What is Endometriosis

What is ovulatory dysfunction?

Regular menstrual cycles with failure to ovulate or irregular menstrual cycles.

What happens in normal ovulation?

Ovulation is the release of a mature egg from the ovary. It normally happens approximately every 26-32 days.

Two hormones produced by the pituitary gland in the brain are needed for this process. The first is follicle stimulating hormone (FSH) and the other is luteinizing hormone (LH). In the first half of the menstrual cycle, FSH is needed in the correct amount to stimulate the egg to grow within a fluid-filled cyst (follicle) in the ovary. At mid-cycle, LH causes the egg follicle to rupture and release the egg.

As part of this growth process, the hormone estrogen is made by the egg follicle. Estrogen causes the lining of the uterus (the endometrium) to thicken in order to receive and nourish the fertilized egg. After ovulation, the same egg follicle makes the hormone progesterone which keeps the thickened lining in place until pregnancy occurs or a menstrual period comes.

What causes a woman to ovulate poorly or not at all?

An imbalance of hormone levels that prevent the growth and release of an egg from an ovary or the implantation of a fertilized egg in the lining of the uterus

Irregular menstruation

Extra weight (more than 30% over her ideal body weight)

Excessive exercise or eating disorders leading to extreme weight loss (long distance running, anorexia)

Medical conditions such as thyroid disease, diabetes, or increased prolactin levels

Polycystic ovary syndrome (PCOS)

Genetic conditions such as Turner's syndrome

Use of tobacco, marijuana or alcohol

What tests can be done to see if I am ovulating? How accurate are these tests?

Daily temperature charts (BBT): least accurate

Ovulation predictor kits (home urine testing kit for LH): very accurate

Blood tests: most accurate

Pelvic ultrasounds: somewhat accurate

Self awareness of ovulation indicators (twinges in the lower abdomen and clear, stretchy vaginal discharge): somewhat accurate

How is ovulatory dysfunction treated?

Specific treatment depends on the cause. For instance, a weight loss program based on improving nutrition and increasing exercise will help ovulatory dysfunction associated with being overweight.

Clomiphene citrate (Clomid®) is a pill that works on the pituitary gland in the brain to increase FSH to help the egg grow.

Daily gonadotropin injections work directly on the ovary to stimulate the egg growth. Other shots help the follicle to release the egg.

Oral medications treat thyroid or prolactin problems that can interfere with ovulation.