But, it is not a given that every woman between the ages of menarche and menopause are ovulating. There are many reasons ovulation isn’t occurring and these reasons are worth discussing considering it is so important for overall health.
A very normal reason ovulation may not be occurring is the time around menarche which the first menses. The average age of menarche is 11.9 years. What a time! I remember my mom brought me flowers and gave me a big hug, which basically led me to feel unbelievably mortified. In my older years I grew to appreciate my menses and my mom’s sweetness, but many women can relate to the initial shock I am sure! I digress. Menarche is a very normal time to not ovulate. You might have heard about young women having irregular cycles for a few cycles before them regulating. This could mean the body is not ovulating and is very common. When cycles start for the first time it can take the body some time to get into the rhythm of how the brain communicates with the ovaries. This should normalize within a few months, but if it doesn’t or any significant symptoms such as acne, cramps, mood issues, or otherwise come up it is a great idea to seek support from a holistic practitioner.
Another very normal reason ovulation does not take place is in perimenopause which means the time before menopause. The average age of menopause is 51 years old. As fertility normally decreases ovulation occurs less often as well.
There are many other reasons that lead to lack of ovulation that should be addressed and treated. Some of the most common reasons are polycystic ovarian syndrome (PCOS), hypothalamic amenorrhea, thyroid disorders, primary ovarian insufficiency (POI), or hypothalamic or pituitary signaling issues.
PCOS is one of the most common reasons for lack of ovulation, otherwise known as anovulation. There are many causes of PCOS but no matter the cause the underlying mechanism that leads to anovulation is the same. There are too high of androgens or male type hormones in the blood that interfere with the delicate hormone signaling between the brain and ovaries and ovulation cannot occur. Instead, multiple cysts develop on the ovaries revealing an attempt of the ovary to ovulate, but the inability to. PCOS has 4 main causes which include blood sugar dysregulation and insulin resistance, stress or adrenal PCOS as it is sometimes called, inflammatory PCOS which can occur from a host of issues including disrupted gut health or hidden infections, or post-birth control PCOS.
Hypothalamic amenorrhea occurs when the body simply does not have enough energy to expend to ovulate. The communication from the brain to the ovaries is simply not occurring. This is due to overexercising, under-eating, or excessive stress.
Thyroid disorders including both hypothyroidism and hyperthyroidism, can both lead to anovulation and can cause either shortened cycles or lengthened cycles respectively.
Primary ovarian insufficiency (POI) occurs when a woman is headed towards menopause before 40 years old. This can occur due to genetics, radiation, endocrine issues, lack of blood supply to the ovaries, autoimmune conditions, infections, or environmental toxin exposures (heavy metals or mold). This can be slowed or reversed in some cases depending on the cause, if the assaulting factors are removed.
Pituitary or hypothalamic signaling issues are another issue that can cause anovulation. The most common occurrence in this cause is actually when a woman is breastfeeding! Which is a very normal reason to not ovulate. To breastfeed, the pituitary releases a hormone called prolactin to stimulate the making of breast milk. When prolactin is high it suppresses the body’s ability to ovulate. This can also happen pathologically with something like a tumor in the pituitary which is called a prolactinoma. Prolactin is a common lab test completed when a woman, who is not breastfeeding, is not having a period. This is completed to ensure this more serious cause of anovulation is not part of the picture.
Having what seems to be a normal and regular cycle does not mean that ovulation is occurring. Most of the time ovulation is occurring in these instances, but not always. There are multiple ways to evaluate if you are ovulating. Cycle charting by tracking cervical mucous and basal body temperature is my favorite way as it connects women to their bodies and allows them to be in tune with themselves. But, completing a blood draw for progesterone post-ovulation in the second half of your cycle can also confirm ovulation. Any value of progesterone above 5 ng/mL means ovulation occurred.
As I have mentioned in my previous blog post “What is Ovulation Anyway?" a follicle undergoes its most robust development 120 days before being released. This means it can take a significant amount of time for hormones to change enough for ovulation to occur. When trying to correct some of the imbalances that lead to anovulation like PCOS or hypothalamic amenorrhea, patience can be difficult! Especially when it comes to possibly imbalanced hormones and the symptoms people can be experiencing, but these symptoms can improve, these conditions can be treated, and ovulation can happen.
Even if ovulation is happening, having good egg quality is essential for becoming pregnant and maintaining a pregnancy. Good egg quality is a hard thing to measure unless the eggs are retrieved, as they are in in-vitro fertilization (IVF), and genetically analyzed. But, the level of progesterone in the body post-ovulation can give us a hint about egg quality. Usually higher progesterone means better egg quality. This can mean chances are higher for people to become pregnant.
You can support ovulation and egg quality/adequate progesterone in many ways. Some of these recommendations can be different based upon what cause of lack of ovulation someone is prone to. But, some basic ways to support healthy ovulation include:
- Eat a well-balanced omnivore diet. I recommend a diet with at least some animal products as they are very nutrient dense, have a lot of protein, and fat.
- Keep your blood sugar balanced. Eat protein and fat with every meal.
- Don’t restrict calories.
- Exercise regularly, but not too much. Overexercise is perceived as a stress on the body. I was a college athlete and had some friends lose their period temporarily from our exercise regimes.
- Reduce stress. You can do this with anything you like including having fun with friends, laughing, doing a creative project you like, going to therapy, watching TV, reading, yoga, exercise, quitting something that isn’t serving you or your health, and many more things!
- Sleep! I recommend at least 8 hours of sleep per night.
- Reduce inflammation. This can mean SO many things. I recommend eating a healthful organic diet, exercising, laughing with loved ones, and reducing stress as the basics. Sometimes this is when testing can help identify the causes of inflammation as they can be hidden like with environmental toxins, heavy metals, mold, hidden infections, or gut health issues.
- Avoid environmental toxins. Many of these environmental toxins act as synthetic hormones in the body. Avoiding most plastics in the house, getting rid of any products with fragrance, and using a water filter are all good places to start when trying to avoid these toxins.
- “The Fifth Vital Sign” by Lisa Hendrickson-Jack
- "Trends and Patterns in Menarche in the United States: 1995 through 2013–2017” by National Health Statistics Reports.
- "Menopause" by the Mayo Clinic.