Anovulation (Cycles Without Ovulation)

What it is

Anovulation is the absence of ovulation: the ovary doesn't mature or release an egg during the cycle, and the period, when it comes, is irregular or unpredictable. It's one of the most common causes of difficulty conceiving and of disorganized bleeding. It can be occasional, as in the first years after the first period and during the transition to menopause, or persistent, when there's hormonal imbalance, polyendocrine metabolic ovarian syndrome (SOMP), thyroid or prolactin changes, stress, and significant weight changes. Besides its impact on fertility, cycles without ovulation leave the endometrium exposed to estrogen without the protection of progesterone. The gynecology team at Femi Saúde investigates the cause and treats it according to each woman's goals.

Most common symptoms

• Irregular, spaced-out or absent periods
• Intervals longer than 35 days between cycles
• Unpredictable bleeding, sometimes light, sometimes heavy
• Difficulty conceiving naturally
• Absence of ovulation signs, such as clear, stretchy mucus
• Acne, excess hair or hair loss in SOMP

Causes and risk factors

• Polyendocrine metabolic ovarian syndrome (SOMP)
• Thyroid changes and elevated prolactin
• Significant weight loss or gain and excessive exercise
• Physical or emotional stress
• The first years after menarche and the transition to menopause
• Low ovarian reserve and premature ovarian failure

How it is diagnosed

The gynecologist reviews the menstrual history, weight, medication use, signs of excess androgens, and how long the patient has been trying to conceive. Progesterone measured in the second half of the cycle confirms whether ovulation occurred. Blood tests measure FSH, LH, estradiol, prolactin, thyroid hormones, androgens, and metabolic markers such as blood glucose and insulin. Transvaginal ultrasound evaluates the ovaries, the number of follicles, and endometrial thickness, and may be repeated on specific days of the cycle to track the growth of the dominant follicle. Cycle and basal body temperature charts help round out the assessment.

How we treat it at Femi Saúde

Treatment depends on the cause and on whether pregnancy is desired. When there's a thyroid or prolactin abnormality, correcting it usually restores ovulation. In SOMP, lifestyle changes and metabolic medications are part of the plan. For those who don't want to conceive right now, the gynecology team at Femi Saúde may prescribe cyclic progestogens or hormonal contraceptives, which regulate bleeding and protect the endometrium. For those trying to conceive, ovulation induction with oral or injectable medications is monitored with serial ultrasounds, with referral to assisted reproduction when needed. Follow-up is individualized and reviewed according to the response.

What we offer