The importance of ovulation goes beyond fertility, and this article will focus on the other benefits of ovulation. Not everyone who ovulates wishes to become pregnant, but may not know that ovulation plays other important roles in the body. Ovulation refers to the release of an egg from an ovary, where it can travel to the uterus, potentially be fertilized by a sperm and result in pregnancy. This occurs approximately midway through a menstrual cycle, and is associated with some physical signs as well as hormonal shifts. In fact, understanding whether or not you are ovulating each month is more useful than only monitoring menstruation, because sometimes people can have regular menstrual cycles without ovulating.[1] 

There are a variety of reasons why someone might not be ovulating (anovulation). In my naturopathic practice, the most common reasons are: high stress, nutritional imbalances, thyroid conditions, and polycystic ovary syndrome (PCOS). With that said, ovulation does not occur during pregnancy or menopause, may stop during breastfeeding, and is prevented by certain contraceptives, and all of that would be considered normal. Ovulation is prevented by the following contraceptives: birth control pill, ring, patch, shot, and emergency contraceptive pills.  It is also important to note that hormonal intrauterine devices (IUD) can prevent ovulation in some people. Anovulation is a concern that needs to be discussed with a healthcare provider, and appropriate lab testing will need to be completed in order to determine why ovulation is not occurring. 

There are a number of ways to determine whether or not you have ovulated, including tracking your menstrual cycle, basal body temperature charting, monitoring cervical fluid, using ovulation predictor kits (OPK) and measuring blood progesterone levels during the second half of the menstrual cycle (luteal phase). A typical menstrual cycle is between 25 and 35 days, therefore, an irregular menstrual cycle, or one that is shorter or longer could indicate a lack of ovulation. Basal body temperature refers to your temperature first thing in the morning, before any physical activities or food. Following ovulation, progesterone levels begin to rise. Progesterone raises body temperature, so if you are tracking your basal body temperature daily, you will notice the approximately 0.5 F rise throughout the luteal phase that indicates ovulation occurred. Often, these methods work well together, along with monitoring for changes in cervical fluid. Prior to ovulation, cervical fluid will have specific characteristics, and will appear clear, slippery, and stretchy. It is often described as having an egg-white consistency.[2] OPK’s measure a hormone known as luteinizing hormone (LH) in the urine, which surges 10-12 hours prior to ovulation. After a few days of monitoring LH in the urine, it will be obvious when LH surges, and will indicate that ovulation is going to occur. Finally, measuring blood progesterone during the luteal phase is another way to know whether you have ovulated, as progesterone rises as a direct result of ovulation occurring. The blood sample will need to be taken around cycle day 18-24, or approximately 7 days prior to the next period.[3]

As we have now seen, ovulation is necessary for progesterone production. Therefore, if ovulation does not occur, progesterone levels will be lower during the luteal phase. This has negative effects on uterine health, because progesterone is needed to balance estrogen, which builds the uterine lining (endometrium). Without progesterone, estrogen works unopposed and the endometrium will continue to grow until it sloughs and menstrual bleeding occurs irregularly and possibly heavily. Progesterone is important for other reasons too. One study showed that bone mineral density was lower in women with anovulatory menstrual cycles compared to those who ovulated more regularly, putting them at an increased risk of osteoporosis.[4] It is thought that this is due to the role that progesterone plays in bone health. In addition, long-term anovulation is associated with an increased risk for diabetes, heart disease, hypertension, endometrial hyperplasia (excessive build-up of uterine lining), and infertility. It is important to note that these risks will vary due to the underlying cause of anovulation. Learning how to tell whether or not you are ovulating is a powerful tool, because you will gain insight about possible hormone imbalance, and will be able to advocate for appropriate testing and proactive care. Whether or not fertility is a concern, ovulation is important for uterine health, bone health, and cardiovascular health. In addition, long-term anovulation often signals an underlying health concern, like PCOS, which should be diagnosed and managed.

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References:

[1] Prior J. et al. (2015) Ovulation prevalence in women with spontaneous normal length menstrual cycles – a population based cohort from HUNT3 Norway. PLoS ONE. 10(8): e0134473.

[2] Druet A. (2019) Types of vaginal discharge and how to tell them apart during your cycle. Clue.

[3] Welt C. et al (2019) Evaluation of the menstrual cycle and timing of ovulation. UpToDate.

[4] Danni L. et al (2014) Negative spinal bone mineral density changes and subclinical ovulatory disturbances – prospective data in healthy premenopausal women with regular menstrual cycles. Epidemiologic Reviews 36(1): 137-147.