Anovulation
Anovulation is the absence of egg release during a menstrual cycle. It may be occasional or persistent and can cause irregular bleeding or difficulty conceiving.
Key takeaways
- Irregular or absent periods suggest anovulation but do not prove it, and apparently regular bleeding does not always confirm ovulation.
- Pregnancy, polycystic ovary syndrome, thyroid disease, high prolactin, major weight change and intense exercise are possible causes.
- Treatment differs depending on whether the goal is cycle protection, symptom control or pregnancy.
The listings below do not identify why ovulation is absent; hormonal treatment should follow appropriate assessment.
What evaluation may include
History covers cycle pattern, medicines, weight change, exercise and signs of androgen excess. Pregnancy testing is an early step. Progesterone timed to the expected luteal phase can provide evidence of ovulation, while thyroid, prolactin and androgen tests or pelvic ultrasound may be indicated.
Treatment priorities
Addressing an underlying thyroid, nutritional or medicine-related cause may restore ovulation. Progestogen may protect the uterine lining when periods are infrequent, while ovulation-induction medicines are used only when pregnancy is desired and require monitoring for response and multiple-pregnancy risk.
When to seek urgent care
Seek urgent care for severe one-sided pelvic pain, fainting, heavy bleeding, fever with pelvic pain, or pain and bleeding when pregnancy is possible.