The anovulatory cycle: when it’s normal and when it’s not
An anovulatory cycle is defined as such when the obvious signs of ovulation are not noticed between a menstruation and a subsequent blood loss. Or more generally when after one menstruation, the next ones no longer occur due to lack of ovulation.
There are several reasons why a woman doesn’t necessarily ovulate every month. Some are linked to particular stages in a woman’s life such as adolescence, breastfeeding, pregnancy or menopause.
Other causes are temporary such as having just stopped taking birth control pills or other hormones, or due to stress, illness, too much exercise, suboptimal body weight and travel.
Then there are more serious causes due to particular physical conditions.
It is important to understand the causes of anovulatory cycles and put them in the correct context. Sometimes these are very normal, predictable events, but if you think there is a more serious cause, always talk to your gynecologist.
In a normal menstrual cycle, the body prepares for ovulation (the release of the egg cell) by showing typical and predictable symptoms. After menstruation, under the influence of a progressive increase in estrogen, the woman experiences a few days of mucus-free and dryness. Subsequently she increases the sense of wetness and the increasingly stringy and elastic losses that indicate a fertile cervical mucus. These symptoms increase as ovulation approaches to a peak of relaxation and lubrication. Once the egg has been released the cervical mucus rapidly becomes thicker and drier until the next menstruation. Then the cycle begins again.
An anovulatory period refers to that length of time in which a woman does not experience any ovulation. This period can also last a long time as in the case of premenopausal breastfeeding or in an underweight condition.
In this period, estrogens fail to reach those levels which would allow the ovulatory mechanism to start. There are attempts that manifest themselves with mucus losses which, however, do not have that evolutionary trend typical of the ovulatory phase, interspersed with periods of dryness.
Most common causes of the anovulatory cycle
Adolescence
On average, the menarche (the first menstruation) occurs between the ages of 12 and 14. But this does not mean that from then on the girl will ovulate every cycle.
In fact, the cycles of adolescents can be very irregular due to the fluctuation of hormone levels. It takes a few years for the whole hormonal mechanism to mature and therefore to arrive at a regularity.
Pregnancy and breastfeeding
Obviously, during pregnancy you do not ovulate and consequently you do not have menstrual cycles.
It’s probably a great relief for everyone to be able to stay away from PMS, pain, tampons, pads and cups for 9 months!
The woman will not ovulate again until the baby is born.
Once the baby is born, breastfeeding on demand may delay ovulation by several more months.
Every time the baby attaches to the breast, it indirectly suppresses the hormones that trigger ovulation. But to keep suppressing it, the child has to attack frequently, day and night.
Otherwise, when feedings become more infrequent, especially with weaning, but it can happen earlier, without much warning the woman will ovulate again. For this reason it is important to always take the necessary precautions when having intercourse if you are not looking for a new pregnancy.
Menopause
Menopause is that period in a woman’s life when she stops ovulating and having periods. It usually occurs around the age of 51. But already several years earlier, during that phase called premenstrual, the cycles begin to change, even a lot.
They can shorten or lengthen, become intermittent until they cease altogether. To understand if the premenopause phase has begun, it is enough to do some hormonal dosages.
Indispositions
A flu or a particular indisposition can interfere with the regularity of the menstrual cycle. How it interferes depends on the phase of the menstrual cycle in which you get sick.
If the flu arrives before ovulation it can delay or block it. Getting sick after ovulation rarely interferes with your period, as your luteal phase always remains between 11 and 16 days.
Trips
Travel affects the regularity of the menstrual cycle. This does not apply to all women, there are those who continue to be a Swiss watch and those who, during the holidays, are no longer able to understand if she has ovulated and therefore when to expect her period.
In fact, the journey can be seen by the body as a sort of physical stress. So you may experience long cycles (due to delayed ovulation) or no ovulation and therefore no menstruation.
This is where basal temperature monitoring helps us, which allows us to keep an eye on what is, or isn’t, happening.
Physical exercise
Excessive physical activity can delay or block ovulation. But don’t use this fact as an excuse not to exercise.
In fact, we talk about excess and it is something that often affects athletes who have little or very little fat mass.
Weight gain or loss
In order for a woman to maintain normal ovulatory cycles, she should have 20% body fat . Women who are excessively thin or suffer from eating disorders such as anorexia often fall into secondary amenorrhea , do not ovulate, and no longer menstruate.
This happens because their body no longer produces enough estrogen to pass the threshold level and thus trigger ovulation.
Even women who lose 10-15% of their total weight (or a third of their body fat) can see their periods disappear.
Due to the stress of competitions and lack of fat mass, female athletes often do not menstruate.
On the other hand, women who tend to be overweight may not ovulate. Obesity with its excess of adipose tissue can lead to an excess of estrogen which disrupts the feedback mechanism that regulates the ovulation process.
Stress
One of the most common causes of very long cycles is stress, both physical and mental. When stress affects a menstrual cycle, it tends to delay ovulation. as we know the moment in which ovulation occurs then determines the overall length of the menstrual cycle. The later you ovulate, the longer your menstrual cycle will be. If the stress is so much it can even block ovulation for months
Health problems
There are a number of physical conditions that can block ovulation. Among them we find high levels of prolactin or micropolycystic ovary syndrome . These are conditions that can be treated with the help of a specialist.
The importance of monitoring the menstrual cycle
To understand if you ovulate regularly or not, a method that helps us is that of the basal temperature . If the graph has a biphasic trend it confirms ovulation, if it is a continuous ups and downs it indicates an anovulatory cycle (as in the figure below.
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.