Disorders of Ovulation and Control of Ovulation

Symptoms

If you don't experience ovulatory symptoms or if you have irregular menstrual cycles, it means that ovulation may not occur every month.
The main symptoms associated with ovulation disorders are:

menstrual irregularities
absence of menstruation (amenorrhea)
lengthening of the natural rhythm of the menstrual cycle (oligomenorrhea)
excessive and sudden weight loss
abnormal or excessive growth of body and face hair
galactorrhea (milk discharge from the nipples)
obesity
acne and hirsutism (abnormal or excessive growth of body and face hair)

Oligo-ovulation and Anovulation

Ovulation disorders are classified as menstrual disorders, and include:

Oligo-ovulation: it is the infrequent or irregular ovulation, usually identified by the presence of cycles longer than 36 days or numerically less than 8 cycles in a year.
Anovulation: Common cause of infertility, occurs when a woman does not ovulate. Other possible symptoms of anovulation are extremely short or long menstrual periods or a complete absence of menstruation. Anovulation is the absence of menstrual flow in childbearing age for a period of at least 3 months and usually manifests itself as an irregularity in the menstrual cycle, understood as an "unpredictable variability in the duration, or amount of menstrual flow. Anovulation can occur." also cause the cessation of menstrual periods (secondary amenorrhea) or excessive bleeding (dysfunctional uterine bleeding).
SYMPTOMS: in itself, anovulation is not associated with any physical symptoms, however in women who do not ovulate, cervical mucus tends to be irregular, while hirsutism may be present in those with high androgen values.

Classification

The World Health Organization (WHO) has developed the following classification of ovulatory disorders, based on: 1) prolactin level; 2) level of gonadotropins LH and FSH; 3) level of estrogen

GROUP I - Pituitary hypothalamic failure: Women with amenorrhea (absence of menstruation) and absence of signs of estrogen production, prolactin levels within the limits, low levels of FSH, absence of signs of anatomical lesions of the hypothalamic-pituitary region.
GROUP II - Dysfunctions involving hypothalamus and pituitary gland (most common cause): Women with various disorders of the menstrual cycle such as insufficiency of the luteal phase, anovulatory cycles, polycystic ovary syndrome, absence of menstruation, with the presence of estrogen production and normal levels of FSH and prolactin
GROUP III - Ovarian failure (Ovarian failure): Women with no menstruation, no signs of ovarian function, high FSH levels, normal prolactin values
GROUP IV: congenital or acquired alteration of the reproductive system: Women with no menstruation who do not respond to repeated cycles of estrogen
GROUP V: Infertile women with hyperprolactinemia and lesions in the hypothalamic-pituitary region: Women with various cycle disorders, high levels of prolactin and signs of lesions in the hypothalamic-pituitary region
GROUP VI: Women with infertility, hyperprolactinemia and absence of lesions in the hypothalamic-pituitary region: Women with various cycle disorders, high levels of prolactin, just like in group V but WITHOUT lesions in the hypothalamic-pituitary region.
GROUP VII: Women with no menstruation, prolactin values within the limits and signs of lesions in the hypothalamic-pituitary region: Women with low estrogen levels and prolactin values within the limits

Causes

Some ovulation disorders can be caused by:

Hyperprolactinemia - Hyperprolactinemia is the presence of abnormally high levels of prolactin in the blood.
Prolactin is a peptide hormone produced by the pituitary, mainly associated with breastfeeding. Hyperprolactinemia can cause the spontaneous production of breast milk and alterations in the normal menstrual cycle, thus reproducing the normal variations of the body during pregnancy and lactation (the majority of breastfeeding women are in conditions of absence of menstruation due to ovulation). When the production of prolactin increases outside this period, due to various causes, the ovulation processes are disturbed, even if the menstruation maintains a normal rhythm. The classic signs of hyperprolactinemia are amenorrhea and galactorrhea. Hyperprolactinaemia is often caused by diseases that affect the pituitary gland (for example, due to the presence of small benign tumors of the pituitary gland, called adenomas).
Polycystic Ovary Syndrome (PCOS) - Polycystic Ovary Syndrome (PCOS) is one of the most common female endocrine disorders. PCOS is a complex heterogeneous disorder that can cause various disorders: anovulation, resulting in menstrual irregularities or amenorrhea, the appearance of ovarian cysts (hence the term polycystic ovary) and excessive amounts of androgens or amplification of their effects, cause of acne and hirsutism; it is often associated with insulin resistance, obesity, type 2 diabetes and high cholesterol levels.
Symptoms and severity of the syndrome vary greatly among affected women.
Endometriosis - Endometriosis is a pathological condition that affects the cells of the inner lining of the uterus (endometrium), which under normal conditions are subjected to hormonal stimulation and exfoliation on a monthly basis during menstruation. In the presence of endometriosis there is a proliferation of these endometrial cells outside the uterine cavity, most commonly on the peritoneum that lines the abdominal cavity and on the "ovary, where" menstrual "blood collects in cysts, giving rise to reactions by of the organism which cause negative effects on the anatomy and physiology of the entire reproductive system. The main (but not universal) symptom of endometriosis is pelvic pain in various manifestations.
Abnormalities of the thyroid gland
Abnormalities due to stress, weight loss, cushing's syndrome, ovarian or adrenal tumors, hypothalamic tumors

Control of ovulation

1) Induction of ovulation

Ovulation induction is a promising assisted reproductive technology for patients with diseases such as polycystic ovary syndrome (PCOS) and oligomenorrhea (alteration of the rhythm of the menstrual cycle). It is also used in in vitro fertilization to bring follicles before egg retrieval. Usually, ovarian stimulation is used in combination with ovulation induction to stimulate the formation of multiple oocytes.
When ovarian stimulation is complete, a low dose of human chorionic gonadotropin (HCG), a hormone typically produced by the embryo immediately after implantation in the uterus, can be injected. Ovulation will occur between 24 and 36 hours after "HCG injection.

2) Repression of ovulation

Contraception allows you to suppress the events of ovulation.
In fact, most hormonal contraceptives focus on the ovulatory phase of the menstrual cycle, because it is the most important time period for fertility. Estradiol and progesterone, taken in various forms, including the use of combined oral contraceptives, mimic the hormonal levels of the menstrual cycle and exercise negative feedback control by turning off folliculogenesis and ovulation.

Hormone therapy can therefore positively or negatively interfere with ovulation and can give a sense of cycle control and fertility for the woman.