Ovulatory dysfunction is a medical condition that is characterized by abnormal, irregular (9 or fewer episodes of menstruation per year), or absent ovulation.
Ovulation is the phase during the menstrual cycle where the ovaries produce an egg that is ready to be fertilized. Any issues that lead to ovulatory dysfunction will, therefore, lead to infertility in the affected individual which means that they will struggle to become pregnant.
The most common causes of ovulatory dysfunction in women before they enter menopause are:
- Polycystic ovarian syndrome (PCOS) – this condition is a hormonal disorder that commonly occurs among women of reproductive age. The condition is associated with infrequent and prolonged menstrual periods or an excess of the male hormone androgen. The ovaries tend to develop numerous small collections of fluid, called follicles, and there is a failure of the tissue to release eggs for fertilization.
- Hyperprolactinemia – this occurs when the pituitary gland in the brain, which is responsible for the release of numerous hormones, causes an increased production of prolactin which is responsible for the development of breast milk.
- Hypothalamic dysfunction – when the pituitary gland is once again involved, the release of the hormones FSH and LH can be negatively impacted and this can result in decreased or absent menstruation.
Symptoms and Signs
Ovulatory dysfunction is suspected if menstrual periods are absent, irregular, or not preceded by other symptoms such as lower abdominal discomfort and/or bloating, breast tenderness, or mood changes in the affected individual.
How the Diagnosis is made
The way that ovulatory dysfunction is diagnosed is by looking at various factors such as:
- The affected individual’s menstrual history.
- By measuring and monitoring one’s basal body temperature.
- By measuring serum or urinary hormone levels.
- Through the performance of an ultrasound examination of the female reproductive tract.
However, more accurate investigations can be performed when measuring morning body temperatures and these include:
- Home test kits – these can detect an increase in the LH levels around 24 to 36 hours before ovulation. This requires daily testing to be done for a few days starting from about 9 days from the first day of menstruation.
- Ultrasound examination of the pelvis – this investigation is used to monitor the diameter of the ovarian follicle and if there are any cysts that may be enlarged or ready to rupture.
- Measuring blood levels of progesterone and its urinary metabolite pregnanediol glucuronide. If the respective serum and urinary levels are elevated then this indicates that ovulation has occurred.
The treatment for ovulatory dysfunction is to induce ovulation and this can be performed with the following medications:
- Clomiphene – this antiandrogen agent is used in patients who have ovulatory dysfunction that is not caused by hyperprolactinemia. This drug is most effective when the cause of the condition is PCOS.
- Metformin – this diabetic medication is used in patients with ovulatory dysfunction, especially if they have a body mass index (BMI) equal to or greater than 35. The drug works significantly well to induce ovulation if the patient is diagnosed with PCOS and is insulin-resistant.
- Exogenous gonadotropins – these medications are used if clomiphene is not effective enough to induce ovulation.
If other underlying causes of ovulatory dysfunction are identified then they are treated accordingly to manage the disease.