What causes you to not ovulate?

Ovulation is a key part of the menstrual cycle and fertility. It occurs when an ovary releases an egg each month. The egg then travels down the fallopian tube where it may be fertilized. There are many different reasons why you may not ovulate or experience irregular ovulation. Understanding the potential causes can help you identify issues and improve your chances of conception.

Table of Contents

What is ovulation?

Ovulation occurs when a mature egg is released from one of your ovaries during your monthly menstrual cycle. The egg is swept into the fallopian tube where it may be fertilized by sperm. Ovulation signals the end of the follicular phase and the start of the luteal phase of your cycle.

For ovulation to occur, your body follows several steps each month known as the menstrual cycle:

Follicle stimulating hormone (FSH) causes follicles on your ovary to grow and mature.
One dominant follicle becomes the largest and secretes estrogen.

The rise in estrogen triggers a surge in luteinizing hormone (LH).
The LH surge causes the mature follicle to rupture and release the egg.

This process leads up to ovulation and prepares the uterus for potential implantation. Ovulation typically occurs about 14 days before the start of your next period.

What prevents ovulation?

There are several factors that can disrupt normal ovulation and lead to irregular cycles or missed ovulation. Common causes include:

Hormonal imbalances

Hormones like FSH, LH, estrogen, and progesterone control the menstrual cycle. Imbalances in these hormones can prevent normal ovulation:

Polycystic ovary syndrome (PCOS): A hormonal disorder causing irregular menstrual cycles, ovarian cysts, and lack of ovulation.

Thyroid problems: Both overactive (hyperthyroidism) and underactive (hypothyroidism) thyroid can impact ovulation.
High prolactin: Increased levels of the hormone prolactin can interfere with ovulation.
Premature ovarian insufficiency: Early decline in ovarian function leading to irregular cycles.

Medications

Certain prescription medications can temporarily stop ovulation or menstrual cycles:

Birth control pills: Prevent ovulation as part of their mechanism.
Antidepressants: Like SSRIs and SNRIs may inhibit ovulation.

Steroids: Glucocorticoid steroids can suppress ovulation.
Breastfeeding: Releases prolactin which can prevent ovulation.

Ovarian or pelvic conditions

Problems affecting the ovaries or pelvis may impact ovulation:

Ovarian cysts: Can interfere with normal menstrual cycles.
Pelvic inflammatory disease: Infection and inflammation disrupts ovulation.
Prior ovarian surgery: May cause scarring and adhesions.

Chemotherapy or radiation: Can damage ovaries and affect ovulation.

Other medical conditions

Various medical problems can also contribute to lack of ovulation:

Eating disorders: Extreme weight loss or gain impacts hormone levels.

Thyroid disorders: Both hyperthyroidism and hypothyroidism affect cycles.
Adrenal disorders: Such as Cushing’s or Addison’s disease.
Liver or kidney disease: May impact hormone regulation.

Stress

High stress levels lead to increased cortisol, which can interfere with other reproductive hormones and inhibit ovulation.

Obesity or low body weight

Body weight extremes of obesity or being underweight can impact normal hormone levels and reduce fertility.

Excessive exercise

In women who do intense exercise, physical stress may lead to lack of ovulation.

Advancing maternal age

As women get older, especially over 35, egg quantity and quality decline, increasing odds of anovulation.

Diagnosing causes of anovulation

If you suspect you are not ovulating regularly, there are tests your doctor can use to help identify potential causes:

Physical exam to check for signs of various conditions.

Blood tests to measure hormones like FSH, LH, estrogen, prolactin.
Pelvic ultrasound to examine the ovaries and uterus.
Ovulation predictor kit to detect LH surges.

Progesterone test to confirm ovulation occurred.
Thyroid function tests if thyroid issues suspected.

Based on your test results and health history, your doctor can determine what factors are contributing to lack of ovulation. Targeted treatment can then help restore normal cycles and ovulation.

How to ovulate regularly

There are various options available to help induce ovulation, depending on the underlying cause:

Fertility medications like Clomid, Femara, gonadotropins stimulate ovulation.
Metformin can regulate cycles in women with PCOS.

Thyroid medication restores normal cycles if due to hypothyroidism.
Prolactin medication such as bromocriptine if prolactin is elevated.
Surgery may be done to remove cysts or scar tissue.

Lifestyle changes like diet, exercise, stress reduction help balance hormones.

With treatment tailored to your particular issues, most cases of ovulation problems can be successfully managed. Work closely with your doctor to ensure proper follow-up until regular ovulation is achieved.

When to see your doctor

See your doctor promptly if you notice any of the following signs that may point to lack of ovulation:

Irregular menstrual cycles with variability in length greater than 7-9 days
Menstrual cycles longer than 35 days or shorter than 21 days
Absence of periods for more than 3 months (amenorrhea)

Inability to get pregnant after trying for 6 months to 1 year, especially if over 35
Pelvic pain or discomfort around time of expected ovulation
Excess hair growth, acne, and other signs of androgen excess

Sudden unexplained weight gain or loss
Increased anxiety, depression, fatigue, or other symptoms affecting quality of life

Evaluation of these symptoms can reveal if lack of ovulation is an issue and allow timely treatment.

Key takeaways

Lack of ovulation prevents pregnancy and causes irregular menstrual cycles.
Hormonal problems like PCOS and thyroid disorders often underlie ovulation issues.
Certain medications, health conditions, stress, and lifestyle factors may also impact ovulation.

Tests like bloodwork, pelvic ultrasound, and ovulation predictor kits help diagnose the problem.
Treatment with fertility drugs, thyroid medications, surgery, or lifestyle changes can improve ovulation.
See your doctor right away if you suspect you are not ovulating regularly.

The bottom line

Ovulation is essential for fertility and regulating menstrual cycles. Multiple medical issues like hormone imbalances, medications, ovarian cysts, and stress can disrupt normal ovulation. Diagnosing the underlying cause through proper testing allows specific treatment to help restore ovulation. If you suspect you are not ovulating regularly, promptly consult your doctor to get back on track.