Anovulation – a common cause of infertility and a particularly distressing side effect of PCOS.

In fact, PCOS is the most common cause of chronic anovulation. But, what actually is it? What are the symptoms of anovulation? And, importantly, how do you treat it?

What is anovulation?

Quick biology lesson: During ovulation, one of your ovaries releases an egg every month at the beginning of your menstrual cycle. This is when you’re in your most fertile window.

The egg travels down the fallopian tube where, if met by sperm, can be fertilised and, well, you know the rest.

Anovulation, in contrast, is when one of your ovaries does not release an egg during your monthly cycle.

It is a common – and often distressing – side effect for people who have PCOS, though it’s thought that many people with female reproductive organs will experience anovulation at least once during their reproductive years. Anovulation is also common in adolescents, when someone has recently started menstruating, and around the time of menopause.

What are the symptoms of anovulation?

The frustrating truth is that anovulation doesn’t present any symptoms, so it is hard to tell whether ovulation has occurred or not.

Some telltale signs that you might be experiencing an anovulatory cycle include:

• Late or irregular periods

• Spotting mid-cycle

• A longer-than-usual period

Some people will still experience bleeding during an anovulatory cycle, though it technically isn’t a period (it’s called a withdrawal bleed), and this is what tends to cause confusion.

Instead of seeking out symptoms of anovulation, it may be helpful to look for signs that you are ovulating, which can include:

• Regular periods
• A change in your body temperature (it increases a little after ovulation, though this isn’t a super reliable method)
• Noticeable changes to your discharge (it may appear more clear and wet ahead of ovulation. But, again, this isn’t the easiest method of tracking ovulation)

Ovulation tests, unfortunately, aren’t reliable for tracking ovulation when you have PCOS. This is because they work by identifying levels of luteinising hormone (LH), which tend to be raised around the time of ovulation, but people with PCOS often have higher baseline levels of LH, which can skew the results and make them misleading.

What causes anovulation?

There are a number of reasons you might experience an anovulatory cycle, including:

• If you have only recently started menstruating

• If you are close to menopause

• Over-exercising at a high intensity for an extended period of time

• Stress

• Thyroid issues

• Medication, such as contraception

And, of course, anovulation tends to be a byproduct of PCOS, too. In fact, PCOS is the most common cause of chronic anovulation.

Why? Well, you know as well as we do that there’s still loads to learn about the intricacies of PCOS. That said, it’s widely thought that a hormone imbalance (raised levels of androgens – often referred to as “male” hormones – and LH, which stimulates ovulation) commonly found in people with PCOS could be a contributing factor to anovulation.

Can you get pregnant with anovulation?

No, you can not get pregnant during an anovulatory cycle.

In order to conceive, one of your ovaries must release an egg. If, one month, it doesn’t, then you will not be able to fall pregnant that month (or until you begin ovulating again).

Anovulation is incredibly distressing for those trying to conceive. If this is you, rest assured that help and support is available to you, and do not hesitate to contact your GP with any concerns.

What’s the best anovulation treatment?

Honestly? It depends on what’s causing anovulation to occur. Either way, it’s best to speak to your GP, who will recommend treatment specific to your circumstances.

If anovulation looks to be caused by factors such as over-exercising, for instance, your GP will likely advise lifestyle changes (so, in this case, reducing the amount of high intensity exercise you engage in).

However, if chronic anovulation is caused by PCOS, your GP will probably explore medication options (such as clomifene, which helps to encourage ovulation) for you.

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