Ovulation is when a mature egg (ovum) is released from the ovary. It is a hormone-mediated process where the follicular stimulating hormone (FSH) stimulates follicular growth, and the luteinizing hormone (LH) triggers ovulation. The released ovum moves from the ovary to the fallopian tube and stays alive for 12 to 24 hours, and it may fertilize during this time. This may occur about 14 days before menstruation in a 28-day menstrual cycle (1). You can predict ovulation by tracking its signs and symptoms or using ovulation predictor kits. The fertile window is five days before ovulation and the day of ovulation. Knowing the ovulation time may help a woman conceive or prevent pregnancy accordingly. Read on to know more about the signs and symptoms of ovulation, tests to detect ovulation, and ways to manage ovulation problems.
What Are The Signs And Symptoms Of Ovulation?
Ovulation signs and symptoms may not be the same for all women. Some may not notice any symptoms at all. The time of ovulation can also vary; while some ovulate on the same day of their cycle every month, others ovulate on different days in each cycle. Signs and symptoms of ovulation may include (2): Tracking these changes for a few months may help women understand how their body changes during ovulation. These are fertility awareness methods that may help achieve or prevent pregnancies.
What Are Secondary Signs And Symptoms Of Ovulation?
Ovulation signs and symptoms that are not consistent are called secondary signs. They may be consistent in some women, but not in all cases. Secondary signs and symptoms of ovulation may include: It is important to know these body changes and signs since ovulation is related to fertility and general well-being. In addition, these changes would help you identify and seek early medical care for ovulation problems.
What Are The Signs Of Ovulation Problems?
Keeping track of your menstrual cycles and knowing the signs and symptoms of ovulation can help you understand ovulation problems or not ovulating (anovulation). The following signs and symptoms are often associated with ovulation problems (7):
Lack of periods (amenorrhea) means missing one or more menstruations without being pregnant.
Irregular periods are when the time between periods keeps changing. It can be shorter or longer than usual.
Heavy period is when more than 80ml blood (16 teaspoons) of blood is lost during a period or if the menstruation lasts more than seven days.
Light period is when less than 20ml (less than 4 teaspoons) of blood is lost in menstruation.
Lack of ovulation signs includes no cervical mucus changes or basal body temperature.
Negative results on ovulation predictor tests
The absence of ovulation (anovulation) is not always associated with a lack of menstruation (amenorrhea). You may seek medical care if you have problems with menstruation or cannot conceive.
How To Increase Your Chances Of Ovulation?
The following ways help increase your chances of ovulation (8):
Maintain normal BMI: Keeping bodyweight around the average of your height and weight helps resolve ovulation problems related to obesity and overweight
Avoid strenuous exercise: You may seek expert opinion on physical activity levels since excessive exercise can affect ovulation.
Avoid sudden dietary changes: Fasting, skipping meals, crash diets, and other disordered eating habits may affect ovulation. Eating regularly and properly can regulate ovulation in many women. Seek expert advice if you change eating habits for weight loss or are concerned about eating disorders, such as bulimia nervosa or anorexia nervosa.
Reduce stress: Chronic emotional stress can affect ovulation. You may try relaxation techniques, meditation, etc., to cope with the stress.
How To Check Ovulation At Home?
You may use an ovulation home test to determine ovulation. This home urine test detects a rise in luteinizing hormone (LH) in the body. LH surge triggers ovulation, and the test helps to predict it. You may get the ovulation test kits in drug stores. The test kit may contain several sticks to test for several days near your ovulation time based on the length of the menstrual cycle. For example, a woman with a 28-day cycle interval may begin testing on the 11th day after the menstruation to detect ovulation. If ovulation occurs, there can be color change or other positive signs, as mentioned by the manufacturer. Ovulation can also be tracked by digital handheld devices called home fertility monitors. These devices predict ovulation based on the salivary electrolyte levels, basal body temperature, or urine LH levels. Some monitors can store ovulation details for several cycles. Sometimes, the test may miss the surge, especially if you have an irregular menstrual cycle. Rarely, false-positive results may occur. You may visit your doctor or see an infertility specialist if you cannot conceive or detect LH surge for several months (9).
How Is Ovulation Detected In The Clinic?
Doctors may ask detailed questions about your cycle length, date, menstruation, ovulation symptoms, and test results. Your doctor may order some of the following tests to detect ovulation problems before prescribing medications (10):
Ultrasound to visualize the ovaries and uterus
Blood tests to detect hormone levels
Hysterosalpingogram (HSG) visualizes the fallopian tube and uterus using a dye.
Laparoscopy and hysteroscopy use lighted telescopes to look through small incisions into the belly and uterus.
Endometrial biopsies help identify ovulation and progesterone levels by analyzing endometrial tissue.
Imaging tests help identify structural anomalies, such as a blocked fallopian tube. In such cases, infertility treatment is done after tube repair; otherwise, it may increase the risk of ectopic pregnancy.
How Are Ovulation Problems Treated?
Lifestyle modifications may help some women improve ovulation. However, irregular menstrual cycles and no menstrual cycles (amenorrhea) due to ovulatory dysfunctions require medical treatment. Commonly prescribed medications for ovulation problems may include (10):
Clomiphene citrate (CC) is an ovulation-induction drug. This medication stimulates ovulation by making the pituitary gland release more follicular stimulating hormone (FSH). Increased FSH levels can stimulate the maturation of ovarian follicles.
Aromatase inhibitors such as letrozole and anastrozole decrease the estradiol levels. A temporary decrease in estradiol stimulates the pituitary gland to make more FSH. This medication is also FDA-approved for treating some types of breast cancer in women after menopause.
Insulin sensitizing drugs such as metformin are often prescribed for women with insulin resistance and hyperinsulinemia (high insulin levels in the blood) and associated ovulation problems such as polycystic ovarian syndrome (PCOS). Treating insulin resistance can lead to regular ovulation and menstruation in some women. Insulin sensitizers can also be combined with clomiphene.
However, these drugs are currently not approved by USFDA to stimulate ovulation, and they are only approved for type 2 diabetes treatment to improve the body’s insulin sensitivity.
Gonadotropins contain FSH or LH or both and are administered as injections. They can stimulate ovulation in some women. Human chorionic gonadotropin (hCG) can also be given to induce ovulation. Ovulation may happen about 36 hours after hCG since this drug is structurally and functionally similar to LH, which causes the follicle to release the egg (ovulation).
Bromocriptine and cabergoline are prescribed for women with ovulation disorders due to hyperprolactinemia (high prolactin levels in the blood). Higher than normal prolactin levels inhibit the release of LH and FSH hormones from the pituitary gland and disrupt follicle maturation and ovulation. Prolactin levels can be high due to pituitary adenomas (benign tumor), certain painkillers, alcohol, oral contraceptives, hallucinogens, and thyroid or kidney diseases.
Gonadotropin-releasing hormone (GnRH) helps release FSH and LH from the pituitary gland. Usually, GnRH is naturally released from the hypothalamus in small amounts every 90 minutes. When it is not released naturally, replacement is given with synthetic GnRH. This synthetic hormone is delivered in small amounts using a special pump through needles beneath the skin every 60 to 90 minutes.
GnRH analogs, including agonists and antagonists, are synthetic hormones similar to natural GnRH. But these are chemically modified to change the GnRH function. Leuprolide acetate, goserelin acetate, and nafarelin acetate are GnRH agonists that stimulate the pituitary gland to secrete FSH and LH. GnRH antagonists such as ganirelix and cetrorelix can suppress FSH and LH production.
These medications can treat infertility or menstrual disorders due to ovulation problems. Doctors may also prescribe them for superovulation (mature two or more ovum) before in vitro fertilization (IVF). Gonadotropins and clomiphene citrate are not associated with congenital disabilities or increased risk of ovarian cancer.
