Anovulation - it dishormonal menstrual disorder in which the mature egg can not leave the ovary.By mean menstrual cycle cyclic hormone incremental changes in the uterus and appendages, controlled by the central nervous system.Due to the menstrual cycle a woman can get pregnant.
normal menstrual cycle lasts 25-35 (usually 28) days, but a small number of women found a physiological shortening or lengthening of the cycle.For 75% of healthy women the average duration of menstrual period is 3 - 7 days, the physiological blood loss does not exceed 50 ml.
all the processes taking place in the womb of the menstrual period, independent of the ovarian hormones and controlled by the brain, namely the hypothalamus-pituitary system.The menstrual cycle, in turn, consists of ovarian and uterine cycles.The ovary matures the egg and the uterus is responsible for preparing the terms of a potential pregnancy.
conditionally equivalent to the menstrual cycle is divided into two phases.The first p
ovum remains viable and can be fertilized only during the two days.If such is not the case, it dies, and the uterus begins preparation for the elimination of unnecessary structural changes - too overgrown endometrium gradually rejected (the second phase).The process of its total rejection and out is called menstruation.
Full ovulation is a sign of normal-phase of the menstrual cycle.In the absence of ovulation, menstrual cycles become irregular.
anovulation is not always indicative of pathology.In healthy women under the influence of unfavorable conditions for the life of the unit may occur anovulatory cycles, resulting in serious violations.
In the period of menstrual function, as well as during its decline, anovulatory cycles are regarded as physiological.
Anovulation almost always accompanies menstrual dysfunction, and infertility.
The menstrual cycle is the result of a complex multi-stage interaction of the uterus, ovaries and of the central nervous system.Abnormalities in any of these stages may cause anovulation.
most credible causes of anovulation are:
- Pathology of the hypothalamus and pituitary gland.Developed as a result of strenuous exercise, stress, blood disorders or traumatic injuries.Significant weight loss, including due to incorrect diets or starvation, causing disruption of the hypothalamic-pituitary system.Excessive secretion of the hormone prolactin by the anterior pituitary resulting in the formation of benign tumors of hormone - prolactinoma, which is a violation of steroidogenesis in the ovaries.
- premature ovarian failure.Against the backdrop of rise of FSH and lower total production of estrogen follicles do not mature.
- Ovarian dysfunction that may occur after surgeries or against diseases associated with impaired blood supply to the pelvic organs.Tumors and ovarian cysts are also accompanied by disruption of the normal steroidogenesis and lead to anovulation.
- Polycystic ovaries.Excessive production of androgens in polycystic leads to the fact that the outer shell of the ovaries (namely it contains follicle and oocyte maturation occurs) becomes thick and dense.As a result, the egg can not leave the follicle, and ovulation does not occur.
- Diseases of the thyroid gland, adrenal glands, severe endocrine pathology provoke breach of steroidogenesis in the ovaries and as a result, anovulation.
- Since adipose tissue is able to produce its own estrogen, women with severe obesity in the background hyperestrogenism common anovulation.
- Congenital malformations of adrenal gland or ovaries.
Anovulation is not always associated with complex disease processes in women and may be of short duration, followed by self-correction.Individual time anovulatory cycles can occur in women on the background of severe mental strain, inflammation of the appendages, during physical exertion or after taking hormones.
Some natural causes provoke physiological anovulation: puberty, pregnancy and lactation, menopause.In such cases, with regular monthly anovulation is not a pathology.
Symptoms and signs of anovulation
symptoms of anovulation determined disease that accompanies it.
Every fifth patient infertile anovulatory menstrual cycle is detected.
irregular periods during anovulation is the first symptom of it.The exception is when the regular monthly anovulation in women with physiological causes.
term chronic anovulation sounds when violations of the regularity of the menstrual cycle are permanent.When this is not detected in the ovaries no structural abnormalities diagnosed and even functioning follicles.
constant lack of ovulation leads to the fact that in the month of anovulation cease completely - developed amenorrhea.
However, chronic anovulation is not a sentence for infertile women, in some cases it is possible not only to restore a regular menstrual cycle, but also to provoke a full ovulation.
More than half the cases (70%), dysfunctional uterine bleeding occurs on a background of anovulatory cycles.In the absence of ovulation had grown under the influence of excess estrogen the endometrium can not be cut off completely and uniformly develops long acyclic uterine bleeding.
If anovulation develops in the polycystic ovary or adrenal disease, in patients with an overall examination revealed obesity, hirsutism (hair growth on the face, legs and arms) and acne.
Dishormonal breast disease (mastitis) in the background accompanied by anovulation hyperprolactinemia and hyperestrogenism.
volume of diagnostic tests depends on the causes of anovulation and comorbidity.
diagnosis anovulation itself is not difficult, as the most reliable sign of her menstrual cycle is monophasic.A popular and affordable method is a simple measurement of basal body temperature.The method is based on the ability of progesterone slightly increase body temperature.Since the influence of progesterone after ovulation begins the second phase of the menstrual cycle, no increase in basal body temperature indicates a single phase menstrual cycle.The patient for several menstrual cycles independently measures the temperature in the rectum and reflects the data in a graph.If the temperature curve has "wave" in the middle of the cycle, the presence of anovulation is most likely.
to determine hormonal causes of infertility it is advisable to assess the level of hormonal disorders by determining the FSH, LH and progesterone.Assess the degree of disorders of the pituitary gland helps to determine the level of prolactin in the blood and increase the thyroid hormone (TSH, T3 and T4) will point to the dysfunction of the thyroid gland.Patients with polycystic ovaries and / or external signs of hyperandrogenism is determined by the level of testosterone.
Ultrasound scanning is able to detect structural abnormalities in the ovaries and to determine the absence of signs of ovulation.Along with those diagnosed cysts, tumors and inflammation of the appendages.
If there is evidence of skull radiography, MRI and electroencephalography.
Treatment of anovulation Anovulation
is not an independent disease, as a symptom, it is accompanied by a considerable number of gynecological diseases.Eliminate anovulation without appropriate treatment of the underlying disease is not possible.
for the successful elimination of anovulation should first restore the normal rhythm of menstruation.Sometimes, after the restoration of the regular two-phase cycle anovulation disappears.Unfortunately, most of the recovered remains anovulatory menstrual cycle, and the next stage of treatment is to hormonal stimulation of ovulation.
Hormone treatment, regardless of the cause of anovulation, occupies a leading position.The choice of drug is always dependent on any link in the hormonal regulation violations occurred.
parallel as necessary correction is made exchange-endocrine disorders and the elimination of psycho-emotional disorders.
Stimulation of ovulation - a complex process with unpredictable results.Hormone Stimulator ovulation Clomiphene is widely used in the treatment of anovulation.In some cases, it is administered in combination with other hormonal agents.
Treatment of anovulation and infertility treatment - not identical concepts.Recovery after ovulation stimulation is observed in 70-90% of patients, but pregnancy is not a guarantee, it occurs in only half the cases.For successful treatment of infertility requires a broader therapeutic program aimed at addressing the hormonal and physical reasons, and stimulation of ovulation is the final stage.
use of hormonal stimulation of ovulation is justified if a woman wants to have children.In all other cases relevant only to restore normal menstrual rhythm.
Any hormonal therapy requires careful personal approach, preparations are matched according to age, clinical manifestations, and survey data.
Physiological anovulation does not require treatment and resolves on its own.