Can You Get a Period If You're Not Ovulating?

A common cause of infertility in people with ovaries is a problem with the body's ability to ovulate, or release an egg from the ovary. Menstruating people typically need to ovulate to have a period, but in some rare cases, it's possible to not ovulate but still have a period or breakthrough bleeding. Or, you might ovulate sporadically instead of every month, which would cause irregular cycles.

Either way, if you're not ovulating but still have a period, you may have difficulty getting pregnant, along with other symptoms like hormone disruptions, weight gain, or changes in your sleep patterns.

Here's a closer look at what might be going on if you're not ovulating. That said, always talk to a doctor if you experience any new and lasting changes to your menstrual cycle.

How Is Ovulation Tied to Fertility?

Ovulation must occur for pregnancy to be achieved naturally. If you're not ovulating at all, it's called anovulation or absent ovulation. When ovulation is irregular (but not completely absent), it's called oligo-ovulation. Both anovulation and oligo-ovulation are types of ovulatory dysfunction, which is a common cause of female infertility.

When a person doesn't ovulate, they can't get pregnant because there's no egg to be fertilized. If a person has irregular ovulation, they may have fewer chances to conceive because they ovulate less frequently. Additionally, because ovulation is controlled by hormones, irregular ovulation usually means that hormone levels will be abnormal, too.

Symptoms of Ovulation Dysfunction

People with anovulation usually have irregular periods—and some don't experience a period at all, which is known as amenorrhea.

If your cycles fall within the normal range of 21 to 36 days, but the length of your cycles varies widely from month to month, that could also be a sign of ovulatory dysfunction. Additionally, cycles that are shorter than 21 days or longer than 36 days are also potential symptoms of ovulation dysfunction.

Why Am I Not Ovulating But Still Having a Period?

It's possible to get your period on a normal schedule and still not ovulate, although it isn't common. During the first phase of the menstrual cycle, estrogen in the body increases, sending two signals: One to tell the follicle to begin producing an egg and another to tell the uterus to begin preparing an environment for that egg to implant if it's fertilized.

Even if the egg is never produced or released, the uterus still produces the lining intended to support an embryo after implantation. When estrogen levels drop, if there is no coinciding increase in progesterone, the uterus sheds its lining. This is what we typically think of as a period or menstrual bleeding.

Typically, you won't have menstrual bleeding without ovulating first, but some people may experience some form of vaginal bleeding even without ovulation occurring.

Causes of Anovulation

The most common cause of ovulatory dysfunction is polycystic ovary syndrome (PCOS). However, here are some other potential causes:

• Extreme exercise
• Extremely high-stress levels
• Hyperprolactinemia
• Low body weight
• High body weight and obesity
• Perimenopause or low ovarian reserves
• Premature ovarian failure
• Thyroid dysfunction

How Do I Know If I'm Not Ovulating?

If you're still having a period, it can be difficult to tell if you're not ovulating. You should schedule an appointment with a health care provider if you notice a new and lasting change in your menstrual cycle, if your periods are absent or irregular, or if you're trying to get pregnant.

Your doctor may run tests such as:

• Blood tests to check your hormone levels
• Ultrasound imaging of your uterus and ovaries

Ultrasounds can also be used to track follicle development and ovulation, though it's not commonly done. If a health care provider decides to go this route, you might need to have several ultrasounds done over a one- or two-week period.

How To Treat Ovulation Dysfunction

The treatment for anovulation will depend on the underlying cause and your goals. Some treatments may also be used together.

Lifestyle changes

Some cases of anovulation can be treated with changes to your lifestyle or diet. For example, if low body weight or extreme exercise is causing you not to ovulate, gaining weight or easing up on your workout routine might be enough to restart ovulation.

The same is true if you have excess body weight. If you have more body fat, weight loss might be enough to restart ovulation. Talk to a health care provider before making any distinct changes to your lifestyle.

Medication

In other cases, medication may be an appropriate treatment route. The most common treatment for anovulation is fertility drugs. Clomid (clomiphene) is the first fertility drug that's usually tried. If Clomid doesn't work, your health care provider might recommend other fertility treatments.

If you have PCOS, on the other hand, insulin-sensitizing drugs like metformin might help you start ovulating again. However, six months of treatment is required before you'll know if the metformin will work.

Your doctor might also recommend taking fertility drugs combined with metformin. The combination has been shown to increase the chance of success in people who did not ovulate using fertility drugs alone. For people who have PCOS, the cancer drug letrozole (Femara) might be successful at triggering ovulation.

If you're not trying to get pregnant, hormonal birth control might be recommended to help reduce any bothersome symptoms you may be having.

Assisted reproductive technology

Fertility drugs are less likely to work when the cause of anovulation is premature ovarian failure or low ovarian reserves. Having one or both of these conditions doesn't mean you won't be able to conceive with your own eggs, but some people will need in-vitro fertilization (IVF) treatment with an egg donor.