Can you have a period without ovulating?
A period or menstruation is the bleeding that occurs about 12 to 16 days after ovulation or the release of an egg. If ovulation does not occur, no egg is released, and hence technically there should be no bleeding at all. This is known as anovulation. In women where ovulation fails to occur because of an anovulatory disorder, bleeding can occur nevertheless. This is known as anovulatory bleeding and is not a normal menstrual period.
There is a huge difference between cycles in which the woman ovulates but does not get her period, and one in which she gets her period but does not ovulate. In the former case, the woman is almost certainly pregnant. In the latter case, she has had an anovulatory cycle.
If you do not chart your ovulation and have an anovulatory disorder, then you may assume that you are menstruating normally when anovulatory bleeding occurs during your cycle. This anovulatory bleeding occurs when estrogen production continues to develop in the uterine lining without reaching the threshold necessary to trigger ovulation. In such a case, either of the following two things may happen, both leading to what appears to be a menstrual period but is really not one.
Either the estrogen will build up slowly to a point below the threshold and then drop, resulting in estrogen withdrawal bleeding.
Or the endometrium builds up slowly over an extended period of time, eventually to the point where the resulting uterine lining is so thickened it can no longer sustain itself. This is known as estrogen breakthrough bleeding. This is a more common occurrence.
In either case, if you weren’t charting your ovulation, you might think you were simply menstruating, though you would maybe notice a difference in the type of bleeding. Some women may notice a difference in the flow of bleeding. It may become heavier or lighter than your usual flow.
What is an Anovulatory Cycle, what causes it and how to prevent it?
By definition, an anovulatory cycle is a menstrual cycle in which ovulation fails to occur. This means that you do bleed but do not release an egg or ovulate. Hence the term anovulation. This is normally supposed to happen during menopause. If it does happen before then anovulation translates into difficulty in conception or infertility. Anovulatory cycles tend to occur occasionally throughout the childbearing years, but are most common during adolescence and in the years before menopause (“perimenopause”).
Causes and Prevention of Anovulatory Cycles
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. Some causes are relatively easy to identify, whereas others are much more difficult.
Hormonal imbalances are the most probable cause of anovulatory cycle. 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. Anxiety and other forms of emotional stress can also take their toll on normal ovulation.
The disorder may also result from eating disorders, hypothalamic dysfunction, hyperprolactinemia, polycystic ovary syndrome, luteal phase defects, or tumors of the pituitary gland adrenal gland or ovaries. Other causes of anovulatory cycles are primary ovarian failure, resistant ovary syndrome and autoimmune oophoritis.
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.
Once you know the probable causes of anovulation, you must take care to avoid any of these, especially if you have a history of fertility problems. Avoid any strenuous exercise without consultation and do not attempt to try out fad diests as these may lead to anovulatory cycles. Learn to manage stress and develop a healthy lifestyle to keep this disorder at bay.
Diagnostic Tests for Anovulatory Cycles
Anovulation can 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, scant, erratic, short and/or painless menstrual cycles can sometimes alert a woman or her doctor about an anovulation problem.
If you experience bleeding between periods for more than 2-3 cycles, you should notify your doctor immediately. Too many of these anovulatory cycles can contribute to irregular bleeding, or endometrial hyperplasia. A diagnostic test for anovulatory cycles may include the following depending on other factors like your age and medical history.
- Serum assays
- LH (on days 13 and 15 of menstrual cycle, to detect midcycle peak)
- Testosterone and SHBG (for obtaining Free Androgen Index [FAI] or calculated free testosterone levels)
- CT scan or MRI scan of pituitary and hypothalamus
- Endometrial biopsy
- Ovarian biopsy
- Specific antibody tests
Treatment for Anovulatory Cycles
Treatments for anovulatory cycles vary based on the underlying cause of the condition and other factors like age and medical history. For many infertile women with anovulation, treatment with one or another of fertility drugs can be remarkably successful. Clomiphene citrate (Clomid) is often a good first choice for an anovulatory woman who is producing estrogen.
If clomiphene alone is unsuccessful, Pergonal is added to bolster the attempts to ripen a follicle. Pergonal bypasses the natural hormone stimulation of the pituitary on the ovary. It applies stimulation directly to the ovary, and then, once a follicle grows to sufficient size, HCG is used as the final step to release the egg.
Some other treatments that can used in tandem with medication are :
Medications for specific underlying conditions
Surgery (in the case of tumors)
What is Ovulation?
Ovulation is the release of a single, mature egg from the ovarian follicle. The human ovary produces a multitude of ova during the course of a month, largest of which is expelled into the pelvic cavity and swept into the Fallopian tube. Ovulation does not follow a regular pattern between ovaries each cycle and which ovary releases the egg is fairly arbitrary. Once released, the egg is capable of being fertilized for 12 to 24 hours before it begins to disintegrate. If the released ovum or egg is fertilized and successfully implants, it results in pregnancy.
If the egg is not fertilized, it is passed from the reproductive tract during menstrual bleeding, which starts about two weeks after ovulation. Occasionally, cycles occur in which an egg is not released; these are called anovulatory cycles. Note that you can get your period even though you are not ovulating. Your ability to ovulate can vary from month to month.
Ovulation – The Hormones
During ovulation, two ovarian hormones, oestradiol and progesterone, are produced, which create conditions conducive to fertilization.
- Oestradiol is produced alone by the developing follicle before ovulation; it stimulates the glands of the cervix to secrete a particular type of mucus (“mucus with fertile characteristics”) which is essential for the sperm to pass through the cervix and reach the ovum. oestradiol also stimulates growth of the endometrium lining the uterus (womb).
- After ovulation, progesterone and oestradiol are produced by the corpus luteum which forms from the ruptured follicle. This progesterone causes the abrupt change in the mucus which occurs immediately after ovulation and defines the Peak symptom. Progesterone also prepares the oestrogen-primed endometrium for implantation of the fertilized ovum.
In the absence of pregnancy, production of oestradiol and progesterone begins to decline approximately 7 days after ovulation and this results in shedding of the endometrium as menstrual bleeding 11-16 days after ovulation.
Ovulation and Getting Pregnant
Ovulation is the ideal period of your cycle when your chances of getting pregnant are highest. Your fertile period starts about 4-5 days before ovulation, and ends about 24-48 hours after it. This is because sperm can live in your body for approximately 4 to 5 days, and the egg can live for 24 to 48 hours after being released. In normally fertile couples there is a 25 percent chance of getting pregnant each cycle, meaning around 75 to 85 percent of women who have sex without using birth control will get pregnant within one year. You can boost your chances of getting pregnant by learning exactly when you ovulate by understanding the cyclic hormonal and physical changes that take place in your body each month.
What is Polycystic Ovary Syndrome (PCOS)?
Polycystic Ovary Syndrome (PCOS)
The ovaries are the main reproductive organs in women that produce the eggs or ova. Eggs grow, develop, and mature in the ovaries and then are released during ovulation. Polycystic ovary syndrome (PCOS) is a syndrome in which the ovaries are enlarged and have several fluid-filled sacs or cysts. Ovarian cysts form on the ovaries when the follicles (sacs) on the ovary that contain the egg mature, but do not release the egg into the fallopian tube where it would be fertilized.
Polycystic ovaries are usually 1.5 to 3 times larger than normal ovaries. A woman can have one to many cysts which look like a string of pearls or a pearl necklace. Women with PCOS may experience a number of other symptoms as well. PCOS is a leading cause of infertility and is the most common reproductive syndrome in women of childbearing age. An estimated five to ten percent of women of childbearing age have PCOS (ages 20-40) and at least 30% of women have some symptoms of PCOS.
Causes of PCOS
PCOS develops when the ovaries overproduce androgens (eg, testosterone). Androgen overproduction often results from overproduction of LH (luteinizing hormone), which is produced by the pituitary gland. Research also suggests that when insulin levels in the blood are high enough, the ovary can be stimulated to produce more testosterone. Obesity, which itself can cause insulin levels to rise, may intensify PCOS. Yet, not all women who are overweight develop PCOS.
Symptoms of PCOS
Polycystic ovary syndrome is an endocrine (hormonal) disorder in which symptoms first appear in adolescence, around the start of menstruation. However, some women do not develop symptoms until their early to mid-20’s. Although PCOS presents early in life, it persists through and beyond the reproductive years.
No two women experiencing PCOS have exactly the same symptoms. The following symptoms are very often associated with PCOS, but not all are seen in every woman:
- Infrequent menstrual periods, no menstrual periods, and/or irregular bleeding;
- Infrequent or no ovulation;
- Increased serum levels of male hormones, such as testosterone;
- Inability to get pregnant within six to 12 months of unprotected sexual intercourse (infertility);
- Pelvic pain that lasts longer than six months;
- Weight gain or obesity;
- Diabetes, over-production of insulin, and inefficient use of insulin in the body;
- Abnormal lipid levels (such as high or low cholesterol levels, and high triglycerides);
- High blood pressure (over 140/90);
- Excess growth of hair on the face, chest, stomach, thumbs, or toes;
- Male-pattern baldness or thinning hair;
- Acne, oily skin, or dandruff;
- Patches of thickened and dark brown or black skin on the neck, groin, underarms, or skin folds; and
- Skin tags, or tiny excess flaps of skin in the armpits or neck area.
PCOS and pregnancy
PCOS can negatively affect fertility since it can prevent ovulation. Some women with PCOS have menstrual periods, but do not ovulate. A woman with PCOS may be able to take fertility drugs, such as Clomid, or injectable fertility medications to induce ovulation. To help ovulation occur, women also can take insulin-sensitizing medications or steroids (to lower androgen levels). Research also shows that taking low doses of aspirin, which helps prevent blood clotting in the uterine lining and improves blood flow, can improve chances of pregnancy.
There appears to be a higher rate of miscarriage in women with PCOS (possibly by 45%). Elevated levels of insulin and glucose can cause problems with development of the embryo in pregnant women. In women with PCOS, insulin resistance and late ovulation (after day 16 of the menstrual cycle) may reduce egg quality further, which can lead to miscarriage. The best way to prevent miscarriage in women with PCOS is to normalize hormone levels to improve ovulation, and normalize blood sugar, glucose, and androgen levels.