Ovulatory Dysfunction: Symptoms And Treatment Options
Not Ovulating? Ovulatory Dysfunction Might Be The Reason
Ovulatory dysfunction results from congenital defects, hormonal deficiencies and/or the aging process. Some women don’t have menstrual periods while others menstruate but don’t ovulate. Women with amenorrhea have never had a period or had irregular periods that stopped prematurely. With anovulation, eggs aren’t released from the follicles and oligo-ovulation is characterized by longer cycles and infrequent ovulation. Other forms of ovulatory dysfunction, called luteal phase defects, occur when a woman has a menstrual cycle and is ovulating, but the cycle is too short for the uterine lining to thicken properly.
Symptoms Of Anovulation Or Ovulatory Dysfunction
Common forms of ovulatory dysfunction include:
Premature Ovarian Failure (POF) – menopause usually occurs after several decades of menstrual cycles and natural depletion of the ovarian reserve. Premature ovarian failure, or early menopause can be caused by exposure to certain chemicals, chemotherapy and radiation for cancer treatment. It also results from other conditions that affect the cycle-regulating hormones or damage the ovaries so they no longer produce eggs. Certain genetic disorders can trigger premature ovarian failure, as can autoimmune diseases – such as lupus or rheumatoid arthritis – that cause the body to mistakenly attack the ovaries.
Polycystic Ovarian Syndrome – genetically linked hormonal imbalances can cause polycystic ovarian syndrome (PCOS), a condition that prevents ovulation. Without the necessary level of follicle stimulating hormone (FSH), the follicles don’t develop properly and the eggs don’t mature. An imbalance of luteinizing hormone (LH) causes overproduction of estrogen, abnormal thickening of the uterine lining and very heavy and/or irregular periods. High levels of LH can trigger over production of male hormones, including testosterone, which cause acne and facial hair – common symptoms of PCOS. Over time, elevated estrogen levels associated with PCOS may create an increased risk of uterine cancer and diabetes.
Hyperprolactinemia – this condition is associated with the pituitary gland located in the brain, which produces prolactin to help regulate ovulation and stimulate breast milk production in pregnant women. Overproduction of prolactin results from tumors on the pituitary, an underactive thyroid (hypothyroidism) or an adverse reaction to certain prescription medications, including antihistamines, oral contraceptives, tranquilizers and antihypertensives. As a result, women experience irregular or no ovulation, and they may produce breast milk even though they aren’t pregnant.
Hypothalamic Amenorrhea – the hypothalamus gland, also located in the brain, produces gonadotropin-releasing hormone (GnRH). This chemical stimulates the pituitary gland to release follicle stimulating hormone (FSH) and luteinizing hormone (LH). When the hypothalamus stops producing GnRH as a result of this condition, it affects the FSH and LH levels needed for egg development and ovulation.
Thyroid Dysfunction – Hyperthyroidism or Hypothyroidism can both be associated with irregular menses
Treatment Options For Ovulatory Dysfunction
Medication – birth control pills can stimulate and regulate the menstrual period if a woman is not trying to get pregnant. Infertility patients with PCOS may start with Clomiphene Citrate (Clomid) or Letrozole (Femara) medications designed to stimulate the ovaries to induce ovulation. Other fertility drugs – human chorionic gonadotropin (HCG) and human menopausal gonadotropin (HMG) and follicle stimulating hormone (FSH) – also may be prescribed if clomiphene citrate alone is not effective. Finally, progesterone may be necessary to help mature the uterine lining and sustain pregnancy.
Medication also is available to suppress overproduction of prolactin caused by hyperprolactinemia. In cases of hypothalamic amenorrhea, gonadotropins (LH and FSH) are prescribed to regulate levels of these hormones.
Thyroid hormone for hypothyroidism, and PTU for hyperthyroidism
Ovulation Induction (OI) – used alone or with insemination, OI relies on fertility drugs to stimulate development of the follicles and eggs. For this reason, it can be an effective treatment for various forms of ovulatory dysfunction and luteal phase defects. As part of an OI cycle, progesterone may be prescribed alone – or combined with other fertility medications – to stimulate development of the uterine lining to support pregnancy. Follicle stimulating hormone (FSH) and Human chorionic gonadotropin (HCG) also may be prescribed to overcome luteal phase defects by triggering ovulation.
In Vitro Fertilization (IVF) – recommended as it may offer the best chance for pregnancy when infertility is related to ovulatory dysfunction. Injectable hormones designed to regulate the reproductive cycle and stimulate the development of multiple eggs will provide more chances for fertilization.
Donor In Vitro Fertilization – required in cases of premature ovarian failure when there are no eggs available. Eggs from a young female donor, whose body has been stimulated by fertility drugs, are retrieved and fertilized in the laboratory with the male partner’s sperm. The embryos are transferred into the recipient’s uterus, which has been prepared to support pregnancy.