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Anovulatory Cycles

Updated: Mar 24, 2023

Now the thing I wanted to focus on the most, because this is the most common cause of abnormal bleeding, is called anovulatory cycles. I really want you to understand this because once you do, it's going to make a lot of sense why women go through this period of time with erratic bleeding patterns. So as you know, ovulation is when you have the release of an egg from the ovaries. An anovulatory cycle means that you're not actually releasing that egg from the ovary.

Your symptoms could be things like bleeding cycles that are too close together or you can go months without bleeding and then you have a bleeding cycle that's really heavy for two weeks. So it's erratic. These are the changes that can start to happen. I want you to keep in mind that you can have more than one of these things present. So for example, you can have a fibroid and have anovulatory cycles. All women go through these anovulatory cycles because it's a direct function of that ovarian pool declining. We have less follicles within the ovaries as we age, and these anovulatory cycles become more frequent.

Let's go a little bit more into the physiology of this. So I'll kind of go back to what would happen in a reproductive cycle. Again, a lot of us don't actually learn this in school, but basically when you're ovulating an egg, there's this leftover tissue that's called the corpus luteum. And the corpus luteum is what produces your progesterone. So if you don't ovulate, you don't produce progesterone. That's really important to remember. And what is progesterone’s role? Progesterone matures and thins the uterine lining to prepare it for a possible pregnancy.

The way I like to think of this is to think of your estrogen as being the fertilizer on the grass. It's the fertilizer to the uterine lining, the endometrium. It fertilizes it and helps it grow. And then progesterone is that lawnmower that comes and it cuts the endometrial grass every month. So it really thins and gets that lining ready for a possible pregnancy. Again, if you're not going to have progesterone, it's not going to be there to thin the uterine lining. So what starts to happen is that without that progesterone, that endometrial lining continues to proliferate and it eventually outgrows its blood supply. And so then when you bleed, you're bleeding a lot more and you're bleeding more profusely because you have a lot more of that tissue that's built up. You didn't have that lawnmower to come and cut the grass.

Just to reiterate again, when pregnancy doesn't occur, the uterine lining that has been matured by progesterone gets shed. If you have an anovulatory cycle where progesterone is not released, then the uterine lining that needs to be shed at the end of the month is often thicker and more inflamed. And again, anovulation is going to directly happen because ovarian function starts to decline. So I hope that makes sense. This really does help explain a lot of what starts to happen. And they're irregular, these anovulatory cycles. You can have a cycle where you ovulate and then you can go three cycles without ovulating and then you might ovulate again. It will be sporadic.

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