Treatment of anovulation

If this condition is the result of improper eating habits, then in most cases it is enough to correct (reduce or increase) body weight to normalize the menstrual cycle. Sometimes, even in cases of poly- (sclero-) cystic disease, accompanied by obesity, competent dietary programs can help restore reproductive function, which returns with normalization of weight.

Women with an emotional type of temperament are prone to psychogenic anovulation and require competent psychotherapeutic assistance.

In other cases, preference is usually given to drug hormonal therapy. Such therapy is carried out only under the supervision of a doctor and after a thorough examination. The scheme, drugs and their dosage are selected individually, based on the results of diagnostics, the nature of the symptom complex and the duration of anovulation.

Hormonal treatment of anovulatory cycles

Hormonal drugs are prescribed to normalize the balance of hormones, restore ovulatory function, and stop uterine bleeding (if any).

Of course, women are interested in: how to get pregnant with anovulation? The main conservative method for a woman with ovulatory dysfunction to become a mother is ovarian stimulation. This procedure should be performed under strict medical supervision and ultrasound control. The most dangerous complication of this procedure is ovarian hyperstimulation syndrome, when the number of developing follicles is approximately twice the norm, the estrogen level increases sharply, the ovaries enlarge, the follicles turn into cysts and there is a high probability of their rupture. Symptoms of this syndrome are pain in the lower abdomen, flatulence, uterine bleeding. When signs of this condition appear, stimulation is stopped immediately. A woman can undergo the stimulation procedure no more than five or six times in her life. Repeated courses of such therapy increase the risk of developing hyperstimulation syndrome, and its consequence is early exhaustion of the ovaries and premature menopause.

Various drugs are used for stimulation. For example, Clomiphene citrate, which in small doses is a stimulator of egg maturation and its release from the ovary. However, with a thin layer of the endometrium (up to eight millimeters), preference is given to other drugs, since this drug does not promote the growth and development of its cells.

Stimulates proliferation of the endometrium Menogon, which contains gonadotropic hormones. The drug induces ovulation and promotes implantation of the fertilized egg. Puregon is a β-folliotropin, which ensures normal growth and maturation of follicles until the preovulation state is reached.

Ovarian stimulation is contraindicated in cases of neoplasms of the pelvic organs, pituitary gland and hypothalamus, mammary glands; vaginal bleeding; diseases of the thyroid gland, adrenal glands, pituitary gland, not related to the sexual sphere.

The scheme, drug and duration of stimulation are determined by the doctor. Upon reaching the preovulation state (dominant follicle not less than 18 mm), the patient is given an injection of chorionic gonadotropin. After proven ovulation, which usually occurs on the second day after the drug is administered, progesterone therapy is prescribed (injections or tablets - Utrozhestan or Duphaston). The intake continues until the confirmed onset of pregnancy or menstruation.

In general, Duphaston is a very popular drug, prescribed to almost everyone without distinction, including patients with anovulation. This is due to the widespread opinion among practicing doctors about the general deficiency of progesterone. Indeed, the role of progesterone in the successful implantation of the fertilized egg and its further development cannot be underestimated. The "pregnancy hormone" synthesized by the corpus luteum ensures its successful course, prevents the release of eggs from neighboring follicles in a given cycle and stimulates the proliferation of cells of the mucous layer of the uterus. If ovulation has definitely occurred, and the plasma concentration of progesterone is below normal, treatment with progesterone preparations allows you to maintain the pregnancy. With a single-phase cycle in case of a violation of the ovulatory function, progesterone monotherapy does not make sense.

Duphaston can be used for anovulation to stop dysfunctional uterine bleeding, during premenopause, and also in the ovarian stimulation scheme. The absence of such a side effect as ovulation suppression, which is stated in the instructions attached to Duphaston, raises doubts among adequate gynecologists. Moreover, ovulatory dysfunction is not voiced in the same indications for use from the manufacturer.

In case of absence of ovulation due to disorders of hypothalamic-pituitary function against the background of increased prolactin levels, therapy with dopamine stimulants has a good therapeutic effect, restoring the hypothalamus's control over the production of prolactin, follicle-stimulating and luteinizing hormones, and also allowing to reduce the pituitary adenoma. For example, Bromocriptine - the dopaminergic effect of the drug is based on the ability to stimulate dopamine receptors of the hypothalamus, simultaneously inhibiting the secretion of hormones of the anterior pituitary gland, in particular, prolactin. The drug itself does not disrupt the process of its synthesis. When taking Bromocriptine, blood pressure and the production of catecholamines decrease. It is contraindicated in patients who have had a recent myocardial infarction, with a tendency to spasms of peripheral vessels, arrhythmia, pathologies of the digestive organs, mental illnesses. Calms and reduces concentration, is incompatible with oral contraception, alcohol consumption, taking antidepressants from the MAO inhibitor series and drugs that depress the central nervous system. Start taking three tablets and gradually reduce to a maintenance dose - one tablet per day. The duration of treatment is determined by the doctor (the course can last more than six months). If the patient has reduced thyroid function, the drug is prescribed simultaneously with replacement therapy with thyroid hormones, for example, Levothyroxine. Dosage is individual.

In normogonadotropic anovulation, estrogen-gestagen drugs with a contraceptive mechanism of action are used, stabilizing the menstrual cycle in order to activate the function of the hypothalamic-pituitary system after their cancellation - a rebound effect (Kliogest, Divina) and antiestrogens, for example, Clomiphene citrate, which blocks the synthesis of estrogens and suppresses the proliferation of the endometrium.

In case of hypogonadotropic anovulation, medications are prescribed in the following order: Pergonal, containing equal proportions of follitropin and luteotropin, stimulates the development of ovarian follicles and proliferation of endometrial cells, increases the content of estrogens; human chorionic gonadotropin (Gonacor; Profasi; Horagon), which regulates the synthesis of progesterone, the development and maintenance of the corpus luteum. An alternative is pulse therapy with gonadotropin-releasing hormone.

Excessive production of male sex hormones is controlled by Dexamethasone, a synthetic analogue of a steroid produced by the adrenal cortex with prolonged action. It is intended for systemic use. The action is carried out through receptors of two systems in the cellular cytoplasm: gluco- and mineralocorticoid. The former regulate glucose homeostasis and inhibit the activity of proinflammatory mediators. The latter normalize the water-mineral balance. Therapy for androgenital syndrome involves taking the drug in a daily dose of 2.5 to 5 mg, divided into two or three doses.
Polycystic ovary syndrome requires consistent treatment, including a course of estrogen-gestagens, which restore the regularity and normal duration of the menstrual cycle, and also trigger the rebound effect. Then, therapy is carried out with Clomiphene citrate, which replaces the intake of follicle-stimulating hormone. The drug Metrodin, the active ingredient of which is urofolliotropin, acts as an endogenous substance, activating the development of ovarian follicles, the synthesis of estrogens, and an increase in the endometrial layer. It does not have a luteinizing effect, so if it is necessary to support this function, small doses of Pergonal or human chorionic gonadotropin are used.

If the patient has concomitant androgenital syndrome, an additional course of Dexamethasone is prescribed; if the prolactin level is excessive, dopamine stimulants are used. If inflammation of the appendages, sexually transmitted infections, etc. are detected, the appropriate means are included in the scheme; vitamins or vitamin-mineral complexes are almost always included in the prescriptions.

When anovulation is of unclear origin, the doctor may prescribe ovarian stimulation with vitamins. It is known that vitamin E deficiency inhibits follicle development, prevents maturation and release of an egg ready for fertilization at the right time. Therefore, the prescription of this vitamin in combination with vitamin B9 (folic acid) is basic for anovulatory cycles. Folic acid promotes the development of a full-fledged egg and its release from the follicle, promotes the implementation of the luteal phase after ovulation - prevents progesterone deficiency and promotes the growth of the endometrial layer.

The gynecologist may recommend taking other vitamins - A, C and D, minerals. Usually in such cases, vitamin and mineral complexes are prescribed. In combination with a complete and varied diet, a healthy lifestyle, such therapy can lead to normalization of reproductive function and natural conception.

In addition to drug and vitamin therapy, physiotherapeutic procedures are used. This may be gynecological vibration massage, mud therapy is considered effective for anovulation. The method of stimulating ovulation is endonasal electrophoresis on the hypothalamic-pituitary area, electrical stimulation of the cervix, acupuncture, helium-neon laser therapy. Sometimes physiotherapeutic effects are effective even without the use of medications, but this is possible only with minor disorders of the ovulatory cycle.

Ineffectiveness of conservative therapy serves as an indication for laparoscopic ovarian biopsy and adjustment of the treatment regimen taking into account the changes identified. Modern treatment methods are quite successful in restoring fertility during anovulation. More than half of patients with this problem restore their ovulatory cycle with conservative therapy.

In cases where therapy has proved ineffective and pregnancy has not occurred, assisted reproductive technologies can be used. The simplest is intrauterine insemination during anovulation, which involves introducing specially prepared sperm into the uterine cavity of a woman who has undergone a course of hormonal treatment.

In vitro fertilization can help women with even severe forms of anovulation to find the joy of motherhood. IVF for anovulation will become a real way to fulfill your main dream. This is a more complex procedure, which is carried out in several stages. An egg cell, already fertilized and “grown” in a test tube, previously extracted from her, is placed in the woman’s uterus, which only needs to attach to the mucous membrane.

Folk remedies

As with all painful conditions of the body, there are non-drug methods of correcting them that have come to us from the depths of centuries, and since they are still used, their positive effect should not be ruled out.

Traditional Indian treatment – yoga therapy – offers healing without taking any medicines internally. The best way out of the situation is to practice under the guidance of an experienced trainer or yoga therapist. However, it is possible to learn some poses on your own. Having started practicing regularly, basically all women notice positive changes in their well-being. A course of yoga classes is quite capable of normalizing the hormonal balance of the body, which will manifest itself in the stabilization of the menstrual cycle and the absence of other unpleasant symptoms. Moreover, it is quite compatible with taking medications, herbal, homeopathic preparations, over time the need for taking them will disappear by itself. It has long been proven that the impact on certain muscle groups affects the condition of the internal organs.

A pose that helps restore ovarian function and normalize hormonal levels Baddha Konasana (Bound Angle Pose). Ideally, to take this pose, you need to sit straight on a mat spread out on the floor, put your feet together with the soles of your feet and pull them up to the perineum, trying to put your hips on the floor. The back should be straight, shoulders relaxed, spine straight, look straight ahead, stretch the crown upward. The pose should not cause discomfort. How clearly you can perform it depends on the mobility of the hip joints. Many women, even those who are not trained, can sit in this pose without difficulty right away, while others cannot put their hips on the floor even after long training. There are options for performing this pose - leaning your back against the wall, sitting on a folded blanket, a brick-shaped stand. In this case, you can also put bolsters under your hips to ensure convenience and comfort. Fix and hold the pose for several breathing cycles (inhale-exhale for four seconds).

Then you can master the triangle pose (Trikonasana) and the hero pose (Virasana). If you practice on your own, you can find the technique on the Internet. Gradually mastering several poses and practicing for 15 minutes a day, in a month you will notice an improvement in your condition. Classes should be persistent and regular, they should be accompanied by healthy, nutritious nutrition, a positive attitude and the rejection of bad habits.

Herbal treatment of ovulatory disorders can also be very effective. Many plants contain phytohormones that resemble the action of sex hormones and restore reproductive health. Herbal preparations are free from most of the side effects of medications, however, before starting a course of herbal therapy, it is advisable to consult a specialist in this field, since medicinal herbs also have contraindications.

Perhaps the most famous plant used to treat female infertility is sage. It contains phytoestrogens that compensate for the deficiency of these female hormones and stimulate the production of their own. This plant is not used for hyperestrogenism, breast tumors, endometriosis, hypothyroidism and low blood pressure. Therefore, it is not recommended to drink sage infusion without examination. Sage has a hemostatic effect, so it must be taken according to a certain scheme. Start taking it on the third or fourth day of menstruation and take it until preovulation. Then stop taking the infusion, since the herb helps reduce progesterone levels, has a stimulating effect on the smooth muscles of the uterus and does not contribute to successful implantation of the fertilized egg after ovulation. Sage for anovulation can only be taken under ultrasound control or basal temperature measurement. If the patient's anovulatory cycles are distinct, the infusion can be taken by calculating the moment of ovulation. For example, with a short cycle of 21-22 days, sage is taken from the fourth to the ninth-eleventh day, with a 32-day cycle - from the fourth to the 16-17th day. The course of treatment with sage is three months, no more than three such courses can be taken per year. To prepare the infusion, a teaspoon of crushed dry herb is brewed with 200 ml of boiling water, after 30 minutes it is filtered and a third of a glass is drunk before three meals. Linden blossom, licorice root, yellow sweet clover, mistletoe also have an estrogen-like effect.

With increased levels of sex hormones, herbs with antihormonal activity may be useful. These are comfrey, pearl grass, and honey plant.

For hyperprolactinemia, chaste tree, raspberry, and silverweed are used, which affect the pituitary gland, stimulating the production of luteotropin and, consequently, progesterone.

The drug Cyclodinone, which can be purchased in pharmacies and without a prescription, was created on the basis of the extract of the fruits of the Abraham tree. It is intended for the treatment of hormonal disorders of the reproductive system and is used for anovulation with hyperprolactinemia. This drug can become a full-fledged replacement for dopamine receptor antagonists.

I would like to remind you once again that all herbal preparations that affect a woman's hormonal background are not harmless herbs. They should be used only after a thorough examination and consultation with a phytotherapy specialist.

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Homeopathy

Homeopathic restoration of ovulatory function can also be very successful. Constitutional remedies are used more often to treat anovulation, so the homeopath's choice can fall on any remedy from the arsenal of homeopathic medicine. Symptomatic remedies for restoring ovulatory function are Juniper Cossack (Sabina juniperus), Eupatorium purpureum, Crocus sativus, Aletris farinosa, Cornflower (Caulophyllum thalicroides) and many others. The appointment should be made by a specialist, then there is hope for a successful cure and a lasting effect.

Complex homeopathic preparations from Heel can be included in drug treatment regimens. They can be a worthy alternative to synthetic hormones.

Mulimen drops stimulate the activation of natural immunity, due to which the restoration of impaired neurohormonal functions of the female body occurs. Its pharmacological properties are determined by the action of the ingredients.

Abraham's tree (Agnus castus) - has a beneficial effect and normalizes the functioning of the pituitary-ovarian axis, in addition, it eliminates smooth muscle spasms, migraine-like pain and improves mood;

Cimicifuga – complements the antispasmodic and antidepressant action of the previous component;

Jasmine evergreen (Gelsemium) – corrects sexual development defects of adolescence;

St. John's wort (Hypericum) - relieves inflammation, regulates the central and autonomic nervous system, corrects endocrine disorders;

Stinging nettle (Urtica) – has a hemostatic effect in dysfunctional uterine hemorrhages, relieves itching and swelling in the genital area and mammary glands;

Contents of the black cuttlefish bursa (Sepia) – eliminates systemic symptoms of physical and nervous exhaustion;

Sperm whale intestine substance (Ambra grisea) – relieves symptoms of female sex hormone deficiency;

Calcium carbonicum Hahnemanni and Potassium carbonate (Kalium carbonicum) – eliminate anxiety, apathy and improve mood;

There are no contraindications or adverse effects of taking the drug; it is compatible with any medications.

Place 15-20 drops under the tongue three to five times a day 30 minutes before meals or 60 minutes later. Swallow, holding in the mouth. You can dissolve a single dose in a small amount of water (one or two tablespoons) or a daily dose in a glass, drinking evenly throughout the day.

Ginikohel drops can also be prescribed for various forms of infertility, including those caused by the absence of ovulation. Their multi-component composition has a beneficial effect on the female genital area and helps normalize reproductive processes.

Metallic palladium (Palladium metallicum) – diseases of the uterus and ovary (especially the right one), accompanied by pain and discharge;

Honey bee venom (Apis mellifica) – absence or excessive menstruation, dysfunctional uterine bleeding accompanied by pain, swelling and severe weakness;

Ammonium bromide (Ammonium bromatum) – effective for inflammation of the appendages and its complications;

Aurum jodatum – has a beneficial effect on the endocrine organs;

Venom of the Indian cobra (Naja tripudians) – diseases mainly of the left ovary, dysmenorrhea, pain, consequences of gynecological operations;

The common hornet (Vespa crabro) – ulcers and erosions of the cervix, lesions of the left ovary;

Metallic platinum (Platinum metallicum) – infertility, cysts and tumors, bleeding, vaginismus;

Yellow chamaelirium (Chamaelirium luteum) – menstrual cycle disorders, normalization of production of female sex hormones, prevents spontaneous abortion;

Tiger lily (Lilium lancifolium) – pain in the ovaries, sensation of prolapse of the genitals, depression, increased excitability, haste;

Viburnum opulus – menstrual cycle disorders, infertility, uterine pain;

Sweet clover (Melilotus officinalis) – discharge from the genitals with pain and aching sensation in the lumbar region.

The drug is prescribed to patients over 18 years of age, and is used with caution in patients with liver and thyroid pathologies, after craniocerebral injuries. Take 10 drops dissolved in half a glass of water three times a day, holding in the mouth.

When treating inflammatory gynecological diseases, to increase effectiveness, combine the treatment with Traumeel S drops, and for menstrual cycle disorders - with the homeopathic antispasmodic Spascuprel.

Alternating injections of Ovarium and Placenta compositum may be prescribed for the treatment of anovulation.

The first preparation includes two dozen components of various origins - organ, plant, mineral, as well as - catalyzing their action, aimed at regulating the hormonal status in disorders of the hypothalamic-pituitary-ovarian axis. The preparation improves nutrition and drainage of tissues of female genital organs; normalizes metabolic processes in diseases of the pelvic organs. It has a moderate calming and anti-inflammatory effect.

The second has a detoxifying, antispasmodic and vascular toning effect, has a beneficial effect on the functioning of the pituitary system, improves blood circulation and tissue respiration.

The drugs are prescribed one ampoule at a time, twice a week. The contents can be used as a drinking solution, diluted in a tablespoon of water. Swallow, holding in the mouth for a while.

Surgical treatment

Currently, laparoscopy is widely used for anovulation – a minimally invasive surgical intervention that involves a puncture or partial removal of the ovarian medulla under the control of ultrasound equipment.

This operation allows the follicles to be freed for the mature egg to exit and restores the ability to conceive. During the operation, cysts that produce excess estrogens are removed. This procedure normalizes the activity of the ovaries.

Before the operation, diagnostic curettage of the uterine cavity is performed to exclude malignization. The disadvantage of the method is the lack of a stable result. Without further treatment, the effect lasts for about six months after the operation. Laparoscopic treatment allows for more accurate diagnostics, excluding or confirming the causes of anovulation. Sometimes, by changing the treatment method, it allows for pregnancy.