What you need to know about anovulation

How often, women seek medical attention, the inability to get pregnant, they hear in response that the cause of their infertility is anovulation - a strange and confusing term. Anovulation is often accompanied by infertility, and can act as an independent cause of it, and the accompanying symptoms of acute or chronic diseases not related to the sexual sphere.

Any malfunction of the internal organs can affect the functioning of the ovaries, which leads to disruption of oocyte maturation, and as a result, to infertility. Ovulation - a process characterized by the maturation of the egg, its exit into the abdominal cavity from the ovary, corpus luteum formation and preparation of the endometrium for implantation of a fertilized egg. Violations during the normal menstrual cycle phase change with the change of the endometrium (proliferative, secretory phase and desquamation) and the lack of oocyte maturation leads to disruption of the menstrual flow and anovulation.

There are physiological and pathological anovulation.

Physiological anovulation (lack of ovulation is normal)

• Postpartum
• Lactation
• Menopause (gradual ovarian failure)
• Puberty Puberty child - stages of a complex path   (puberty), generally for two years after menarche
• In healthy women of reproductive age 1-2 menstrual cycles per year can occur without ovulation Ovulation - How to determine as accurately as possible?

Pathological anovulation (chronic anovulation, leading to infertility)

The menstrual cycle and ovulation are regulated by a complex system: giptalamus-pituitary-adrenal-ovary. If you fail at any level of the system is a violation of the menstrual cycle and the appearance of anovulation.

Why get anovulation

• Tumors of the pituitary gland
• Violation of the functions of the hypothalamus
• Hyperprolactinemia (increased production of prolactin by the pituitary gland)
• Injuries and circulatory disorders of the brain (eg, stroke)
• Hyperandrogenism (increased secretion of male hormones by the adrenal glands or ovaries)
• Acute and chronic inflammation of the uterine appendages
• Stress and physical trauma
• Anorexia (lack of appetite and drastic weight loss)
• Increased body weight (estrogens accumulate in the fatty tissue, and their withdrawal from the body is broken)
• Early menopause or ovarian failure syndrome
• Gynecological diseases (uterine fibroids, ovarian cysts, endometriosis, endometrial hyperplasia)
• Thyroid disease and liver
• Taking certain medications (corticosteroids, atropine, psychotropic, narcotic and other)
• Gestation
• Receipt of estrogen in the body from the outside (oral contraceptives)

Signs

Clinical manifestations are directly dependent on the duration of anovulation and the degree of dysfunction of the ovaries.

• Changes in the nature, duration of menstruation and the spaces between them. There are dysfunctional uterine bleeding, leading to oligomenorrhea, then to amenorrhea.
• Hirsutism (body hair male pattern)
• Hair loss, the appearance of acne (acne)
• Breast Disease (from mastitis to breast cancer)
• The inability to conceive, and in the event of a problem pregnancy, childbearing
• Endometrial hyperplasia as a consequence of amenorrhea; possible and endometrial cancer

Among other things, persistent anovulation increases the risk of cardiovascular disease and diabetes. In severe cases, acromegaly is accompanied by anovulation.

Methods of examination of when anovulation

• When collecting history doctor finds out whether surgery, diagnostic curettage of the uterus Curettage - how dangerous it is? Transferred infectious processes. Required general and gynecological examination.
• Functional diagnostics tests are conducted to determine the extent of estrogenic saturation. One such test is the control of the basal (rectal) temperature. Normally, the temperature curve rises to 0, 2-0, 4 C (over 37 degrees) in the second phase of the menstrual cycle. When anovulation temperature schedule presented mono-line, without a sharp rise in temperature up.
• Hormonal studies. Determining the level of prolactin, testosterone, cortisol, FSH and luteinizing hormone.
• Craniography (X-ray of the skull bones and the identification of tumors of the pituitary gland)
• The study of thyroid function
• Ultrasound X-rays of the breast

Treatment depends on the cause of anovulation, caused it and the objectives pursued by the doctor and the patient.

When the disease of the thyroid gland (hypothyroidism or hyperthyroidism) are appointed by the thyroid hormones. In obesity treatment is aimed at weight reduction and gives a very good effect. In the case of hyperprolactinemia prescribers that suppress the production of prolactin, such as bromocriptine (parlodel). To restore the ability to conceive prescribed stimulants of ovulation (clomiphene). With a view to the normalization of cyclical processes in the endometrium, recommended low-dose estrogen Estrogen - the key to bone health -gestagennye contraceptives.

Anovulation itself is not a disease, but one of the signs, whistleblower in the female reproductive system.

Anna Sozinova

Treatment of anovulation

Weight Change

Women with polycystic ovary syndrome who have an overweight or obese (body mass index more than 30 units) can be offered a variety of programs for weight loss. Reducing body weight of only 5% reduction in the level of insulin and testosterone, whereby menstrual cycle becomes more regular ovulation has restored, and increases the chance of pregnancy. Pregnant women suffering from obesity, there is an increased risk of miscarriage.

Patients who have a very low weight (body mass index less than 18 units) should take steps to increase the weight. Any means for treating anovulation and sterility can only be assigned after the weight will be in the normal range.

Treatment of hyperprolactinemia

One of the safest and most widely used for the treatment of this disorder is bromocriptine.

Treatment should begin with receiving 1.25 mg in the evening, with food. The next evening dose of bromocriptine increased to 2.5 mg. Regularly check the level of prolactin, and if it is below 1,000 IU / L, further dose should be taken with the help of which managed to achieve such a result. Side effects of bromocriptine may be postural hypotension, nausea, dizziness, headache. Some patients because of these side effects have to stop taking the drug. Cabergoline and quinagolide - a newer class of drugs dofiminovyh receptor agonists that cause fewer side effects. Currently, they are also quite often prescribed for the treatment of hyperprolactinemia Hyperprolactinemia: determine the cause .

In 70-80% of women after the prolactin level in the blood falls below 1000 IU / L, ovulation has restored.

Treatment of hypothyroidism

Lower levels of thyroid-stimulating hormone, typical of hypothyroidism can be a cause of anovulation. Successful treatment of hypothyroidism using replacement therapy with synthetic analogues of thyroxine Thyroxine - the main thyroid hormone   It helps, inter alia, to normalize the prolactin level in the blood and restore ovulation Ovulation - How to determine as accurately as possible? .

Ovulation induction

• Pulsating release of gonadotropin-releasing hormone

Treatment of gonadotropin-releasing hormone, which is carried out in a specialized facility, suitable for women who have anovulation is associated exclusively with the activity of the hypothalamus. Such therapy may be given to patients, and that led her weight back to normal, but despite this, they still have not recovered ovulation. During treatment, the woman bears a small mechanical device that every 90 minutes injected subcutaneously with gonadotropin-releasing hormone. Typically, this results in the onset of ovulation. Side effects of this treatment are as low - typically this is only mild reaction in the area where the injection was made.

The probability of conception as a result of such treatment is approximately the same as that of healthy people - it is 20-30% in one cycle, and 80-90% per year.

• Clomiphene

Clomiphene - a drug that belongs to the group of antiestrogens. It blocks estrogen receptors in the pituitary gland, resulting in increased production of follicle-stimulating hormone, which stimulates the development of follicles and plays an important role in the process of ovulation. Clomiphene can be taken only under certain violations, which include polycystic ovarian syndrome. Ovulation induction using clomiphene may be carried out only if in the future it will be possible to conduct ultrasound examination of the ovaries - is associated with increased risk of development of multiple follicles. Furthermore, there is some chance of developing ovarian hyperstimulation syndrome.

In 70% of patients as a result of treatment with clomiphene ovulation, and the probability of becoming pregnant within six months of 40-60%. The probability of the birth of twins is 10%, and the triplets - 1%.

It is important to note that the objective of ovulation induction is a regular maturation of one egg per cycle, in order to avoid multiple pregnancies. Clomiphene increases the probability of maturation of several eggs. In addition, studies have shown that clomiphene for more than 12 months, a substantially increased risk of developing ovarian cancer. For this reason, treatment with clomiphene usually does not last more than six months.

• Metformin

The research results suggest that taking 1500 mg of metformin daily can normalize the menstrual cycle by reducing the level of insulin and testosterone. The same result was obtained for all subjects with polycystic ovary syndrome - whether they have been identified obesity, or not. However, the use of metformin for the treatment of anovulation does not yet have official approval, and it is possible that this therapy may be as yet unknown consequences. In order to come to final conclusions, more research is needed.

• The injections of follicle stimulating hormone

This method of treatment is appointed in cases where anovulation is associated with disorders of the hypothalamus and pituitary gland, as well as women with polycystic ovary syndrome, which is not helped clomiphene. Since the most serious complication of this therapy is ovarian hyperstimulation syndrome and a high probability of multiple pregnancy, it is important that in the course of treating a patient to undergo regular ultrasound.

Surgical intervention

For the treatment of anovulation in women suffering from polycystic ovary syndrome, can be used laparoscopic ovarian diathermy. The probability of successful treatment is approximately the same as with injection of follicle stimulating hormone, but the risk of multiple pregnancy and ovarian hyperstimulation after operation is much lower. If during laparoscopy Laparoscopy - why is it necessary?   It is destroyed too much of ovarian tissue, which may result in premature ovarian failure in the future.