Three (Non-Hormonal) Reasons You Might Not Be Ovulating

When it comes to our cycles, ovulation is everything.

We tend to think that our periods—the monthly bleed—is the main event of the menstrual cycle but really that is just the after-math or the by-product. Honestly, it isn’t even the piece that affects our lives the most! Instead, ovulation is the “big deal” aspect of our cycles, albeit highly underrated.

The hormonal shifts that accompany ovulation have profound implications for our wellbeing, and of course when it comes to fertility and TTC we know that ovulation is essential. But of course, it’s possible to have menstrual cycles without ovulation, so called “anovulatory cycles.” We most often discuss the hormonal reasons for anovulatory periods, but there are also a handful of environmental factors that can cause them.

3 Causes of Anovulatory Cycles (That Have Nothing to Do With Hormones)

NSAID or Opioid Use

Inflammation is typically seen as a bad thing, and it certainly is a problem when uncontrolled. However, small inflammatory processes are physiological, meaning they are normal and necessary for the healthy functioning of humans. Painkillers like NSAIDs and opioids can be helpful in controlling pain (or inflammation, as is the case with NSAIDs) but they also can incidentally shut down necessary processes in the body including the digestive tract and fertility.

A study conducted in Europe showed that after just 10 days, NSAID use prevented ovulation in 93.7% of women using diclofenac (Flector, Cambia, Zipsor) 75% of women using Naproxen (Aleve, Flanax, All Day Pain Relief) and 92.7% of women using etoricoxib (Arcoxia – note that this drug has been banned in the US.) This was in comparison to a control group in which 100% of women ovulated successfully. While ibuprofen did not have the same effect on ovulation, it was associated with increased size of ovarian follicles which can lead to cysts (and subsequent ruptured) as well as problems with IVF egg retrieval cycles. Note that in women who are trying to conceive, ibuprofen can prevent implantation and increase risk of bleeding and miscarriage, including early miscarriage, so it should be avoided. Acetaminophen is also not considered safe for use when TTC or in pregnancy/postpartum due to effects of glutathione depletion.

Likewise, opioid use is linked to pregnancy loss and lower chance of conception. These drugs also affect the uterine lining, ovarian follicles and egg quality.

Smoking and Impaired Blood Flow

Smoking creates oxidative stress which on its own is damaging to eggs and early pregnancy. However, it also creates secondary effects in the reproductive system through negative feedback caused by inflammation. Because smoking elevates levels of inflammatory chemicals, it can by extension suppress ovulation.

The inflammatory chemicals produced from smoking also affect blood vessel quality and blood flow, which reduces nutrient and oxygen delivery to the ovaries. This on its own can lead to under-nourished ovaries and failure to ovulate. Effects on blood flow secondary to smoking can also affect the quality of the uterine lining, leading to reduced chances of implantation, birth defects and more. Many of these effects can linger after smoking cessation, and steps should be taken to reduce oxidative stress in patients who have a history of smoking.

Pelvic Adhesions

If you’ve ever looked at a drawing of the organs in the human body, you know that for most people, things like the liver, intestines and bladder occupy the same general area of the abdomen. However, this doesn’t mean that our organs are stationary. In fact, they move throughout the abdomen which is essential for their protection during periods of movement. (Consider this, if your organs couldn’t move around when you bend forward to touch your toes, which ones do you think would get squished first?)

Injury, surgery, and some illnesses can cause tiny bands of scar-like tissue to develop in and around pelvic and abdominal organs, limiting their movement. As the ovaries move change throughout the menstrual cycle, movement is essential for proper functioning, but those tiny bands of scar-like tissue (called adhesions) can hold the organs back from normal movement. This can affect blood flow, development of follicles, and ovulation. Many women benefit from therapeutic abdominal massage by trained professionals (such as pelvic floor therapists, Mercier therapists, and other professionals with training in abdominal massage techniques.)

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I’m Dr. Alexandra MacKillop, a functional medicine physician, food scientist and nutrition expert.

I specialize in women’s health & hormones, addressing concerns like fertility, disordered eating, PCOS, endometriosis, dysmenorrhea (painful periods), PMS symptoms like bloating and mood changes and more.

If you’re looking for a new way to approach your health, I’d love to work with you. Click to learn more.

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