Not Ovulating?

There are lots of reasons why a woman wouldn't ovulate, but let's take a step backwards and try and determine whether you are ovulating or not.   If your periods do not come at all, or they are more than 40 days apart, then there is a very good chance that you are not ovulating.  There are also some women who appear to have regular periods but are still not ovulating.  Although this is fairly unusual, it can happen.

There are several ways to determine whether you are ovulating.  The least expensive way is with something called Basal Body Temperature Charts (or BBT's).  You will need a thermometer.  They do make special BBT thermometers, but a digital thermometer will also do.  Do not use the ones that go in your ear.  They can vary depending on how far into your ear you get the probe, and you want a very accurate temperature for this.  There are many websites where you can print out a graph for your temperatures, and some of them will even plot them for you.  There are even ap's for that!  First thing in the morning, before you have gotten out of bed or done anything, take your temperature.  Plot it on the graph.  Do this every morning from the first day of your period until the first day of your next period.  If you are ovulating, you will find that your temperatures hover around the same number until about 14 days from your next period.  They will then dip down for a day, go up to a new temperature, and then hover around that new higher temperature until you get your next period.  If you can see that on your graph, then you are ovulating.  The dip is the day you are ovulating.  If you cannot see that, you may not be ovulating.  It can be hard to interpret these some times, so if you don't see what I just described, don't get discouraged.  Try one more method to see if you are ovulating before you decide.

Another option is to try ovulation predictor tests.  These look just like the home pregnancy tests you can buy, but they are to determine when you are ovulating instead.  Unfortunately, different brands vary in their accuracy.  We have had the best luck with the ClearBlue Easy brand.  They are very accurate, and their digital ones are very easy to read.  They either give you a smiley face, if you are ovulating, or nothing, if you are not.  ClearBlue Easy also makes a hand held computer device (fertility monitor) too.  If you are finding positive tests with the regular "pee-on-the-stick" kind, then you don't really need the fertility monitor.  If you are not having luck with the stick version, then the monitor may be helpful.  You can usually find quite a few of them on eBay.  Inside the box of sticks you will find instructions on when to start testing based on how long you cycle is.  The tests usually turn positive about a day before you actually ovulate.  If you find a positive test, then you are almost definitely ovulating.  If you get your period 13-16 days after the positive test, then you are definitely ovulating.  If you do not get your period in that time frame (and you are not pregnant), then you may have something called PCOS (see below).  PCOS can give you false-positive ovulation tests.  Ten percent of ovulating women will not get positive ovulation tests, unfortunately.  So if you are having regular cycles but can't find a positive ovulation test, you may still be ovulating.  Talk to your doctor.

The final way to determine whether you are ovulating or not is to have your doctor do a blood test to look at your progesterone level.  Progesterone is a hormone that your ovaries make after you ovulate.  The best way to test your progesterone level is to draw the blood about a week before your next period is due.  If your progesterone level is over 3 ng/ml, then you are ovulating.  If your cycles are too irregular to predict when your next one is coming, then it can be drawn 3 weeks or more after your last one.

OK, so now you know how to figure out if you are or are not ovulating.  Lets talk about reasons for not ovulating.  Both underactive or overactive thyroids can affect ovulation.  Other symptoms of thyroid disease include feeling hot when everyone else is cold or vice versa, unexplained weight gain or loss, hair loss, fatigue, nervousness, or skin changes.  It is diagnosed by blood tests and is easy to treat.

 A more uncommon reason for not ovulating is an excess of a hormone called prolactin.  Prolactin is the hormone involved in breast feeding, and so many women with high prolactin levels will also have a milky discharge from the breasts too.  Just like breast-feeding women do not get regular periods, women with high prolactin levels who are not breast feeding will do the same.

Extreme stress or excessive dieting or exercise will also lead to ovulation problems.  A woman's body is designed to decrease her fertility if it thinks there isn't enough food around to support a pregnancy or baby or there is too much stress (perhaps predators chasing you?).  So if a woman has very low body fat or a low dietary fat intake or is under extreme stress, she will stop ovulating.  This is common with marathon runners, ballet dancers, women on death row, and body-builders.  It can definitely happen with less extreme cases too.  Decreasing the amount of exercise, increasing calorie and especially fat intake, or changing the stressful situation can reverse the ovulation problems.

Another very common reason for not ovulating is something called PCOS or polycystic ovarian syndrome.  This is a condition where eggs cannot mature enough to be able to ovulate.  These semi-mature eggs produce a lot of testosterone and other male hormones.  These male hormones feed back to the pituitary (the gland in your head that controls your menstrual cycle), and they confuse your pituitary.  Your confused pituitary send out the wrong hormones to the ovaries (too much LH and not enough FSH), and keep your ovaries from being able to ovulate.  This causes more testosterone production and the cycle just gets worse and worse.  All the sacs with the stuck eggs look like cysts on the ovaries, which is why it's called "polycystic".  Women with PCOS usually have other signs of high testosterone levels such as acne;  hair growth on the face, chest, back or belly; and sometimes even male-pattern balding.  It is a called a syndrome rather than a disease, because what causes it can vary woman to woman.  One of the main causes is insulin-resistance.  This is a condition where a woman's insulin is not working as well as it should.  It can lead to diabetes, when it gets very bad.  The ovary has insulin receptors.  When it sees too much insulin, it stops ovulating and makes male hormones and therefore PCOS.  Women with this condition often times (about 50% of the time) are overweight, and many also have a family history of adult onset diabetes in her older relatives.  PCOS needs to be diagnosed by your doctor.  He or she will do blood tests and perhaps and ultrasound as well.

About 10% of women who do not ovulate have no defined reason why they are not ovulating.  It appears that their pituitaries just do not send out the right signals.  There are also other much rarer hormonal causes.  Most of these will have other signs and symptoms that bring that person to the attention of a doctor.

No matter why you are not ovulating, you need to see a doctor!  If the lining inside the uterus does not shed with a period at least every 6 weeks, it can start to turn abnormal.  It can even turn into cancer.  My cousin died from this type of cancer in her 30's, so this is serious!  If you are not ovulating because of extreme stress, exercising, or dieting; then you are also at risk for osteoporosis and bone breakage.  If your prolactin levels are high, then you may have a tumor on your pituitary.  Although these tumors are usually benign, they can permanently affect your vision if they grow too large.  Thyroid disease and PCOS have implications for the rest of your health as well, so go see your doctor.  Most of these conditions are very easy to diagnose and treat, so why not go see someone today?