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Anovulation (no ovulation)

Q: I have very long menstrual cycles and my period often doesn't come for several months. Now my menstrual period hasn't come for three months. What could it be?

A: Irregular long cycles are often due to "anovulation" which means that you are not ovulating.

One way to make the diagnosis is by keeping a BBT (basal body temperature) chart..
Once the diagnosis of anovulation is made, your doctor needs to examine you and do some tests to find out the possible causes. Each cause needs to be treated differently.

The four most common causes of ovulatory dysfunction are

  1. Polycystic Ovary Syndrome (PCOS) (approximately 70% of cases of ovulatory dysfunction. 
  2. Hypothalamic amenorrhea, also known as hypogonadotropic hypogonadism (approximately 10% of cases)
  3. Hyperprolactinemia (approximately 10% of cases), and
  4. Premature ovarian failure, also known as hypergonadotropic hypoestrogenic anovulation (approximately 10% of cases)

There are three distinct parts of the body that contribute to ovulation problems: the hypothalamus, the pituitary gland, and the ovaries.

1. Hypothalamic problems (GnRH pulses FSH and LH)

  • Polycystic ovary syndrome
  • Prepubertal
  • Strenuous Exercise
  • Certain Diets
  • Stress
  • Low BMI, anorexia, sudden weight loss
  • Chronic or severe illnesses
  • Some drugs (e.g., opiates)

2.Pituitary Causes

  • Hypothyroidism
  • Hyperthyroidism
  • Too much Prolactin. Prolactin may be increased with certain drugs (e.g. major tranquilizers). Any pressure on the gland such as certain tumors (prolactinomas) can also cause a rise in the prolactin hormone (hyperprolactinemia), which in turn can cause problems with ovulation.

3. Ovary

  • Premature ovarian failure (POF)
  • Ovarian failure = menopause
  • Primary ovarian failure (often a chromosomal problem)
  • Secondary ovarian failure (cause often unknown, but can be due to an autoimmune disorder or caused by chemotherapy, radiotherapy, or surgery. The FSH is usually increased as there is no estrogen or inhibin feedback


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