Anovulatory Cycles

Question

I'm 22 years old and have a question—how can you have regular periods and not make an egg? I thought it took dropping progesterone levels for the flow to start. We've been married for two years, using the Pill until last month when I stopped because we are thinking about a pregnancy. My period came on time, but I don't think I ovulated based on the morning temperatures I've been writing on the bottom of the Menstrual Cycle Diary.

Answer

Thanks for your question—it is a common misunderstanding that regular periods mean normal ovulation. And you are right that most grade 7 science classes imply that dropping estrogen and progesterone levels are required to start the flow. However, about a month is as long as an endometrium with normal estrogen-stimulation can last without progesterone's stabilizing effect. So, without ovulation, periods, may and often are, regular and within the normal range of 21 to 35 days. In fact, two studies of women randomly chosen from the population showed that 10 to 18 percent of all regular cycles are anovulatory, meaning no egg was released(1;2).

Don't be discouraged if you didn't ovulate during the first cycle after stopping oral contraceptives. On average it takes about six months to conceive after stopping the Pill—that is longer than with non-hormonal contraception methods that average about three cycles(3). In addition, being as young as you are, I would guess only about 10 years after your first period, means you have a higher likelihood of not ovulating regularly.

Because ovulation is so closely tied to emotional, social, psychological as well as physical well being, you can encourage fertility by doing things that make you feel “at home” with yourself, your future, your friends and family. Also, ovulation is related to nutrition so be sure your body mass index (BMI, weight in kilograms divided by height in metres squared) is between 22 and 25. If you are already regularly exercising, continue but don't increase exercise intensity or time—if you are not exercising, it will help with stress and general health to start a regular walking programme. Finally, your best chance for conceiving when you ovulate is to have sex when your cervical mucus approaching midcycle becomes stretchy (about a “2” or 2 cm of stretch). Also, start now taking a maternity vitamin that has folate in it.

Your likelihood of becoming pregnant increases the more you learn about yourself—that's one of the most important benefits from Diary charting.

I hope this is helpful to you.

Reference List

1. Swain MC, Bulbrook RD, Hayward JL. Ovulatory failure in a normal population and in patients with breast cancer. J.Obstet.Gynaecol.Br.Commonw. 1974;81(8):640-3.
2. Sowers M, Randolph JF, Crutchfield M, Jannausch ML, Shapiro B, Zhang B et al. Urinary ovarian and gonadotropin hormone levels in premenopausal women with low bone mass. J.Bone Min.Res. 1998;13(7):1191-202.
3. Bracken MB, Hellenbrand KG, Holford TR. Conception delay after oral contraceptive use: the effect of estrogen dose. Fertil.Steril. 1990;53(1):21-7.