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VERIFIED CONTENTAuthor: Dominika Wilk

Lack of ovulation is one of the causes of problems getting pregnant. If the causes of the anovulatory cycle do not result from anatomical obstacles, e.g. obstructed ovaries, they can often be eliminated through appropriate pharmacological treatment, diet change and a change in lifestyle.

Lack of ovulationcan have many different causes. It can result from diseases as well as the negative effects of stress and other factors on the body. Ovulation can be restored with drug treatment. There are also other ways to deal with this problem. They can include, among others. change of lifestyle and diet.

How should a woman's normal monthly cycle look like?

1 day of the menstrual cycle is the day of your period. Then the endometrium exfoliates, which is associated with the appearance of bleeding. The next phase that follows menstruation is the follicular phase. Then the endometrium, i.e. the mucosa lining the uterus, grows to create favorable conditions for possible fertilization.

In this phase of the cycle, estrogens dominate and they influence the ovaries so that Graff's follicles begin to mature in them. One of them becomes the dominant follicle during the cycle and releases the egg at the time of ovulation (if this does not happen, we are dealing with an anovulatory cycle).

The released egg cell matures and if the sperm does not reach it and fertilization takes place - it dies. Progesterone dominates in the second phase of the cycle and it is responsible for the maintenance of pregnancy.

When the egg is not fertilized, the level of progesterone decreases at the end of the cycle and bleeding occurs, which is synonymous with the beginning of the next monthly cycle.

It is assumed that a normal menstrual cycle should last from 28-32 days. But it is an individual matter and it happens that with longer cycles a woman ovulates properly and becomes pregnant without any problems. This is due to the fact that the first phase of the cycle, i.e. the follicular phase, may be prolonged and last even more than 20 days. The luteal phase, on the other hand, is rather permanent and is estimated at 14 days.

The follicular phase can also be shorter and be less than 14 days old, cocauses ovulation to accelerate, and a woman can become pregnant in a period when she is not expecting it.

How to recognize non-ovulatory cycles?

The best way to tell if we are dealing with ovulatory cycles is by observing. During ovulation, body temperature is slightly elevated (though not in all women), and for a few days you may notice clear, stringy mucus with the consistency of egg white.

In addition, some women may experience breast tenderness or a stinging sensation around one of the ovaries at this time. During ovulation, there is also a greater libido and a greater desire to have sex.

If the woman does not notice the presence of mucus, her body temperature is not higher, her cycles are too long (over 35 days) or the menstruation does not occur for the next 3 months (and this condition is not caused by pregnancy) then she should see a gynecologist and do the appropriate tests to find out what is causing the ovulation disorder.

To find out if ovulation occurs (and when exactly it occurs), you can purchase a special ovulation test at a pharmacy, which is performed in a similar way to pregnancy tests. Just put a few drops of urine on the test strip and wait about 10 minutes to read the result. It is worth knowing that the ovulation test should not be performed with morning urine, and the consumption of drinks should be limited 2 hours before it is performed.

This type of test detects luteinizing hormone (LH) in the urine, which may indicate a possible ovulation. The test is performed either in the middle of the cycle (if we have cycles 28-32) or, remembering that the second phase of the cycle is 14 days, subtract these 14 days from the number of days of our monthly cycle and perform the test at the right time.

For example, with a cycle lasting 36 days, we perform the test around day 22; with a 21-day cycle - we do it on day 6.

Causes of anovulatory cycles

Lack of ovulatory cycles can be for a variety of reasons. But the most famous are:

  • PCOS, or polycystic ovary syndrome,
  • hypothyroidism,
  • chronic stress,
  • insulin resistance,
  • overweight or underweight,
  • age over 37.

Change of diet to regain ovulation

Diet is not a miracle remedy for regaining ovulation, but it is an important factor that may have a beneficial effect on regaining hormonal balance and thus restoring a normal monthly cycle.

In diseases such as: insulin resistance, hypothyroidismthe thyroid gland or PCOS diet can have a positive effect on the functioning of the body, which will translate into a greater likelihood of ovulation and a greater chance of getting pregnant.

Diet for ovulation with PCOS

Polycystic ovary syndrome, or PCOS, is one of the most common causes of menstrual disorders and lack of ovulation. It is assumed that this disease may have a genetic basis, although environmental factors also have a significant impact on its occurrence. What is most characteristic of PCOS is the presence of numerous immature follicles in the fallopian tubes, none of which becomes dominant, which prevents ovulation from occurring.

The symptoms in the external appearance that suggest the presence of this disease are: excessive hair (hirsutism), which appears, for example, on the face or chest, or androgenic alopecia.

Women with PCOS also often struggle with acne, energy loss and overweight, which in turn is associated with the often accompanying insulin resistance. Absence of menstruation, irregular cycles or miscarriages in the first trimester are also typical symptoms of PCOS.

Restoring normal monthly cycles, and thus ovulation, should be associated with the desire to normalize the insulin metabolism.

If one of the reasons for the appearance of PCOS is a bad diet, e.g. excess carbohydrates, lack of sufficiently long intervals between meals, then glucose disorders may affect hormonal imbalance and aggravate the problem in polycystic ovary syndrome.

A diet in PCOS should first of all:

  • based on products with a low glycemic index,
  • be anti-inflammatory,
  • introduce a lot of antioxidants,
  • take care of an adequate supply of essential, unsaturated fatty acids,
  • provide the right proportions of animal and vegetable proteins.

Products contraindicated in PCOS include:

  • saturated fat,
  • fast food,
  • alcohol,
  • table s alt,
  • carbohydrates with a high glycemic load,
  • carbonated drinks, fruit juices,
  • table s alt.

The introduction of products with a low glycemic index (GI) and dishes with a low glycemic load (they may contain products with a high GI, but they are balanced by other products that reduce insulin jumps, e.g. fats, proteins), insulin content in women with PCOS stabilizes and the fatty tissue on the abdomen, which is an active tissue, decreasesthat produces hormones. This type of diet allows you to restore the hormonal balance.

A large amount of antioxidants in products such as: blueberries, blueberries, broccoli, apricots, nuts will also be beneficial in PCOS, because it reduces inflammation in the body, and thus normalizes the state of the body (this is especially important in the case of immune PCOS, in inflammation that induces the disease).

An important element of diet therapy in polycystic ovary syndrome is the consumption of the right proportion of anti-inflammatory omega-3 fatty acids to omega-6 fatty acids, which, although he althy, have a pro-inflammatory effect in larger amounts.

Why is the ratio, which is around 5: 1 (omega-3 to omega-6), so important? Because these fats fight for the same receptors. As the omega-6s take up more of them, there won't be much space left for the omega-3s. Nevertheless, omega-6 fatty acids are worth eating, especially evening primrose oil, which has a positive effect on the hormonal balance of women.

Diet for ovulation in hypothyroidism

Untreated and decompensated hypothyroidism has a very large impact on the disorders of the menstrual cycle, and thus ovulation. The very fact that thyroid hormone receptors have been found in oocytes proves that they play an important role in the process of normal ovulation. Research shows that women with hypothyroidism are three times more likely to have menstrual disorders than he althy women.

Disorders of the thyroid gland function, among others, on SGHB, i.e. sex hormone binding globulins. In women with hypothyroidism, their amount drops significantly, which leads to an increase in the concentration of, for example, androgens. In addition, in such people the level of prolactin increases significantly, and hyperprolactinemia is the main cause of menstrual disorders and it is she who leads to anovulatory cycles. Hypothyroidism also makes secondary amenorrhea more common, as well as rare periods.

The diet for hypothyroidism should include those nutrients that are essential for the production of thyroid hormones and that improve the conversion of T4 (thyroxine) to T3 (triiodothyronine). One of these ingredients is iodine, without which the right amount of thyroid hormones cannot be produced.

Food products rich in this element are mainly: cod, mackerel, oysters, bran, iodized s alt, mineral waters. In addition, it is necessary to provide selenium with the diet, because it affects the activity of iodothyronine deiodinase, which is a catalyst for the transformation of the inactive form of the hormonethyroid T4 to active -T3.

The most rich in selenium are: Brazil nuts, kidneys, shellfish, fish, and meat in general. Zinc will also be necessary for the proper functioning of the thyroid gland, because zinc fingers are one of the components of the structure of thyroid hormones, and in the absence of zinc, impaired action of T3 is observed. Zinc deficiency also affects the T4 to T3 conversion. A zinc-rich diet should include: cocoa, beef, and whole grains.

Adequate caloric content of the diet is also extremely important for the proper functioning of the thyroid gland. Too restrictive diets weaken its functioning and reduce the activity of deiodinases. In addition, they adversely affect the conversion of T4 to T3 and increase the probability of T4 conversion to the inactive form rT3.

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Diet for ovulation in case of obesity

Obesity in itself is not a cause of ovulation disorders, although patients with excess body weight are more likely to find: increased production of androgens in both the ovaries and adrenal glands, a decrease in SGHB (hormone binding protein), as well as an increase in peripheral aromatization of androgens and disturbance of gonadotropin secretion. After all, in obese women, the most important thing is not the amount of adipose tissue, but its location.

The most problematic is adipose tissue on the abdomen, which is a hormonally active tissue, secretes pro-inflammatory cytokines that contribute to the development of PCOS or insulin resistance, which in turn cause menstrual disorders.

In the case of obese women who experience irregular cycles, ovulation disorders or problems with getting pregnant, weight reduction is necessary.

It can be achieved through a less caloric diet and physical activity. Regular exercise helps to improve insulin parameters, while a less caloric diet based on anti-inflammatory products with a low glycemic index stabilizes the insulin metabolism, positively influencing the woman's hormonal balance.

Diet to improve ovulation - general recommendations

Protein

According to studies, excessive protein consumption may affect ovulation disorders. The source of protein is also important, because too much animal protein consumption (greater than vegetable protein) increases the risk of infertility resulting from ovulation disorders.

Most adverse impact onred meat, such as beef or pork, seems to be fertile. It is recommended for poultry meat and vegetable protein.

On the other hand, there is a positive effect of a diet based on vegetable protein, which may result from the fact that arginine contained in plants improves blood flow through the reproductive organs, which promotes the development of oocytes and facilitates implantation of the embryo.

Carbohydrates

Due to the fact that disturbed insulin metabolism has a significant impact on ovulation disorders, it seems justified that the diet, which is to help regulate the cycle and proper ovulation, contain carbohydrates with a low glycemic index or be combined with other ingredients of the dish so that it has an overall low glycemic load.

Carbohydrates rich in fiber are especially beneficial, such as: groats, whole grain bread, wholemeal flour, which inhibit blood glucose spikes.

Fat

Every diet should contain good quality fats such as: olive oil, linseed oil, hemp oil, borage oil or nut oil. However, in the menu of women with ovulation disorders, it is of particular importance, as it supports the achievement of hormonal balance.

Eating fatty fish rich in omega-3 fatty acids, ingesting fish oil, reduces inflammation in the body, which is of great importance in PCOS or endometriosis affecting ovulation disorders.

Vitamins

Vitamin D deficiency may adversely affect the menstrual cycle and lead to its disorders. Therefore, it is important to provide this vitamin not only in the summer, when there is a natural percutaneous synthesis and we obtain it thanks to the sun's rays, but also in winter or autumn, when there is no sun.

The best source of it will be fatty fish and fish oil. You can also reach for a single vitamin D supplement, ensuring that it contains at least 2000 units.

In addition to vitamin D, vitamin B6 has a positive effect on fertility and the menstrual cycle, regulating the level of prolactin (too high its level blocks ovulation) and has a positive effect on maintaining the proper concentration of progesterone.

Vitamin B12 is also essential for the proper course of ovulation. Vitamin B6 can be found primarily in fish, liver, nuts, bananas and whole grains. On the other hand, the best source of vitamin B12 is meat.

Lifestyle change to regain ovulation

Work environment

Environmental factors have a great influence on a woman's fertility and the proper menstrual cycle. It has been proven that women working inin workplaces where they were exposed to constant excessive contact with paints, adhesives, pesticides, chemical agents present in laboratories or the chemical industry, were exposed to lead or mercury, had ovulation disorders, and were more likely to develop until a miscarriage.

Also, unfavorable ionizing radiation or inappropriate electromagnetic field led to unfavorable changes in the ovaries and even secondary amenorrhea.

If a woman works in the above-mentioned conditions, and at the same time has disorders of the menstrual cycle, she cannot get pregnant, she should change her job to one that will not expose her body to the harmful influence of external factors.

Smoking

Smoking is another factor that disrupts a woman's hormonal balance. This applies not only to active smokers, but also to passive smokers. Tobacco smoke contains so many toxic substances that, as shown in their 2007 research by Homan et al., It can lead to a decrease in LH (luteinizing hormone) as well as increase the level of FSH (follicle-stimulating hormone), which results in an ovulation disorder.

In addition, the substances contained in cigarettes lead to unfavorable changes in oocytes and negatively affect the process of shaping the corpus luteum. They also reduce the number of ovarian follicles and their quality.

In the case of hormonal disorders, one of the first medical recommendations is to quit smoking. This is the quickest and easiest way to eliminate one of the significant factors that adversely affect your menstrual cycle.

Inappropriate physical activity

Moderate physical exertion definitely has a positive effect on a woman's fertility because it regulates the glucose metabolism and prevents obesity. On the other hand, excessive physical activity, too long and too hard workouts lead to an imbalance between muscle and adipose tissue and, with a restrictive diet attached to it, secondary amenorrhea may occur.

Too intense training, especially in young women, may also lead to:

  • for ovulation disorders,
  • disturbances in the secretion of gonadoliberin (a hormone secreted by the hypothalamus),
  • for LH production disorders,
  • hyperprolactinemia,
  • or hyperandrogemia.

If a woman wants to regulate the hormonal balance, she should reduce the amount of training and change it to a lighter one, e.g. change strength training to cycling, yoga, Pilates.

Treatmentpharmacological anovulation

Clomiphene citrate

Pharmacological ovulation stimulation depends on the factor that caused the disruption of the menstrual cycle. One of the drugs for ovulation disorders is clomiphene citrate, which is a selective modulator of the estrogen receptor SERM and has both estrogenic and anti-estrogenic properties.

The effect of using the drug is an increased amount of gonadotropin secretion and stimulation of the pituitary gland and the production of FSH. This, in turn, stimulates the growth and maturation of ovarian follicles and leads to the appearance of a dominant follicle.

Letrozol

Another drug used to stimulate ovulation is letrozole. It belongs to the aromatase inhibitors - an enzyme that allows the conversion of androgens into estrogens.

An inhibitor such as letrozole inhibits this enzyme, resulting in a reduction in the amount of estrogen. This activates the hypothalamic-pituitary-ovaries axis to secrete more FSH, which results in the development of a follicle in the ovary.

Metformin

Since many women have problems with ovulation due to PCOS or insulin resistance, they sometimes use metformin therapy. Metformin is a drug that lowers blood glucose levels. It is usually given in diabetes, although it is sometimes also used in insulin resistance.

If the patient is not aware of the causes of infertility related to other diseases or factors, then metformin is used as monotherapy. However, it is usually combined with clomiphene citrate.

Metformin monotherapy is justified in patients with BMI<30 kg/m2. Przy wyższych wartościach zawsze łączy się ją z cytrynianem klomifenu.

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Female diseases