What are ovulatory disorders?

An ovulatory disorder refers to a dysfunction of the ovaries, which are the producers of oestrogen and eggs in the body. Ovulatory disorders, where ovulation is absent (anovulation) or abnormal, are one of the most common causes of infertility in women.

In a normal menstrual cycle, which lasts around 28 – 35 days, the ovaries will release an egg which will travel down the fallopian tube – a process that is called ovulation – to be implanted into the uterus, ready for fertilisation by a sperm. If the sperm doesn’t come, then uterus will break down and shed its lining, including the egg. However, with an ovulatory disorder, the ovulation process is not able to be executed successfully.

During ovulation, the endocrine system preps the body by producing hormones such as gonadotropin-releasing hormone (GnRH), follicle stimulating hormone (FSH), and luteinising hormone (LSH), which stimulates the ovaries into maturing the eggs, readying them to be released and fertilised. At the same time ovaries produce oestrogen and progesterone, which triggers the thickening and growth of the uterine lining. For those who have ovulatory disorder, it is likely that they will also experience hormonal imbalances, which can be either a symptom of the disorder, or the cause.

Signs of an ovulatory disorder can be an irregular or absent period, moodiness (caused by the hormone imbalances), and difficulty with conception – however, some people may have ovulatory disorders and not show any signs.

What are the kinds of ovulatory disorders?

The most common causes and kinds of ovulatory disorders are:

• Polycystic ovarian syndrome (PCOS), where there is too much androgen, another sex hormone, in the body and causes small cysts on the ovaries. These cysts can obstruct the passage into the fallopian tubes and prevent the eggs from being implanted into the uterus. Signs of PCOS include abnormal menstruation, excessive hair growth, acnes and oily skin, and unexplained weight gain.
• Hypothalamic amenorrhea, where the FSH and LH levels are imbalanced and unable to stimulate the system as they’re supposed to due to the body not does not have the nutrients or fat content it needs to process the hormones correctly. This can be caused by being under- or overweight, and dramatic weight gain or loss. It is most common in athletes, people with obesity and anorexia, and those with extremely psychically active lifestyles.
• Premature ovarian failure, also known as premature menopause and primary ovarian insufficiency, is when menopause occurs before the age of 40. The ovaries stop producing oestrogen as they should and ovulation stops. This can happen because the body runs out of functioning ovarian follicles, which mature the eggs, or these follicles are dysfunctional. Premature ovarian failure can also occur due to autoimmune disorders, genetic conditions, or prior experience with chemo- or radiotherapy. Women who have a hysterectomy are likely to experience an early menopause, and those who have their ovaries removed in what is called a bilateral salpingo-oophorectomy with hysterectomy are guaranteed to have an early menopause.
• Hyperprolactinemia, where the levels of prolactin, which is secreted from the pituitary gland and is responsible for the development of mammary glands and breast milk, are too high. Prolactin levels go up naturally in the months after giving birth, and the presence of prolactin supresses the production of FSH, in turn supressing ovulation. This is normally a helpful thing for new mothers so that they don’t get pregnant again, but for others, this can be a roadblock to conception. It is often caused by a prolactinoma, a benign tumour in the pituitary gland.

Ovulatory disorders can also be caused by extensive use of nonsteroid anti-inflammatory drugs (NSAIDS) like ibuprofen, some steroid medications, and epilepsy medications. Hormonal birth control, in the form of pills, implants, and the hormonal coil, can interfere with ovulation by design, by supplying the body with synthetic oestrogen and progesterone so that the ovaries do not produce these hormones themselves and thus do not release the egg; this is how they work as birth control.

How are ovulatory disorders treated?

Treatment for ovulatory disorder will depend on the cause of the disorder, for example, PCOS may require laparoscopic ovarian drilling, where the ovaries are punctured with a laser or heat source to stimulate them, but the results are temporary. Fertility medications like clomiphene can be used to induce ovulation, providing there are no other obstructing factors to the anovulation. Hypothalamic amenorrhea may be addressed with lifestyle changes to diet, stress levels, and physical activity – with improvements, the ovulation may return to normal function.