What Is Anovulation?

Written by Alyson Powell Key
Medically Reviewed by Jabeen Begum, MD on June 10, 2025
6 min read

Anovulation is a common but treatable cause of infertility. It happens when an egg doesn't release from your ovary. It's also called an anovulatory cycle.

Anovulation is anything that interrupts the ovulation process. It's responsible for about 30% of fertility problems in women. It can happen to anyone with ovaries and childbearing age, which usually ranges from ages 12 to 51.

"Most women typically have menstrual cycles around every 28 days. And a woman with a 28-day menstrual cycle will typically release an egg around cycle day 14. So, anovulation is when our ovaries aren't doing this," says Katherine E. McDaniel, MD, a reproductive endocrinology and infertility specialist at HRC Fertility in California.

Anovulation often happens because of a hormone imbalance. In a typical cycle, hormones in your brain tell your body to prepare for the release of an egg. Then, your ovary releases an egg into your fallopian tubes. If the egg is fertilized 12 to 24 hours after being released, it attaches to the wall of your uterus within five days, and you start growing a baby. If fertilization doesn't happen, you shed the uterine lining during your period.

It's a complex process that involves a lot of organs, glands, and hormones. Possible causes include:

Polycystic ovarian syndrome (PCOS)

"One of the most common causes of anovulation in the United States is a condition called polycystic ovarian syndrome," McDaniel says. Some studies estimate that it causes upwards of 70% of cases, she says.

PCOS causes you to ovulate irregularly or not at all. Sometimes, PCOS is linked to high levels of testosterone, which can also cause you to have excessive hair growth and acne. 

Premature ovarian insufficiency (POI) 

This occurs when your ovaries fail before you're 40. It's sometimes called premature menopause. Some medical conditions and exposures can cause POI, but many times the cause is unexplained. About 5%-10% of women with POI conceive naturally and have a normal pregnancy. 

Hypothalamus or pituitary gland dysfunction 

These glands produce hormones responsible for ovulation. Anything that affects the normal function of these glands, such as a benign pituitary gland tumor, can cause anovulation.

Diminished ovarian reserve (DOR) 

At birth, you have all of the eggs you'll ever produce. It's normal for your egg supply to decrease over time. Women with DOR have fewer eggs remaining than normal. This can have medical, surgical, or congenital (present at birth) causes, or it can be unexplained. Women with DOR produce fewer eggs with fertility treatments, but you may still be able to conceive naturally.

Functional hypothalamic amenorrhea (FHA)

This condition can be caused by stress, excessive exercise, or low body weight. It's sometimes linked to anorexia, an eating disorder. 

Perimenopause and anovulation

This is when you begin to transition to menopause. Your estrogen levels start to drop, and you may have symptoms of menopause. During perimenopause, your doctor may have trouble treating anovulation because of a natural change in your hormones.

Menopause and anovulation

This is a naturally occurring decline in ovarian function that happens around age 50. Menopause is defined as not having had a period for one year. You may experience other symptoms as well, such as hot flashes, difficulty sleeping, and mood changes.

Anovulation after miscarriage

Anovulation can happen after miscarriage, or the loss of a pregnancy in the first 23 weeks. But you'll likely start ovulating again in a month or two, or sooner if you had a miscarriage during your first trimester (12 weeks) of pregnancy.

Can you have a period without ovulating?

Yes. When you don't ovulate, there's no egg to fertilize. But you can still have a period without ovulating. This is called abnormal uterine bleeding (AUB) or anovulatory bleeding.

Other anovulation symptoms

These include: 

  • Not having periods
  • Not having cervical mucus
  • Excessive bleeding during periods
  • Light bleeding during periods
  • Irregular basal body temperature (BBT)

Your doctor will listen to your symptoms and medical history and give you a physical exam. They may also do tests and imaging studies, including:

Depending on the results of your exam, other tests may be needed, such as examining the lining of your uterus.

Treatment for anovulation depends on the cause. Lifestyle modifications may be enough. But you might need medical treatment or even surgery. 

Lifestyle changes. Diet and exercise changes can be helpful when your anovulation is caused by a high or low body mass index (BMI). In either case, nutritional counseling may help. When your anovulation is caused by too much exercise, you may benefit from exercising less. When you have a high BMI, it may help to exercise more. If stress is causing your anovulation, stress management and relaxation techniques may help. 

Medicines. Ovulation induction involves using fertility medicines to treat anovulation. This can help when you're ovulating to raise your chances of pregnancy. Most pregnancies occur within three cycles of this treatment. Commonly prescribed medications include:

  • Clomiphene citrate. Approximately 80% of women who take this medicine will ovulate, and approximately 40% will become pregnant. 
  • Human chorionic gonadotropin (hCG). This is often added to clomiphene citrate or follicle-stimulating hormone treatments. hCG causes your ovary to release an egg and helps time inseminations. It causes false positives in pregnancy tests. 
  • Follicle-stimulating hormone (FSH). It may be used when you don't make your own FSH or you don't get pregnant on clomiphene citrate. It can also be used if you do ovulate to raise your chances of pregnancy.
  • GnRH agonists and antagonists. These synthetic hormones are used to control the release of luteinizing hormone (LH). This prevents the spontaneous release of an egg during fertility treatments. 

Surgery. If you have PCOS that doesn't respond to other treatments, your doctor may do a procedure called ovarian drilling. This is a rare, minimally invasive procedure that is done laparoscopically. That means it's done with small incisions with the aid of a tiny camera. Ovarian drilling works by making small holes in your ovaries. This reduces the amount of testosterone your ovaries produce. Lowering the amount of testosterone can help your ovaries produce an egg every month and start regular menstrual cycles.

  • Anovulation is when you don't ovulate or release an egg. 
  • The condition causes about 30% of fertility problems in women.
  • Causes of anovulation include PCOS, perimenopause, menopause, and miscarriage.
  • Treatment depends on the cause and may include lifestyle changes, medicine, or surgery.

How do you know if you're anovulatory?

Symptoms include changes to your period (not having one, heavy bleeding, or light bleeding), changes to your basal body temperature, and not having cervical mucus. Your doctor will do a physical exam and may also do tests to make an accurate diagnosis.

What is the cure for anovulation?

Treatment depends on what's causing the condition. You may need to make changes to your diet and exercise habits, take medicine to trigger ovulation, or have surgery to lower the amount of testosterone your ovaries make.

How to fix anovulation naturally

Managing your stress, keeping a healthy weight, and doing moderate exercise are nonmedical ways to help treat anovulation.

Can I get pregnant with anovulation?

Yes. With treatment for anovulation, you may be able to get pregnant. But remember that other factors also play a part in a healthy pregnancy.

Can stress cause anovulation?

Yes. Stress can disrupt your balance of hormones needed for ovulation. Those hormones include gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH).