Anovulatory cycle

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An anovulatory cycle is a menstrual cycle characterised by the absence of ovulation and a luteal phase. It may also vary in duration from a regular menstrual cycle.

Patterns

While the normal human

).

Estrogen breakthrough bleeding

Normal menstrual bleeding in the ovulatory cycle is a result of a decline in progesterone due to the demise of the corpus luteum. It is thus a progesterone withdrawal bleed. As there is no progesterone in the anovulatory cycle, bleeding is caused by the inability of estrogen—which needs to be present to stimulate the endometrium in the first place—to support a growing endometrium. Anovulatory bleeding is hence termed 'estrogen breakthrough bleeding'.

Risks

1. Anemia
2. Bone density loss^[1]
3. Endometrial cancer
4. Infertility

Diagnosis

A physician needs to investigate the cause of anovulation. Common causes are:

1. Polycystic ovary syndrome
2. Hypothalamic dysfunction
3. Perimenopause
4. Ovulatory dysfunction^[2]
5. Thyroid disorders
6. Hyperprolactinemia
7. Eating disorders, dieting or other disordered eating
8. Female athlete triad

With excessive or prolonged bleeding the diagnosis has to be made by a physician on a speedy basis. Other causes of gynecological bleeding need to be excluded, specifically bleeding related to pregnancy, leiomyoma, and cancer of the cervix or uterus.

Management

Women who do not ovulate and who want to get pregnant need a medical work-up to find out why they do not ovulate. Drugs are often given to induce ovulation, including oral medication such as

or injectable medications. In patients who do not want to get pregnant anovulation can be managed with the use of cyclic .

See also

• Anovulation
• Menstrual cycle
• Ovulation

Notes