Causes and Treatments of Ovulation Disorders

Ovulation disorders are commonly caused by a problem in the hypothalamic–pituitary axis or ovarian dysfunction, but they can also be secondarily caused by chronic diseases as below. In this case, elimination of the underlying cause can allow the resumption of normal menstruation.

  • Problems in the central nervous system: Pituitary tumors, severe stress, excessive exercise, anorexia
  • Problems in ovarian function: Ovarian aging (premature menopause), polycystic ovaries, ovarian lesions (ovarian tumors, ovarian inflammation)
  • Problems in metabolic functions: Thyroid disease, diabetes, abnormal hormonal secretions (hyperprolactinemia)
Types of Ovulation Disorders
1. Amenorrhea or rare menstration

In the case of amenorrhea or rare menstruation, amenorrhea is defined as a continuous absence of menstruation for 3 or more cycles based on the menstrual cycle, and amenorrhea is defined as a normal menstrual cycle of 2-3 months or longer. Also, in the case of absent or rare menstruation, the low-temperature phase appears continuously for more than 2 months at the basal body temperature. If the menstrual cycle is abnormal like this, progesterone is injected, and the treatment policy is determined depending on case of bleeding and non-bleeding.

2. Menstruation without ovulation (anovulation)

Periodic menstruation does not mean that ovulation takes place. Anovulation is when the follicle does not maturate normally, either stopped maturating during the process or grew up just before ovulation stage without bursting when checked with ultrasound. At this time, the basal body temperature is in a straight line with no change in body temperature. In this case, the medical staff decides the treatment protocol after observing the state of ovulation again for about two months.

3. Short follicular phase

When follicular phases are too short (excessive follicular malformation), basal body temperature is divided into low-temperature and high-temperature phases, but the period from the day of menstruation to ovulation is exceptionally short. This is when luteinizing hormone from the pituitary gland is released before the follicle is sufficiently mature, eventually resulting in the ovulation of an immature egg.

4. Sporadic anovulation

Sporadic anovulation refers to a case in which the cold phase continues irregularly at the basal body temperature. However, in these cases pregnancy may occur spontaneously.

Treatment for Ovulation Disorder
1. Clomiphene

Most commonly used ovulation stimulator. From the 3-5th day of menstruation, take 50mg-100mg per day for 5 days, and ovulation occurs at 6-10 days after intake. It is necessary to check ovulation by ultrasound, and after confirming the ovulation, the couple has sexual intercourse to induce pregnancy. When taking clomiphene, it must be taken regularly at a set time and should not be taken together with vitamins, gastrointestinal medications, or migraine medications.

2. Parlodel (Bromocriptine)

Most effective drug for hyperprolactinemia. When the level of prolactin, the lactation hormone, is elevated, breast milk irrelevant to pregnancy is secreted, and it interferes with pregnancy by causing ovulation disorders and amenorrhea. Take 1 tablet a day for approximately 2 weeks and observe the state of menstruation. However, parlodel can cause nausea on an empty stomach, so it is best to take it before bedtime or during a meal.

3. HMG (Human Menopausal Gonadotropin), HCG (Human Chorionic Gonadotropin)

HMG stimulates the ovary to make the egg mature, HCG commands ovulation. The method of application is to first inject HMG intramuscularly for 7-12 days from the 4th day of the menstrual cycle. Among them, when the follicle is mature, intramuscular HCG injection is conducted 1 to 2 times to induce ovulation. Ovulation inducers differ in the duration and amount of use because the degree of response is different for each subject. Therefore, in order to continuously monitor the growth process of the follicle and know the exact date of ovulation, along with induction of ovulation, ultrasound and blood tests are performed.

4. Surgical method

In the case of polycystic ovary syndrome, the membrane surrounding the ovary is hard and thick thus failing to ovulate a mature follicle. In this case, laparoscope is used to make multiple holes on the surface of the ovary to induce ovulation. Other than that, when there is a prolactin-secreting tumor in the pituitary gland, neurosurgery can be performed depending on its size or location.