What Is Anovulation?
When your body doesn't release an egg—and what you can do about it.
Understanding Anovulation
- Definition: A cycle where no egg is released from the ovaries
- Can you still have a period? Yes—you can bleed without ovulating
- Common causes: PCOS, stress, thyroid issues, extreme weight changes
- The good news: Most causes are treatable
What Is Anovulation?
Anovulation means a menstrual cycle in which ovulation doesn't occur—no egg is released from the ovaries. Without an egg, pregnancy is impossible that cycle.
Here's what surprises many people: you can still have a "period" during an anovulatory cycle. The bleeding is called "withdrawal bleeding" or "anovulatory bleeding"—it happens when estrogen levels drop, causing the uterine lining to shed, even without the progesterone rise that normally follows ovulation.
🔬 Normal vs Anovulatory Cycle
Normal ovulatory cycle:
Estrogen rises → Ovulation → Progesterone rises → Progesterone drops → Period
Anovulatory cycle:
Estrogen rises → No ovulation → No progesterone rise → Estrogen drops → Bleeding
How Common Is Anovulation?
Occasional anovulatory cycles are normal. Most women experience 1-2 anovulatory cycles per year, especially during times of stress or illness. This is usually nothing to worry about.
However, chronic anovulation—where you rarely or never ovulate—is a medical condition that affects fertility and requires treatment. Chronic anovulation is one of the leading causes of infertility.
Signs You're Not Ovulating
Anovulation can be tricky to identify since you may still have monthly bleeding. Here are the key signs:
Irregular or Absent Periods
If your cycles are very irregular (varying by more than 7-9 days month to month), very long (over 35 days), or absent altogether, you may not be ovulating regularly.
Very Light or Very Heavy Bleeding
Anovulatory bleeding often differs from a normal period. It may be lighter and shorter, or heavier and more prolonged than usual. The bleeding pattern is often unpredictable.
No Cervical Mucus Changes
In an ovulatory cycle, you typically see egg white cervical mucus (EWCM) around ovulation. If you never observe fertile-quality mucus, you may not be ovulating.
Flat BBT Chart
If you track basal body temperature, an ovulatory cycle shows a clear temperature shift after ovulation. An anovulatory chart stays relatively flat with no sustained rise.
Never Getting a Positive OPK
If you consistently test with OPKs and never see a positive result (or see multiple "almost positive" results without a clear peak), you may not be having an LH surge and therefore not ovulating.
⚠️ Don't Self-Diagnose
While these signs can indicate anovulation, they're not definitive. Some women ovulate despite irregular cycles, and some have subtle signs they're missing. If you suspect anovulation, see your doctor for proper testing.
Common Causes of Anovulation
Polycystic Ovary Syndrome (PCOS)
The most common cause of anovulation. PCOS affects up to 10% of women and involves hormonal imbalances that prevent regular ovulation. Signs include irregular periods, excess androgen (acne, facial hair), and polycystic ovaries on ultrasound.
Treatment: Lifestyle changes, Clomid or Letrozole to induce ovulation, metformin, or other medications.
Hypothalamic Amenorrhea (HA)
When the hypothalamus stops sending signals to trigger ovulation, often due to stress, extreme exercise, or low body weight/caloric intake. Common in athletes and those with eating disorders.
Treatment: Reducing exercise, increasing caloric intake, stress management, sometimes hormone therapy.
Thyroid Disorders
Both hypothyroidism (underactive) and hyperthyroidism (overactive) can disrupt ovulation. Thyroid hormones play a crucial role in regulating the menstrual cycle.
Treatment: Thyroid medication to normalize hormone levels; ovulation often resumes once levels are stable.
High Prolactin (Hyperprolactinemia)
Elevated prolactin levels (the hormone that stimulates breast milk production) can suppress ovulation. Can be caused by pituitary tumors, certain medications, or other conditions.
Treatment: Medication to lower prolactin levels; treating underlying cause.
Premature Ovarian Insufficiency (POI)
When the ovaries stop functioning normally before age 40. Causes irregular or absent periods and elevated FSH levels. Affects about 1% of women.
Treatment: Hormone replacement therapy; fertility treatment options like egg donation may be discussed.
Stress
Significant physical or emotional stress can temporarily suppress ovulation. The hypothalamus is sensitive to stress hormones and may pause reproductive function during perceived "danger."
Treatment: Stress reduction techniques; ovulation usually resumes when stress decreases.
Extreme Weight Changes
Both very low and very high body weight can cause anovulation. Fat tissue plays a role in estrogen production, and extremes can disrupt hormonal balance.
Treatment: Achieving a healthy weight range often restores ovulation.
Coming Off Hormonal Birth Control
After stopping the pill or other hormonal contraception, it can take a few months for regular ovulation to resume. This is usually temporary.
Treatment: Typically resolves on its own within 3-6 months; see a doctor if cycles don't regulate.
How Anovulation Is Diagnosed
If you suspect you're not ovulating, your doctor may order several tests:
| Test | What It Measures | What It Reveals |
|---|---|---|
| Day 21 Progesterone | Progesterone levels mid-luteal phase | Low levels suggest no ovulation occurred |
| FSH & LH | Follicle-stimulating & luteinizing hormones | Imbalances can indicate PCOS or other issues |
| Estradiol | Estrogen levels | Low levels may indicate hypothalamic issues |
| TSH | Thyroid function | Identifies thyroid disorders |
| Prolactin | Prolactin levels | High levels can suppress ovulation |
| AMH | Anti-Müllerian hormone | Assesses ovarian reserve |
| Pelvic Ultrasound | Ovarian appearance | Can show polycystic ovaries or other abnormalities |
Treatment Options for Anovulation
Treatment depends on the underlying cause. Common approaches include:
Lifestyle Modifications
For many women, changes to diet, exercise, stress levels, or weight can restore ovulation naturally. This is often the first-line treatment for PCOS, hypothalamic amenorrhea, and stress-related anovulation.
Ovulation Induction Medications
- Clomiphene citrate (Clomid): Stimulates the pituitary to release FSH and LH, triggering ovulation. First-line treatment for many causes.
- Letrozole (Femara): Originally a breast cancer drug, now widely used for ovulation induction, especially in PCOS. Often more effective than Clomid with fewer side effects.
- Gonadotropins: Injectable hormones (FSH/LH) that directly stimulate the ovaries. Used when oral medications don't work.
Other Medications
- Metformin: For PCOS, improves insulin sensitivity and can help restore ovulation.
- Thyroid medication: For thyroid disorders.
- Bromocriptine or Cabergoline: For high prolactin levels.
Surgery
In some cases of PCOS, laparoscopic ovarian drilling can help restore ovulation by reducing androgen-producing tissue in the ovaries.
💊 Success Rates
Ovulation induction is highly successful. With Clomid or Letrozole, about 80% of women with PCOS will ovulate, and about 50% will achieve pregnancy within 6 cycles. Your doctor can help determine the best approach for your specific situation.
How to Track Whether You're Ovulating
If you're trying to confirm ovulation at home, use these methods:
BBT Charting
Track your basal body temperature daily. A sustained temperature rise after mid-cycle confirms ovulation occurred. A flat chart with no rise suggests anovulation.
OPK Testing
Ovulation predictor kits detect the LH surge before ovulation. If you never get a positive, you may not be surging. Note: Some women with PCOS have elevated LH all cycle, which can cause misleading results.
Cervical Mucus Monitoring
Track your cervical mucus throughout the cycle. The presence of egg white cervical mucus (EWCM) indicates rising estrogen and approaching ovulation.
Easy@Home BBT Thermometer
Track your temperature daily to see if you're getting the post-ovulation rise. Syncs with Premom app for automatic charting and pattern recognition.
Mira Fertility Plus
Measures actual hormone concentrations (LH, estrogen, progesterone) to confirm whether ovulation is occurring. Especially useful for PCOS and irregular cycles.
The Bottom Line
Anovulation—not ovulating—is one of the most common causes of infertility, but it's also one of the most treatable. If you suspect you're not ovulating (irregular cycles, no CM changes, flat BBT chart), see your doctor for testing.
Most cases of anovulation can be successfully treated with lifestyle changes, medication, or both. With the right treatment, the majority of women with anovulation can achieve pregnancy. 💚