatable condition. For most women, it is possible to reverse anovulatory cycles in order to get pregnant.
It’s completely normal to worry about what anovulatory cycles could mean for your fertility – let’s answer some of the most common questions about anovulation when you are TTC:
How long does an anovulatory cycle last?
A normal menstrual cycle lasts between 21 and 35 days. Cycles that are longer than 35 days or shorter than 21 days may be anovulatory. If your menstrual cycle is much shorter than usual, or you get your period 10 or more days later than expected, you may also be experiencing an anovulatory cycle.
Do you have a period after an anovulatory cycle?
Yes, it is possible to get your period despite anovulation. Low progesterone levels and/or buildup of the uterine lining (the endometrium) throughout the menstrual cycle can trigger menstruation despite anovulation. As a result, you may experience normal bleeding and assume that you have ovulated, if you are not tracking your hormone concentrations throughout your menstrual cycle.
Remember: tracking your period alone will not tell you if you have ovulated or not. You must track your numeric hormone concentrations using a tool like Mira to fully understand whether or not you have ovulated.
When should you expect ovulation after an anovulatory cycle?
Ovulation can return after an anovulatory cycle, but the timing varies for everyone. You may have just one anovulatory cycle before resuming normal ovulation, perhaps due to increased stress or exercise during that particular menstrual cycle. Or, you may experience chronic anovulation due to a condition like PCOS, or due to ongoing problems caused by an unhealthy lifestyle.
If anovulation is caused by an unhealthy lifestyle, you can expect ovulation to return to normal shortly after making changes to your diet, exercise routine, and stress management techniques. If it does not return after making these changes, visit your doctor for further testing and suggestions. They may want to prescribe medication to help you ovulate normally.
Additionally, anovulation can be caused by hormonal birth control. In this case, you can expect normal ovulation to resume one to three months after stopping the pill. If it does not, visit your doctor for further evaluation and treatment.
Certain other medications may also cause anovulatory cycles, such as non-steroidal anti-inflammatory drugs (NSAIDS), which include painkillers like aspirin and ibuprofen. If they are responsible for your anovulatory cycles, ovulation should return shortly after you stop taking these medications. However, do not stop taking any medications without talking to your doctor first.
When anovulation is due to a chronic health condition, it may improve with management of the health condition, or with taking certain medications to promote ovulation. Talk to your doctor if you suffer from a condition like PCOS to discuss how you can restart ovulation when you are TTC.
When should you see a doctor?
You should see a doctor if you have been trying to get pregnant for longer than one year (or six months, if you are over age 35) to no avail. If you suspect anovulation is the cause of your fertility problems, your doctor can help you put together a plan combining medications and lifestyle changes that will help you ovulate normally again.
If you have a reproductive health condition that is causing anovulation, you should talk to your doctor as soon as possible. Your OB/GYN may prescribe medication to help you ovulate normally, especially if you are TTC. Also, talk to your doctor if you suspect a medication you are taking is impacting your fertility.
Finally, you should look out for the following warning signs that something is wrong with your reproductive health tract. It’s essential to visit a doctor as soon as you notice any of the following symptoms:
- Cycles that are shorter than 21 days or longer than 35 days
- Going 90+ days without a menstrual period
- Abnormal uterine bleeding between cycles
- Abdominal or pelvic pain during your period or throughout your cycle.
✔️ Medically Reviewed by Banafsheh Kashani, MD, FACOG
Banafsheh Kashani, M.D., FACOG is a board-certified OB/GYN and specialist in reproductive endocrinology and infertility at Eden Fertility Centers, and has been treating couples and individuals with infertility since 2014. Prior to joining Eden Centers for Advanced Fertility, she was practicing as a top fertility specialist at Kaiser Permanente in Orange County and Reproductive Fertility Center. Dr. Kashani has received numerous awards throughout her years of study and medical training.
Dr. Kashani has conducted extensive research in female reproduction, with a specific focus on the endometrium and implantation. Additionally, Dr. Kashani has authored papers in the areas of fertility preservation, and fertility in women with PCOS and Turners syndrome. She also was part of a large SART-CORS study evaluating the trend in frozen embryo transfers and success rates.
Dr. Kashani is a fellow of the American Congress of Obstetricians and Gynecologists. In addition, she is a diplomat of the American Board of Obstetrics and Gynecology and an active member of the American Society of Reproductive Medicine (ASRM) and Pacific Coast Reproductive Society (PCRS). She is also a member of the Society of Reproductive Endocrinology and Infertility (SREI).