What are the symptoms of anovulatory menstrual cycles?

From the Guidelines

Anovulatory cycles are often characterized by irregular or absent periods, abnormal bleeding patterns, and lack of premenstrual symptoms, and the most common cause is polycystic ovary syndrome (PCOS), which affects approximately 4-6% of women in the general population 1. Anovulatory cycles occur when an egg is not released during a menstrual cycle, and symptoms can include irregular or absent periods, abnormal bleeding patterns, and lack of premenstrual symptoms. Women experiencing anovulatory cycles may notice unpredictable menstrual cycles that vary in length, sometimes with very light or unusually heavy bleeding. Other common signs include absence of mittelschmerz (ovulation pain), no changes in cervical mucus consistency, and lack of the typical breast tenderness or mood changes that normally occur before menstruation. Some key factors to consider in the diagnosis of anovulatory cycles include:

• Hormonal imbalances, particularly elevated levels of luteinizing hormone (LH) and testosterone, which can be indicative of PCOS 1
• Low mid-luteal phase progesterone levels, which can indicate anovulation 1
• Polycystic ovaries, which can be detected by pelvic ultrasound and are associated with PCOS 1
• Insulin resistance and hyperinsulinaemia, which can contribute to the development of PCOS 1 Treatment options for anovulatory cycles depend on the underlying cause, but may include lifestyle modifications, hormonal medications like clomiphene citrate or letrozole to induce ovulation, or addressing specific hormonal imbalances, with the goal of improving fertility and reducing the risk of long-term health consequences such as infertility, metabolic syndrome, and cardiovascular disease 1.

From the Research

Anovulatory Cycles Symptoms

Anovulatory cycles are a common issue in women with polycystic ovary syndrome (PCOS), affecting approximately 80% of women who suffer from anovulatory infertility 2. The symptoms of anovulatory cycles can vary, but they often include irregular menstrual cycles, infertility, and hyperandrogenism.

Treatment Options

Several treatment options are available for anovulatory cycles, including:

• Lifestyle changes, such as weight loss and exercise, which can help improve menstrual cycle regulation and fertility 2
• Pharmacotherapy, such as clomiphene citrate (CC) and letrozole, which can help induce ovulation 3, 4
• Metformin, which can help improve insulin sensitivity and fertility, but has limited benefits in improving live birth rates when used alone 2, 3
• Gonadotropins and laparoscopic surgery, which can be used as second-line treatments for women who do not respond to first-line therapies 2
• In-vitro fertilization (IVF), which can be used for women who fail lifestyle and ovulation induction therapy or have additional infertility factors 2

Comparison of Treatment Options

Studies have compared the efficacy of different treatment options for anovulatory cycles, including:

• Clomiphene citrate versus metformin: a study found that both treatments were effective in improving fertility in anovulatory women with PCOS, but there was no significant difference in ovulation, pregnancy, and abortion rates between the two groups 3
• Letrozole versus clomiphene citrate: a study found that letrozole was a better alternative for ovulation induction in anovulatory women with PCOS, with higher pregnancy rates and shorter time to pregnancy 4
• Metformin-letrozole versus metformin-clomiphene citrate: a study found that there was no significant difference in pregnancy rate between the two groups, although the miscarriage rate was lower in the metformin-letrozole group 5

Risks and Considerations

Women with anovulatory cycles should be informed of the potential risks and considerations associated with treatment, including:

• The risks of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) associated with ovulation induction agents 2
• The potential side effects of ovulation induction agents and IVF on the fetus 2
• The increased risks for the mother during pregnancy and for the child, including the exacerbating impact of obesity on adverse outcomes 2