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Anovulatory Cycles: Symptoms, Causes, and More

Anovulatory cycles are a common concern for couples trying to conceive, being that, well, you can’t become pregnant if you aren’t ovulating, but anovulation can also be behind many issues that bother women not looking to plant belly fruit. Missed periods, long cycles, and spotting between periods can all call a lack of ovulation their cause. So, what causes anovulatory cycles? How can you tell if you have an anovulatory cycle? Are there symptoms? And more importantly, how can you start ovulating again?

What is an anovulatory cycle?

An anovulatory cycle is one where you don’t ovulate.

Ovulation, or the release of an egg from your ovary, normally occurs around mid-cycle. To determine when “mid-cycle” is for you, take your cycle average (the average number of days between the first day of your period and the start of your next period) and divide it by two. For example, if you run a 28-day cycle on average, you probably should ovulate around 14 days after the first day of your period. You can read a more in-depth guide on pin-pointing ovulation here. This may also help you determine if you are ovulating. Note that the presence of a period doesn’t guarantee ovulation.

What causes anovulation?

Almost all causes of anovulation boil down to the same root cause, hormonal imbalance. It’s what’s causing that hormonal imbalance that varies.

To help you better understand the explanation of some causes of anovulation listed below, let’s take a moment to review fertility hormones.

The first hormone involved in ovulation is gonadotropin releasing hormone (GnRH) secreted by the hypothalamus. This hormone cues the pituitary gland to produce follicle stimulating hormone (FSH).

FSH causes a follicle to develop creating a mature egg for ovulation. This development signals the production of estrogen to build your uterine lining for implantation.

Estrogen’s rise triggers the pituitary to increase the release of luteinizing hormone (LH). LH is the hormone that prompts your ovary to release an egg.

After ovulation, the structure left behind by the egg’s exit begins to produce progesterone. Progesterone maintains your uterine lining for a potential pregnancy.

As you can see, the hormones of ovulation are much like dominos, each triggering an effect in the other. This is why an imbalance somewhere in the chain is so likely to cause anovulation. Any condition that alters these hormones, hormones that can affect these hormones, or the structures that release these hormones can then lead to anovulatory cycles.

Common culprits of anovulation include:

Age: Anovulatory cycles are considered normal in women under 19 and over 35.

This is because both timeframes typically include natural hormonal flux as a result of the start of menstruation, and later, the start of menopause. The closer you are to either of these events the higher the chance of anovulatory cycles. For instance, a teen who only began menstruating the following year is more likely to see anovulation than an older teen whose cycle began years prior. A 40-year-old is more likely to see anovulation than a 35-year-old (unless she has a familial history of early menopause).

Ovarian reserve: A lack of eggs can lead to irregular ovulation or anovulation.

The number of eggs available to ovulate throughout your life is set before birth, and as time passes, that number diminishes. While more common in older women (and often the cause of those before-mentioned hormonal shifts in women over 35), low ovarian reserve can affect younger women. In some cases, the cause is unknown, though genetic abnormalities, adrenal conditions, cancer treatments, ovarian surgeries, and earlier excessive fertility drug use can all be factors. High FSH is often a tell-tale sign.

Body fat percentage: Having a BMI below 18.5 or above 25 can increase your risk of anovulation.

High body fat: Estrogen is produced by your ovaries but can also be produced in fat cells. Excess fat cells then can lead to excess estrogen. Excess estrogen will suppress FSH and LH production (this is why hormonal birth control contains synthetic estrogen). Estrogen imbalance also tends to push other key-fertility hormones out of balance, such as progesterone.

Low body fat: While low body fat has been shown to cause anovulation more frequently than high body fat, the mechanism is not fully understood. There are two common theories. One being that body fat is essential to sufficient estrogen production, and the other being an evolutionary reaction to stress. It’s likely both are a factor.

Excessive exercise, dieting/low caloric intake, and/or stress:

In addition to low body fat, any activity that causes the body to react with the release of stress hormones, such as cortisol, can suppress the pulsation of GnRH. As GnRH prompts the production of FSH at the beginning of the menstrual cycle, this can then halt ovulation.

Hyperprolactinemia:

Hyperprolactinemia is a condition of high prolactin, a hormone that aids in the production of breast milk, that can diminish LH and FSH secretion. It’s most commonly caused by small pituitary tumors. Women with hyperprolactinemia may also see nipple discharge outside of breastfeeding.

Hyperthyroidism/Hypothyroidism: Both an over or under-active thyroid can lead to a lack of ovulation. In hyperthyroidism, it’s believed sensitivity to GnRH is increased leading to higher than normal levels of LH, FSH, and estrogen. In hypothyroidism, prolactin levels are elevated, which reduces LH and FSH secretion.

PCOS: Polycystic ovarian syndrome accounts for around 70 percent of chronic anovulation cases under the age of 35 making it by large the most common cause of anovulation in that age group. In patients with PCOS it’s believed excessive androgen production overstimulates the ovaries leading to the maturation of multiple follicles developing eggs. In many cases, none of the eggs mature fully, ovulation doesn’t occur, and multiple cysts form on the ovary (polycystic=many cysts). These cysts further prevent ovulation in the future. Common symptoms of PCOS include high body fat with difficulty losing weight, excess body hair growth (often dark), head hair loss, cystic acne, and irregular/absent periods.

Breastfeeding: As prolactin is necessary for lactation, breastfeeding will cause high levels, which as stated above suppresses LH and FSH secretion.

While the causes above are the most commonly seen, this is not an all-inclusive list. If you suspect you may not be ovulating your care provider is the best person to evaluate your condition. Certain medications may also cease ovulation.

How common is anovulation?

The prevalence of anovulatory cycles varies by life stage. Note that these ranges are not given by age, as the age women hit these stages also varies. They also apply to a general sampling of women, those with a condition known to increase the risk of anovulatory cycles, such as PCOS, would see higher rates or even chronic anovulation.

In the first 2 years after menstruation begins: 50 percent of all cycles are anovulatory.
Between the second year and pre-menopause: 20 to 33 percent of all cycles are anovulatory.
Pre-menopause (periods have not stopped): 60+ percent of all cycles are anovulatory.

How can you tell if you have an anovulatory cycle?

Anovulation Symptoms:

Anovulation is the most common causes of a missed period outside of pregnancy making a missed period one of the most common symptoms of anovulation. Other common symptoms include:

-Irregular bleeding/periods (variance more than 3 days in cycle lengths)
-Spotting between periods
-A lack of typical side effects of high progesterone known as PMS (sore breasts, water-weight gain, irritability, etc.)

There may also be a lack of typical ovulation symptoms such as clear-stretchy cervical mucus around mid-cycle. However, as high estrogen is common in many of the underlying causes of anovulation, and estrogen increases vaginal discharge, this may be less noticeable.

Anovulation with regular periods: Note that while missed or irregular periods are common with anovulation, it is possible to have regular periods without ovulating. This is also known as silent anovulation. In this case, the anovulatory cycles are usually sporadic (not occurring every cycle) rather than chronic.

Anovulatory bleeding vs periods: Knowing that one can have regular period-like bleeding and not ovulate poses and important question, is there a way to tell the difference? Unfortunately, the answer is no. The only difference between anovulatory bleeding and a period is an egg is not shed in an anovulatory bleed. This is not something you can see simply from flow, color, etc.

BBT charts: Basal body temperature can be one way to confirm anovulatory cycles even with regular bleeding. After ovulation the rise of progesterone creates a noticeable temperature shift. If this shift is absent, ovulation is unlikely to have occurred. You can read more about how to chart BBT here.

Anovulatory cycle or pregnant: On the other side of the spectrum, since anovulation frequently causes missed periods (which are actually just very long cycles), how can you tell if you’re pregnant or experiencing anovulation? A pregnancy test is the easiest answer. If your test is negative, and you haven’t had a period in the last 90 days (amenorrhea), it’s best to see your care provider for further testing. Please note that symptoms are not a reliable method of telling anovulation from pregnancy. Both involve hormonal imbalance and can present with similar symptoms.

How are anovulatory cycles treated?

Sporadic anovulation usually requires no treatment and is considered normal. Chronic anovulation is treated by addressing the underlying cause excluding cases where age is the culprit (nothing can be done for age-related anovulation). Often this includes dietary and lifestyle changes aimed at normalizing weight and medications which may induce ovulation, balance a particular hormone, or treat a condition.

Odds of Getting Pregnant: Pregnancy Probability Statistics

What are the odds of getting pregnant? The probability of pregnancy is a common concern for both those trying and trying not to conceive, and unfortunately, that’s not a simple question. Worse, most folks don’t want just a “not likely” or “probably.” They want a number—a statistical chance of pregnancy. Here at Life with Gremlins, we have a page explaining the basics of how to get an idea of your odds of getting pregnant. We even have a quiz that will give you an answer on a continuum from no chance to high, but in an effort to give you that specific number you’re looking for, now we’re going to delve into the complicated world of conception statistics.

Where to start? Well, how about when you did, intercourse timing.

Odds of getting pregnant by intercourse timing:

The fertility window is from 5 days before ovulation up to ovulation itself. It’s important to note this is based on the fact that while most studies agree sperm remain viable up to 5 days (but are most viable in the first 48 hours), research on the egg’s survival range is more conflicting. The mean viability of an egg is generally accepted at 12 hours (the point where in 50 percent of cases, the egg is still viable). However, on the early side, an egg may only survive mere hours, and on the late—and longshot— a rare egg may make it a full 48.

The most complete study done on the odds of getting pregnant on any given day was done in 2013 and published in the Oxford Journal of Human Reproduction. While its findings ran similar to others done on the topic, it was the first to counter in maternal age, cycle regularity, and ethnicity. It presented two sets of data. One simply factored in cycle day and ignored ovulation date. The other was based on the probability of pregnancy depending on when in the fertile window intercourse was. I know, this seems quite confusing. For example, one graph shows that the maximum chance of pregnancy occurs on day 15 at 13.1 percent. However, the other graph shows a maximum chance of 36 percent on the day of ovulation.

Why the difference?

The second, much higher statistic, is guaranteeing the sex occurred in a fertile period. So, with data set one, the percentage is skewed by the chance that sex didn’t occur during a fertile time. For example, a woman has a condom break on day 15 of her cycle. There is a 13.1 percent chance that she is both fertile and will become pregnant. Now, assume that she knows she also ovulated that day. There’s just a 36 percent chance of pregnancy—we already know she’s fertile.

Why am I giving you both?

Data set one is going to be most useful to those who aren’t really trying to conceive and have no idea when they ovulate. The quick and dirty of it is that the odds of getting pregnant begin close to zero and then rise around cycle day 7 (with day 1 being the first day of bleeding). They reach a peak on day 15, followed by a slow decline to close to 0 after day 25. This is because most people ovulate around mid-cycle and the average cycle length is between 28-30 days (hence days 13-16 have the highest chance of pregnancy).

Data set two will be more useful to those trying to conceive who are entirely sure what day they ovulated.

Take away: Considering the high probability of slight miscalculation when predicting ovulation (even with BBT and cycle tracking), most sources average it out to a 20 to 25 percent chance of pregnancy when sex is mid-cycle.

Timing is far from the only factor in the odds of getting pregnant though, for instance, the chances of pregnancy also change with age.

The chances of getting pregnant by age:

In the graph above, you see little change between women under 25 and those over 35. However, when you look at the percentage of women who became pregnant within a year of trying, the difference becomes clearer. This is a result of declining egg reserve and quality.

Take away: In your late 30’s the odds of getting pregnant begin to decline, dropping more dramatically after 40. The vast majority of women under 35 will become pregnant with monthly unprotected sex within one year.

Timing and age are the two primary drivers behind the odds of getting pregnant in general (excluding genetics, which is impossible to factor with a wide audience like this. ) Of course, many smaller health issues can play a big role as well. We can’t possibly cover them all but will try to touch on some of the more common issues.

Factors that can affect your overall odds of getting pregnant further:

-BMI: The chances of natural conception reduce 26 percent in those with a BMI over 35 and 46 percent in those with a BMI over 40. Being underweight likewise reduces the chance of pregnancy, with a 37 percent decrease for those with a BMI under 20.

-PCOS: Often holding hands with a high BMI, PCOS is a hormonal condition that usually results in anovulatory cycles and ovarian cysts. Weight gain, facial hair, thinning hair at the top of the head, and irregular periods are the most common symptoms. Around 10 percent of women of reproductive age suffer from PCOS, and roughly 80 percent of those women are left infertile.

-Smoking: While research is still conflicting, some studies have found active smokers have 50-percent lower odds of getting pregnant each month.

–Activity level: Those who exercise moderately for at least 5 hours a week have an estimated 18 percent higher chance of conception. However, vigorous exercise (more than 5 hours a week, intense workouts) creates a roughly 32 percent lower chance of conception. The exception to this was in women who were overweight, in which case fertility often returns with diet, exercise, and weight loss. Less than 5 hours of exercise a week has no effect on fertility.

The male factor:

Obviously, it takes two to become pregnant, and while this website is predominantly visited by women, the other half of the equation can’t be ignored when it comes to pregnancy probability.

Age is the most predominant factor in the odds of getting pregnant based on a partner. Men are thought to be most fertile from about age 25 to 29. A 2004 study by the American Journal of Gynecology found that the chances a male will conceive a child within a year of trying drops by 11 percent per year. The older a male partner is, the lower the odds of getting pregnant in most cases. Regardless, as a result of age alone, men never cease producing sperm. The oldest known man to father a child was 102 years old.

Other factors on male fertility are less generalized. Things such as environmental exposure to heat or toxins, testicular trauma, genetics, and some health conditions can reduce fertility in younger men.

Next,we’ll have a look at situational factors in the odds of getting pregnant, first with the chances of getting pregnant from precum, but as we are already at over 1,200 words, we’ll split that into its own page.

LH Surge Before Period? What Causes a Positive OPK Before AF

While it’s arguably a waste of tests, many women continue to use LH test strips (OPKs or ovulation predictor kits) after ovulation. Many of those same women then find themselves with a positive LH test just before their period or aunt flow (AF) in TTC-speak. Some assume this means they’re pregnant, as LH strips can pick up hCG, the hormone detected by pregnancy tests. Others are confused and wondering if they’re experiencing double ovulation or failed to ovulate earlier in their cycle. Either way, the situation leads many to ask the Google gods, “LH surge before period” or “LH surge before AF.” So, which is it? Pregnancy or ovulation?

Likely neither.

What is LH, and what does it do?

LH is an abbreviation for luteinizing hormone. Produced by the pituitary gland, it triggers ovulation via a “surge.” This is why LH test strips can be used to reliably predict ovulation within 24 to 36 hours. Low levels of LH also help to maintain the corpus luteum, a structure formed in a mature follicle after ovulation. The corpus luteum secretes a hormone called progesterone to maintain the lining of the uterus for pregnancy. It’s progesterone that produces the temperature shift those who basal body temp can detect to confirm ovulation.

LH is present in varying levels at all times of the menstrual cycle. As a result, LH test strips will almost always show two lines and are only positive if the test line is as dark or darker than the control line.

Why can LH surge before a period?

Progesterone also suppresses LH to prevent ovulation while the body is waiting, so to speak, to see if it becomes pregnant. As a drop in progesterone is what triggers a period to begin, often when progesterone drops, LH briefly sees an upturn as well. Depending on your personal hormone balance, that uptick may be significant enough to show a positive OPK or at the least a darker line than was seen in the test strip pattern on previous days.

This is also supported by the standard ranges (in menstruating women) for “normal” LH levels, which are:

Follicular phase: 1.9–12.5 mIU/mL
Mid-cycle peak: 8.7–76.3
Luteal phase: 0.5–16.9

Notice that the luteal phase range peaks out at 16.9. Most of the stick-type OPKs have a sensitivity of around 20 to 25 miU/mL. Because OPKs of that variety always show a second line for most ladies, levels potentially so close to 20 in the luteal phase can easily cause a positive LH test or one that is easily mistaken as positive. The digital smiley version would be harder to misread or see a false positive, as they tend to have a higher threshold (closer to 40 miU/mL).

It should also be kept in mind that your hormone levels do fluctuate from cycle to cycle. This means seeing an LH surge before your period when you haven’t previously doesn’t necessarily mean anything.

Can you ovulate twice in one cycle? Can LH surge more than once?

While it is possible to release more than one egg per cycle (hyperovulation) and some research suggests many women experience multiple waves of follicular development, the general consensus is that ovulation only occurs once regardless of how many eggs are released or what cycle day ovulation occurs. Hyperovulation wouldn’t result in more than one LH surge, more than one egg would just be released.

However, it is possible to have an LH surge and not ovulate. In fact, it’s common enough to have a name: Luteinized Unruptured Follicle Syndrome. Roughly 10% of menstrual cycles with an LH surge don’t result in ovulation. To further complicate things, not all LH surges are created equal. It’s estimated between 42-48% of women experience a single peak as many expect to see, but 9-12% of women see an LH plateau (more than a 3-day surge), and 22-44% see multiple smaller peaks where only one triggers the release of a mature egg.

In the case of multiple surges, 2 or more small LH peaks are usually concentrated within a week or so and still occur mid-cycle. Keep in mind, that if a second peak were to occur close to when your period was due as the result of a subsequent surge, your period would also be delayed. Multiple LH surges per cycle are thought to be associated with hormonal imbalances, such as polycystic ovary syndrome (PCOS), and follicular insufficiency, which has a higher prevalence among those suffering from early menopause.

Can you have an LH surge before your period and still be pregnant?

Following that logic, you might think that an LH surge at the end of your cycle indicates your period is incoming as it is a sign your progesterone levels have dropped. In most cases, unfortunately, that is likely true, but it is possible to get an LH surge before your period and still be pregnant.

Sometimes when implantation occurs late in your cycle, progesterone levels can begin to fall and then rebound. In this instance, spotting or light bleeding may also occur. In other cases, implantation itself causes a slight hormone dip (visible by a basal body temperature dip as well), which would likewise allow for a slight LH rise.

Can an ovulation test detect pregnancy? OPK as HPT?

Finally, while an OPK can react to hCG, it takes a higher level of hCG to produce a positive result. This means that a pregnancy test will show positive long before an OPK in most cases.

Researchers from the Division of Laboratory and Genomic Medicine at the Washington University School of Medicine tested three major brand LH detection kits: First Response, Clear Blue, and Walgreens. All were digital test kits. Below were their results. As you can see, all three tests did pick up hCG. Clearblue and Walgreen’s digital LH kits were both able to detect hCG once it hit 100 mIU/mL. In comparison, First Response’s early result HPT can pick up levels as low as 5.5, and most other pregnancy tests are around 25. Unfortunately, this study did not cover LH strip tests. In any case, you’re probably better off using a test that was designed to detect pregnancy over one that wasn’t.

We hope this has cleared up some of your questions, but if you have more, feel free to drop us a comment.