diagnosis of anovulation

A failure to ovulate consistently in a regular menstrual pattern is an indication that there is a hormonal imbalance which may or may not lead to a more severe medical condition. The following conditions are a possible consequence of consistent failure to ovulate (anovulation) which results in an overall progesterone deficiency.



Anemia means lack of red blood cells. If you bleed very heavily during menstruation, you can develop iron deficiency anemia, and in extreme cases, low blood volume. If you become anemic, you will feel tired and withdrawn. You will look pale. If you have dark skin, your mucous membranes will look pale. You may stop menstruating or have prolonged, heavy bleeding.

A Complete Blood Count (CBC) and ferritin blood level will confirm if you have anemia. Immediate treatment is iron supplementation and the use of a progesterone cream like ProFeme, from day 12-26 of the cycle will address the underlying progesterone deficiency causing the heavy bleeding and anemia.


Menorrhagia is heavy bleeding more than 80 ml per cycle, or 16 soaked sanitary pads per cycle. Women generally notice a gradual increase of menstrual flow over many months before seeking treatment. A sudden onset, painful or heavy unexplained menstrual blood loss needs to be investigated by a doctor immediately because it is unlikely to be menorrhagia. Menorrhagia is serious because it eventually leads to iron deficiency anemia.

Most of the time, menorrhagia occurs because of an imbalance in estrogen and progesterone hormones or from benign (non-cancerous) uterine tumors called fibroids. Women with menorrhagia notice a slow and steady increase in blood volumes over many months. Very rarely menorrhagia is caused by a genetic bleeding disorder, like von Willebrand’s disease.

Heavy periods and menorrhagia is best addressed by the the use of progesterone cream from day 12-26 of the cycle for three cycles to alleviate heavy menstrual flow.


Metrorrhagia is irregular uterine bleeding between expected menstrual periods. Women with metrorrhagia are prone to anemia from excessive blood loss.

Causes of metrorrhagia generally include:


Menometrorrhagia is irregular and heavy uterine bleeding. The woman with menometrorrhagia bleeds during her expected menstrual period and also at irregular intervals. She is very likely to develop iron deficiency anemia.

Menometrorrhagia is best addressed by the the use of progesterone cream from day 12-26 of the cycle.


Endometrial Hyperplasia
Endometrial hyperplasia occurs when the endometrial cells lining the uterus grow too quickly (proliferate), usually because the woman produces normal or high levels of the hormone estrogen and not enough progesterone.

The glands in the endometrial lining develop irregular shapes and varying sizes, which predisposes the woman to developing cancer later. The uterus enlarges to the size of a three-month pregnancy and the lining is very thick. (Normal lining is 5 mm or less in thickness; hyperplasia is often over 20
mm.) The woman usually has irregular, heavy bleeding (menometrorrhagia) with anemia and pain. As the uterus continues to enlarge, it pushes on the bladder and rectum, so the woman may develop frequent urination and constipation.

Hyperplasia can be a symptom of:


Simple — 1% chance
Complex — 3%-5%  chance
Simple with atypia — 8%-10%  chance
Complex with atypia — 25%-30%  chance


Simple and complex hyperplasia regresses spontaneously in 80% of cases without atypia (the precursor of cancer), however the situation needs to be monitored by your doctor.

If you decide on treatment for endometrial hyperplasia, then your gynecologist will biopsy your endometrium by scraping it with a Pipelle (a flexible suction curette). The biopsy can be performed in the doctor’s office or in a hospital as part of a D&C.

Your gynecologist may also order an ultrasound or hysteroscopy to confirm the findings. The pathologist at the laboratory will look for abnormal cells that indicate a precancerous condition, called atypia. For simple and complex hyperplasia’s a gynecologist may prescribe progesterone or synthetic progestin to prevent endometrial hyperplasia from developing into atypia.


PMS – Premenstrual Syndrome
Take a multivitamin supplement containing 400 micrograms of folic acid and 1,000 milligrams of calcium. Take ibuprofen starting the week before your period begins. Avoid smoking and bingeing on salty or sugary foods, alcohol, or caffeine. Try to get eight hours of sleep nightly. If symptoms persist supplementing progesterone to address the progesterone deficiency usually resolves symptoms within three cycles.



Understand more on Ovulation and Anovulation:

What is Ovulation and Anovulation?

What is a normal menstrual cycle?

All about Anovulation and Ovulatory changes with age

 The information in this article has been taken with permission from the official Lawley booklet on Understanding Anovulation.