Lecture cycle without ovulation

2021-03-18 12:00 AM

The period without ovulation is common during puberty and perimenopause. At puberty, the hypothalamus does not fully secrete Gn-RH, so the pituitary gland secretes insufficient FSH

General perception

The menstrual cycle without the ovule is also known as the one-stage menstrual cycle. During menstruation, it used to be called pseudomen striation because according to old conception, menstruation must be caused by sloughing off a secretory quadrilateral mucosa, meaning the effect of progesterone of the luteum phase. after ovulation. But today it is more widely conceived: Any plasma out of the uterus caused by rupture of the uterine lining under the influence of a drop in female sex hormones is considered menstruation.

The length of the non-oocyte menstrual cycle may be normal, but is usually shorter, 23-25 ​​days. Not only do menstrual cycles do not ovulate, but even terrifying ones with poor posture are also easier to shorten than normal. It is due to the hormones of the ovaries because the corpus luteum does not function well, so it falls more rapidly than normal.

The period without ovulation is common during puberty and perimenopause. At puberty, the hypothalamus does not fully secrete Gn-RH, so the pituitary gland does not secrete FSH inadequately, causing the follicle to not ripen, not enough LH to make follicles (though mature) do not release. As for the premenopausal age, the ovaries are no longer sensitive enough to respond properly to the hormones of the pituitary gland, so the follicle is not ripe and does not release, although LH may remain high. After a miscarriage, the first few periods may then fail to release.

The non-oocyte phenomenon may be functional, but it may in rare cases have physical damage such as pituitary adenoma, Stein - Lcvcnthal (polycystic ovary) syndrome.

Diagnosis of ovulatory failure

Mainly based on exploratory tests. Clinically there is no characteristic distinguishing between oocyte and non-oocyte, although it has long been observed that non-ovulatory cycles end with menstrual periods without colic, as there are many. have ovule without colic. On the contrary, tests and exploration have an important and decisive role in diagnosis.

Test of the cervix

In terms of cervical openness, mucus volume, clarity, dilution, spinning, and leaf-shaped crystallinity. Follow-up if you see that after reaching the maximum and then falling down quickly after a few days, there is oocyte release on the maximum day. If it is slow down and counted from the date of maximum to menstrual period not 10 days, there will be no oocyte or no oocyte but weak imperial position.

Do endocrine vaginal cytology

Monitoring the Eosinophil index and the Eosinophilic index found that without maximum peak, there is no oocyte.

Base heat measurement

In the early mornings before going to bed on time - Take the temperature from the anus or mouth, not from the armpits. If the temperature is lower than 37 ° C, there is no ovulation because the absence of pregnanediol, a metabolite of progesterone, causes an increase in body temperature.

Determination of LH: in the middle of the cycle, there is no peak. Determination of plasma progesterone at week 3 of the menstrual cycle (1 week before menstruation) showed no increase in the absence of oocyte ejaculation. It is possible to quantify pregnanediol in the 24-hour urine, also with no increase.

Laparoscopy

In the second half of the menstrual cycle there is no corpus luteum or scarring of the corpus luteum.

Follow up by ultrasound if you see that the follicle is growing bigger and then distorted, and if it is smaller, the oocyte is released. If not, don't try to ovulate.

Biopsy of the quadrilateral mucosa

At the end of the 3rd week of the cycle (1 week before the expected period), if the uterine lining is not visible, there is no ovulation.

In general, all of the aforementioned exploration methods are only trying to have retrospective properties, which means that they can only be detected after ovulation, in the presence of the luteum and the hormones of the corpus luteum. Particularly, cervical testing is a bit predictive and useful in the treatment of infertility. Indeed, when the signs of the cervix are developing at a high level, that is, the appearance of a maturing follicle, about to release an oocyte, specific steps can be indicated such as advising intercourse, artificial insemination. ...

Treatment

The menstrual cycle without ovulation is actually only for the treatment of infertility. Sometimes there is the purpose of treating menorrhagia with the idea that menorrhagia is due to the absence of progesterone, a result of no ovulation. For irregular menstrual cycles, without ovulation, oral contraceptives can be given for 3 - 6 months. After discontinuation of the drug there is a possible jump effect, the hypothalamus increases Gn - RH secretion and oocyte release may occur.

Based on the mechanism of lower position disputes for estrogen, one can use clomifen citrate, a chemical with mild anti-estrogen effect, to create feed - back positif, stimulating the hypothalamus. increase secretion of Gn - RH, leading to oocysts. For oral administration of clomifen citrate 50mg x 1-2 capsules / day, for 5-10 days, starting from the 3rd or 5th day of the menstrual cycle. In the past, people used to appoint from day 5 of the menstrual cycle, 2 tablets per day for 5 days. Currently, people tend to give medications from day 3 of the period.

Ovulation usually occurs on day 14 of the menstrual cycle. But sometimes later.

If, after monitoring, the follicle develops (through ultrasound, the follicle has a diameter of over 18 mm for example), hCG can be injected with 6000 to 10,000 units intramuscularly. There will be oocyte release within 12 - 24 hours after injection, in fact, rarely only LH without FSH deficiency, so stimulating oocyte alone with hCC (similar effect with LH) has little results. Sometimes people have to stimulate the follicle to develop first with FSH (the brand name Human Menopausal Gonadotropin) and then stimulate the oocyte release with the following hCG (the hCG brand name contains choriogonin, Pregnyl ...). Can combine for clomifen citrate and hCG. Add clomifen citrate first as usual. Towards the expected ejection date, add hCG at the same dose as mentioned above.

It is possible to combine the use of auxiliary methods. These are measures that do not directly apply to oocyte, but only provide additional help. Examples include reducing stress in life, changing living conditions, working situation, residence, hot bath, hot spring water, shortwave, vitamins A, E, etc.