As you know, women and men have different missions on our planet. So, the main purpose of the fair sex is to produce offspring. Sometimes it seems to couples that there are no obstacles to pregnancy, because a woman's menstruation goes regularly, and the sexual partner is completely healthy. However, despite this, the desired pregnancy does not occur. A woman thinks that there is absolutely no reason to seek help from a gynecologist, because it’s just that the time has not come for the onset of pregnancy, sooner or later it will happen. The main thing is to try. But in fact, the picture can be much more sad. For example, the fair sex has critical days without ovulation. This problem is very serious and can be a significant obstacle to the onset of conception.
In this article we will talk about whether there can be menstrual periods without ovulation, whether this is considered to be the norm or pathology, and also find out what gynecologists think about this. Carefully read the information provided in order to secure and arm yourself as much as possible.
What is ovulation
Before answering the question whether there can be menstrual periods without ovulation, it is worth figuring out what the process is. Ovulation is the process of release of a mature egg from the ovary. In addition, each menstrual cycle is allocated, as a rule, only one egg approximately on the fourteenth day of the twenty-eight-day cycle. At the same time, the process of ovulation lasts about a day, and it is at this time that a woman has the greatest chance of becoming pregnant. However, fairly large chances for conception also exist several days before ovulation, and for several days after it.
How to understand that ovulation has come
During this period, almost all the fair sex notice that they have greatly improved mood and there is a strong sexual desire. The woman even changes her appearance: her skin condition is normal, her eyes are glowing, and happiness just radiates. Thus, the fair sex becomes attractive to men.
During menstruation, a dead egg is released from the body, provided that fertilization has not been performed.
Can there be monthly without ovulation: possible physiological reasons
In fact, there are a large number of reasons why a woman does not have ovulation. Scientists classify them as physiological and pathological. First, consider the natural factors.
- The onset of puberty. Most often, the first couple years after the onset of puberty, a young girl cannot yet become pregnant, since the formation of the sexual organs is not yet complete. In this case, the risk of pregnancy is minimal, but it is not excluded.
- Also, physiological signs should include pregnancy and lactation. At this time, ovulation does not occur.
- It does not occur at the onset of menopause.
Many women are interested in the question whether there can be menstrual periods without ovulation after the use of hormonal contraceptives. According to gynecologists, oral contraceptives have a significant impact on the hormonal system of a woman, so ovulation may not occur within a few months after stopping the use of hormonal drugs.
If ovulation does not occur a couple of times a year for natural reasons, then this is not considered a pathology. This is typical of every woman of reproductive age.
The presence of pathological causes
Are there any periods without ovulation? Even as they are. And most often this happens precisely in the presence of pathological causes. Consider what should be attributed here.
The woman is very abruptly dropped or gained weight. Both the first and the second phenomenon leads to serious disruptions in the hormonal system of the body.
Lack of ovulation can occur if a woman has serious problems with thyroid hormones or adrenal glands.
Also, in no case should not exclude malfunctions in the brain system. Head injuries, abnormal blood circulation, or the presence of benign or malignant tumors can lead to disruptions of the menstrual cycle.
The presence of diseases of the female genital organs. Polycystic ovary is considered the most common of these. In the presence of such a pathology, a woman is very hard to get pregnant, because not only the structural components of the female genital glands will change, but also the functions that they perform.
Can there be menstrual periods without ovulation in women who are professionally involved in sports? This phenomenon is quite possible, since excessive physical activity contributes to a significant reduction in the production of female sex hormones, which take an active part in the maturation of eggs.
In no case can not exclude stressful states. Serious problems at work, quarrels in the family, parting with a loved one and many other factors can lead to severe and prolonged depression, which is extremely negative for the female genital organs.
The presence of inflammation and infection of the internal genital organs is one of the most common reasons for the lack of ovulation.
It is also not necessary to exclude the use of drugs that are directly related to the violation of the secretion of female hormones responsible for the ovulation process.
In very rare cases, there is such a phenomenon as a malformation of the ovaries. It is possible to cure such a pathology, but the treatment process will be difficult and take a long time.
Menstruation without ovulation: symptoms
Of course, the exact presence or absence of ovulation can only be determined by contacting a gynecologist for help. However, there are a number of signs by which you can make a diagnosis yourself. Consider the main symptoms of menstruation without ovulation.
The occurrence of excessive acne, obesity, and excessive growth of facial hair according to the male type - such signs are the main evidence that a woman does not have ovulation due to polycystic ovary or if there are serious problems with the adrenal glands.
The occurrence of mastopathy. This pathology arises due to the fact that a woman's impaired production of female sex hormones.
Are monthly periods possible without ovulation? Any gynecologist will tell you that they are possible, and this phenomenon is very frequent.
The absence of ovulation may indicate a very long period. Sometimes there are uterine bleeding, which the representative of the fair sex may mistaken for menstruation.
And, of course, the couple have serious problems with the ability to conceive a child. In the absence of an ovulation process, this is simply not possible.
If you find yourself in at least one of the above signs of menstruation without ovulation, in any case, do not delay a visit to the gynecologist. The sooner you do this, the more likely it is that you can solve your problem quickly. In order to make an accurate diagnosis, the doctor will ask the patient questions about her condition, as well as conduct research and prescribe the delivery of the necessary tests. If necessary, basal body temperature will also be measured.
There is a special test to determine the presence of ovulation. It can be done at home. This test has the form of paper strips, which are coated with a special reagent capable of reacting to the presence of luteinizing hormone in the urine. If its amount in the urine is increased, then it means that ovulation is taking place in your body at the moment. In order to conduct such a test, you need to lower the strip into a container with urine or substitute it under a stream of urine.
When to do such a test
In order for this test to show the most accurate results, you need to calculate the length of your cycle, namely the number of days from the first day of the beginning of the month to the first day of the next month. Doctors recommend doing the test daily from the eleventh day of the cycle. In this way, you can determine which day you have ovulation, if any.
For the test do not take the morning urine, as it will contain a small amount of the necessary hormone. Every day, do the test at the same time of day. The use of this test is not much different from the same to determine pregnancy. Pay attention to the stripes. You may need about thirty minutes to figure out the exact result. So do not hope that you will find out the results within the first minute.
If you saw two strips, it means that ovulation will occur within twenty-four to forty-two hours. One bar indicates that the result is negative. So the test must be done the next day.
Features of treatment
We have already answered the question whether monthly periods are possible without ovulation. Now it is necessary to figure out how to treat this phenomenon. Before prescribing treatment, it is very important to clarify the cause of the disease. Consider, it will not work on your own, so be sure to consult a gynecologist. In some cases, a woman, in order to restore her menstrual cycle, needs to simply revise her diet and lifestyle. If the representative of the weaker sex is obese, then even a slight weight loss can lead to positive changes.
Many women are worried about the fact that the cycle without ovulation. When to wait for menstruation in this case? The body of each of the fair sex individual. At someone they will come in due time, at someone with failures. The main thing is not to delay the visit to the doctor and start treatment in a timely manner. If the problem lies in the work of the thyroid gland, then special hormonal preparations will be prescribed to the patient.
If the body has an excessively elevated prolactin level, then it is very important to prescribe medications that will help reduce it.
The use of drugs
In this article, we answered the question whether monthly periods can go without ovulation. If it is impossible to influence the cause that caused such a phenomenon, then it is necessary to take medications that will artificially stimulate the process of ovulation.
Consider the most commonly prescribed drugs by gynecologists:
- "Menogon" is a very effective drug, causes an increase in the level of estrogen in the blood, stimulates the maturation of the egg.
- Duphaston is also a very effective remedy widely used against infertility and the lack of ovulation. The main advantage of this tool is the complete absence of androgenic side effects.
- "Utrozhestan." It is recommended by doctors as an effective drug that has natural progesterone.
Consider, all listed medicines can be accepted only under the strict recommendation of the doctor. Otherwise, they may cause irreparable harm to your health.
In fact, it is not always so easy to understand that there is no ovulation. Most often it comes to this, if a woman can not get pregnant. Gynecologists strongly recommend monitoring the state of the menstrual cycle, with deviations urgently sent to the hospital. If you cannot get pregnant, be sure to contact the family planning center for a complete diagnosis.
On the question of whether ovulation can occur without menstruation, the answer is yes. According to the patients, this phenomenon is usually accompanied by various symptoms, such as hormonal disorders, general deterioration of health and, of course, the lack of possibility of pregnancy. Reviews of menstrual periods without ovulation indicate that modern medicine creates for the fair sex all the conditions for the occurrence of a desired pregnancy.
Do not ignore the state of their women's health. Even if you do not have ovulation, you still have every chance of becoming a mother. The main thing is to go to the hospital and come to grips with your health. Take care and be healthy!
The menstrual cycle and its features
In the body of a woman who has reached reproductive age, changes periodically occur, which prepare her for a possible conception. This is the menstrual cycle. It consists of 3 interconnected phases and lasts about 21-35 days.
The beginning of the cycle is considered the first day of menstruation, when bloody discharge comes out of the genital tract. In this phase, the pituitary gland produces follicle-stimulating hormone, which is responsible for the maturation in the ovaries of the female germ cells. A dominant follicle forms where the egg cell develops.
The action of estrogen leads to the fact that the endometrial blood is intensively supplied with nutrients. The body prepares the woman for a possible pregnancy.
In the second phase ovulation occurs. Only the dominant follicle synthesizing estradiol develops, and the rest will undergo involution. Formed luteinizing hormone, the final maturation of the egg. The substance promotes the production of enzymes and other hormones that ensure the rupture of the follicle, from which the female germ cell emerges.
In the next phase, the corpus luteum is formed. The egg cell moves to the uterine cavity through the fallopian tube, and the follicle itself produces a pregnancy hormone, progesterone. It is necessary to prepare the endometrium for conception.
If fertilization does not occur, the follicle shrinks, causing a sharp decrease in the hormone levels in the blood. This leads to detachment of the internal uterine lining. The mucous layer leaves the genital tract in the form of bloody discharge.
If a woman in the follicles of the egg does not mature, or they can not pass through the fallopian tubes, there is a disorder of reproductive function, called anovulation.
The simplest method by which the development of the female reproductive cell is calculated by an ordinary calendar. The girl will have to mark the start and end of her monthly period there for six months.
It is necessary to calculate the number of days between the first days of the cycle in 2 months in a row. From the obtained value, subtract 14 and get the day of ovulation. For example, if the cycle is 28 days, then on the 14th day the ripe egg cell leaves the follicle.
The method is good for women with a regular menstrual cycle. Otherwise, there is a high risk of incorrect calculation: it is difficult to predict the number of days, if in 1 month it is equal to 26 days, and the next - 34.
When a girl does not want to make calculations, you can use the online calculator by requesting it in a search engine. He will quickly indicate the covenant day.
A device for determining ovulation is purchased at the pharmacy. The principle of action is designed to respond to the increased content of luteinizing hormone in the urine. The concentration of the substance begins to increase 1-2 days before the egg leaves the follicle, so the tests are used several days before the expected ovulation.
For research you need to follow some rules:
- You can not use the morning portion of urine. It is better to collect urine from 10 to 20 hours.
- Do not drink the liquid within 4 hours before testing.
- Two hours before the analysis, refrain from going to the toilet.
- Before examining carefully read the instructions.
With proper test execution, the method is fairly accurate.
Determination of basal temperature
Temperature measurement is done in the rectum in the morning immediately after waking up. In the days of the release of the egg from the follicle, it is increased compared with ordinary days. Outside of ovulation, it is 36.6-36.9 degrees, and on the coveted day - 37 degrees. To record the fluctuations of values, a calendar is compiled, with which the maturation of the female germ cell can be predicted.
The method accurately shows ovulation in girls with a regular menstrual cycle. If the woman he jumps, instead of measuring the basal temperature is to use another method.
The rise in basal temperature is possible with inflammatory diseases, short sleep, taking alcohol or medicines. It is necessary to take into account all the features.
This is the most accurate definition of ovulation. The gynecologist examines a woman in a special chair, where he observes a change in the cervix: it softens and opens slightly.
Additionally, ultrasound diagnostics are performed. In the course of it it turns out the fact of the onset of ovulation and its stage. Ultrasound carried out with 10 days of the menstrual cycle. In order for the doctor to track the growth of the dominant follicle, the girl needs to come to the study more than once. When a ripe egg leaves the ovary, the resulting yellow body can be seen on the monitor.
Medical diagnosis is resorted to when a woman has had several unsuccessful attempts to conceive a child for a long time.
Can there be monthly without ovulation
Anovulation is characterized by a complete absence of bleeding (amenorrhea) or oligomenorrhea (scanty discharge lasting up to 2 days).
Will there be monthly during anovulation? Yes, this phenomenon happens. Sometimes menstruation does not give cause for alarm, coming with normal intensity, and during pregnancy planning a woman learns about the pathology.
The bleeding depends on the thickness of the inner lining of the uterus, on the growth of which estradiol acts. If conception did not occur, the endometrium should be rejected during menstruation. When the hormone is not enough, the functional uterine layer does not have the required thickness, which leads to a weakening or absence of bleeding.
Why is this happening - possible causes
It happens that women who do not have health problems, monthly go without ovulation. This is rare and does not pose a threat to childbirth.
Natural factors of the anovulatory cycle:
- first menstruation in adolescents
- abrupt change of residence,
- age approaching climax,
- lactation period during breastfeeding: gv suppresses the maturation of the egg.
- ovarian work disorder,
- endocrine gland dysfunction - thyroid, pituitary, hypothalamus and adrenal glands,
- poor nutrition and strict diets
- excessive exercise
- inflammation in the reproductive organs,
- nerve strain.
To restore ovulation and establish a cycle, it is necessary to cure these violations.
Can conception occur in the absence of menstruation
The onset of amenorrhea means that the egg has not matured and has not left the follicle. So, wait for fertilization is not worth it. This is not entirely true.
In case of violation, getting pregnant is problematic. However, the pathological condition may suddenly be replaced by unplanned ovulation, and unprotected sexual contact will result in unplanned conception.
When to see a doctor
If amenorrhea persists for more than 3 months or there are long-term monthly delays, immediately consult a gynecologist to find out the reasons. A broken cycle often means a pathological condition.
Probably, the doctor will prescribe gestagens (Utrozhestan, Duphaston), with which the symptoms of anovulation pass and the cycle normalizes. Prolonged absence of menstruation often leads to infertility.
It is not necessary to exclude the unplanned conception: the bleeding will not come because of the pregnancy. Then the doctor will find out whether the fertilized egg was fixed correctly and put on record.
If you want to get pregnant, but have already experienced several unsuccessful attempts, you should go to the doctor. Perhaps it is normogonadotropic anovulatory infertility that prevents conceiving a baby. Pathology will be eliminated only after therapy.
Do not treat ailment at home. The forums have reviews of women on the restoration of ovulation folk remedies. Such methods of treatment are appropriate only after consultation with the gynecologist.
How to determine the day of ovulation - expert commentary in this video:
"width =" 660 "height =" 370 "allowfullscreen =" allowfullscreen ">
To protect yourself from adverse effects, you need to carefully treat your own health and treat diseases in time.
If the monthly did not go on time or there were other irregularities in the menstrual cycle, consult a gynecologist. So you do not miss the early stages of disease. Remember that chronic anovulation is fraught with serious problems with both health and childbirth.
The causes of irregular menstruation may be several:
- Physiological - if a woman had a miscarriage or she had an abortion, such a phenomenon is quite normal for her. After birth, the risk of this pathology exists, but usually the cycle returns to normal on its own.
- Pathological - cysts, tumors, endometrial polyps, endometriosis, and fibroids lead to malfunctions. Iatrogenic disorders are also attributed to pathological causes. If you choose hormonal contraceptives incorrectly or take them too long, the cycle can be broken.
Is it possible to ovulate without menstruation? The reasons for this phenomenon
Periods of ovulation without menstruation are quite possible. They can be caused by different reasons.:
- Lactation - as a rule, unplanned pregnancy in the absence of menstruation occurs during lactation. If the child is exclusively breastfed, estrogen production is inhibited, the eggs do not mature, ovulation is absent. When the newborn begins to receive complementary foods, milk production is reduced, estrogens begin to stand out in larger quantities. This leads to the maturation of the egg and contributes to conception. In the absence of fertilization, when a dead cell comes out, scanty pale pink color may appear. After a while, ovulations become regular, although menstruation may not yet be present.
- Irregular menstruation begins at different times, sometimes they do not exist at all for several cycles, but ovulation occurs anyway. This picture is typical for the first years of menopause and menopause.
- Ovarian dysfunction - usually a problem associated with thyroid disease and the presence of endocrine disruptions.
- Gynecological diseases - cervical oncology, uterine myoma, inflammation of the ovaries.
- Polycystic ovarian - these women usually have excess weight, skin and hair become oily, small antennae appear on the upper lip, indicating an excess of testosterone. It is because of this hormone cycle is broken, and infertility occurs.
- Weight problems - underweight or obesity is dangerous because it leads to a cycle failure. As a rule, ovulation is preserved. As soon as the weight returns to normal, the problem disappears.
Occasional periods absent with poor nutrition, significant loads, mental injuries, long-term treatment with hormonal drugs.
How to determine ovulation?
With irregular menstruation, it is possible to determine ovulation in several ways:
- Blood test for progesterone - it is done several times a month.
- Ovulation test - it resembles a test that allows you to determine pregnancy. About the onset of ovulation indicate two strips.
- Basal temperature measurement is an accurate method, but it is not convenient for everyone. The temperature should be measured daily for three cycles in the morning, lying in bed.
- Ultrasound of the ovaries - allows you to determine the size of the follicle. When it breaks, ovulation will occur.
- Visual signs - the appearance of viscous discharge, like egg white, increased libido, breast tenderness, pain in the lower abdomen.
When to go to the doctor?
Normally, a mature egg cell breaks the walls of the follicle and moves through the tube into the uterus. In place of the follicle a yellow body forms. It secretes estrogen and progesterone, preparing the uterus to conceive and bear.
If progesterone is not produced, the following happens:
- The yellow body is not formed, the opposite development of the follicle is observed.
- The uterus is not able to accept a fertilized cell.
May appear bloody or blood excreta unrelated to the menstrual cycle. They indicate a lack of hormones and a decrease in the size of the follicle.
The following signs indicate anovulation:
- Lack of transparent and viscous discharge.
- Unstable monthly cycle, when menstruation comes 2-3 times a month or completely absent for several months.
- The presence of heavy discharge for 7 days or more or scanty brownish discharge for 3 days.
A daily measurement of basal temperature will accurately determine that ovulation is absent. In this case, you should definitely see a doctor.
If monthly come irregularly, it is necessary to undergo treatment.
The doctor before him will appoint a thorough examination:
- Blood test for hormones.
- Rarely - MRI.
The treatment plan will depend on the specific causes of the problem, so it is compiled strictly individually. If serious pathologies are not found, it will be enough to take a vitamin complex, correct lifestyle.
Even with deviations in the cycle conception is quite likely, therefore, to forget about contraception is not worth it, to eliminate the possibility of unwanted pregnancy. If a woman is attentive to her health, she necessarily regularly visits a gynecologist and follows his recommendations.
The concept and mechanisms of ovulation
The concept of ovulation is especially closely faced by girls who have not been able to conceive a child for a long time. It is during the release of the egg woman can conceive a baby. If ovulation does not happen, then there will be problems with pregnancy, even with regular sexual intimacy. A vital reserve of eggs is stored in the ovaries. When the first menstruation comes, the female sex cells begin to mature, one month at a time, and sometimes 2-3. The mature cell breaks the ovary and goes outside to meet with the male sperm cell.
The period of maturation and release of the female cell falls approximately in the middle of the cycle, approximately 14 days before the arrival of menstruation. The day of the cage is considered the most favorable for conception, so girls who want to get pregnant, try to accurately calculate this secret date, because the viability of the egg lasts for a day.
After leaving the ovary, the cell is directed through the tube into the uterine cavity. Usually in the tubes there is a meeting with sperm and fertilization takes place. If it does not occur, the cell dies, and then leaves the uterus with the menstrual blood. Sometimes double ovulation occurs when both ovaries are released through the ovum, but these are rather exceptional cases.
But it also happens that the onset of menstruation is, but there is no ovulation. In fact, the egg does not mature and does not leave the ovary in such cycles, which are also called anovulatory ones. At the same time, every month the patient comes in time period, monthly, that is, their regularity and profusion does not change. Usually, anovulatory cycles are the result of hormonal dysfunction, which is characterized by the loss of the physiological rhythm by the female cycle due to the absence of an ovulatory period. Sadly, in most cases, infertility in girls is formed precisely against the background of the absence of ovulation. But it can not be argued that the lack of ovulation is associated with pathology.
The monthly cycle is formed by hormonal processes occurring in the ovaries, which mature with a woman. When the mature age comes, the ovaries begin the secretory activity, due to which the maturation of the eggs is ensured. Inside the ovary is filled with small follicles containing the ovum, which mature sequentially. During one menstrual cycle, only one (at least 2) oocyte has time to mature, although at the same time there are many cells in the ovary that are at different phases of maturity.
When a cell finally completes its development, it loses the need for nutrition, therefore it destroys the wall and leaves the ovary in order to fulfill its purpose - to meet with sperm, fertilize and form into the embryo, and then into the fetus. The period of release of the female cell is called ovulation. After the release, the egg retains its viability for one and a half to two days.
Signs of no ovulation
Women know that menstruation should come regularly and monthly. At the same time, menstrual bleeding is always accompanied by painful sensations, unstable psycho-emotionality and weakness. But not only menstruation have a specific picture, ovulation also has special features.
- In the ovulatory period, the nature of the vaginal secretions changes, which become viscous and transparent. They can come for three days, and then also suddenly disappear along with unpleasant discomfort. If these signs are absent, it means that there was no ovulation.
- Uneven and jumping cycles may also indicate the development of pathology. If there are monthly periods twice a month or are absent for several months, then there is a real risk that the girl has anovulatory cycles.
- Sometimes anovulatory cycles are characterized by unusual menstrual secretions. Unusualness may consist in excessive profusion or scarcity of bleeding, their duration (more than a week) or, on the contrary, short duration (less than three days).
- Basal rates below 37 ° C. Such a sign is relevant for those patients who daily measure rectal temperature. Usually, gynecologists recommend such procedures for girls if they cannot conceive a baby for a long time. Measurements are taken at the same time, with one thermometer, immediately after the morning awakening. Such a temperature jump during ovulation (above 37 degrees) is explained by the release of the female cell from the ovary, normally the basal temperature is 36.6-36.8 ° C.
Well, a characteristic sign of anovulation is the absence of pregnancy, even with regular sexual intimacy, which is caused by hormonal infertility. It is this factor that usually encourages girls to consult a specialist in order to find out the reason for the absence of children.
Ovulation was not, will there be monthly?
In this condition, as anovulation, there is usually an absolute absence of menstruation (amenorrhea) or scanty discharge (oligomenorrhea), lasting 2-48 hours. Long delays are also likely, alternating with scanty bleeding. Some girls have menstruation, as before, so they don’t notice any changes, which seriously complicates the identification of the problem. In such situations, it is possible to establish the absence of ovulation only when planning for conception, when a woman tries in vain to get pregnant.
The presence of menstrual bleeding depends on the thickness of the endometrial uterine layer. It is to him that the female cell is fixed in the course of fertilization. If conception does not occur, the endometrial layer is rejected and in the form of menstruation leaves the uterus. The thickness of this layer is regulated by estradiol hormone, with a deficiency in which the endometrium does not increase to the required size. As a result, the monthly become suspiciously scarce or absent altogether. It is quite normal if a woman has a couple of cycles anovulatory for a year.
Causes of Anovulation
The female monthly cycle develops under the guidance of the most complex immune and endocrine, neuropsychiatric and cardiovascular processes, therefore the factors leading to the lack of ovulation can be caused not only by deviations in the patient's reproductive system and its sexual structures. Anovulation in climacteric patients, when the appendages cease activity, and in adolescents, when the ovarian function is just beginning to work fully, is considered absolutely natural.
Experts subdivide the factors of anovulation development into pathological and physiological ones. Pathological causes usually always cause a chronic absence of ovulatory processes and are caused by the development of a disease. And physiological factors are associated with natural events inside or outside the female body.
Many factors are attributed to the category of anovulatory physiological causes.
- Pregnancy and lactation, menopause and just ended puberty, previous delivery. During gestation, the hormonal activity of the ovary cardinally changes, and after delivery it is gradually restored. But the monthly in pregnant women are restored faster than ovulation. In addition, for normal lactation, the body actively produces prolactin, which is able not only to slow down ovulatory processes, but also menstrual bleeding (while mommy feeds her baby crumbs). According to statistics, half of pregnant women have renewed cycles of anovulatory single-phase nature.
Lack of mass. The origin of this factor does not matter, if the female body is malnourished, a deficiency of beneficial elements such as fats, vitamins, proteins, trace elements and carbohydrates develops. A woman needs subcutaneous fat, because it is he who secretes estrogen hormones, and also participates in thermoregulatory and metabolic processes. If there is a shortage of weight, then the period may completely stop.
Даже интенсивная физическая активность или климатические изменения, долгие путешествия и переутомление способны спровоцировать нарушения овуляторных процессов. The absence of ovulation in patients taking contraceptive drugs is considered normal, since they suppress the maturation of the eggs. With prolonged use of oral contraception, many girls have a characteristic complication, after discontinuation of these drugs, they still live without menstruation and ovulation for half a year, unable to become pregnant.
Cause anovulation and pathological factors, to which experts refer to various kinds of ovarian diseases such as tumor processes, congenital anomalies, inflammatory lesions, polycystic diseases, etc. Also provoke the absence of ovulatory processes and hypothalamic-pituitary pathologies, accompanied by hormonal secretion disorders.
Thyroid diseases can also cause ovulatory disorders. The thyroid gland produces hormones important for the female body that regulate the reproductive activity of the body. In this case, the regularity of the cycle may occur, however, ovulation will be absent. Typically, problems with the thyroid are caused by iodine deficiency, so girls who plan to conceive must take potassium iodide and add iodized salt to their food.
Adrenal pathologies can also serve as a factor provoking anovulation. After all, the adrenal glands synthesize sex hormones, therefore, in violation of their functions, hormonal background shift occurs, leading to disruption of ovarian activity.
In the absence of the desired conception, it is necessary to undergo an examination in order to identify the origin of infertility. In accordance with the reason for the absence of the children, the doctor will select the necessary therapy.
Menstrual cycle women
Any phenomenon of the reproductive system is carried out under the action of hormones. The menstrual cycle consists of two phases, which are delimited by ovulation. The first is called follicular. It begins with the arrival of menstruation and is characterized by the growth of follicles (10-12 pieces) in the ovaries, the eggs inside them mature.
But about the third day after the end of menstruation stands out dominant follicleas a rule, he is alone, but in rare situations there are several of them, which continues to grow. The rest diminish and disappear. Also in this phase there is an increase in the functional layer of the endometrium, which is necessary for the implantation of the embryo in the case of conception.
Approximately 17 hours before ovulation in the body occurs powerful release of the hormone LH. Under its influence, the follicle bursts, and the egg cell is sent to the fallopian tube to meet with sperm. During this period, women have the opportunity to become pregnant.
The body works diligently, preparing to potential conception. This is reflected in external signs. The most obvious of them include:
- Increase the amount of cervical fluid.
After ovulation has occurred, the next stage of the menstrual cycle begins - luteal. It is characteristic increased progesterone hormone. Its growth is caused by the formation of the corpus luteum at the site of the bursting follicle. Under the influence of hormones, the endometrium, which has been growing all this time, changes its structure and accumulates nutrients for a fertilized egg.
If conception did not occur, the corpus luteum resolves towards the end of the cycle. As a result, progesterone is also reduced. As a result, the grown layer of the endometrium is rejected in the form of bleeding - menstruation. And the cycle begins anew.
The phenomenon in which there is no rupture of the follicle and the release of the egg is called anovulation. In almost all situations, this condition is the main symptom of developing infertility. The disease has a specific cause. It may consist of the following:
- Disruption of the hormonal system.
Single anovulations fall within the normal range. Insignificant factors may affect this process. These include a change of residence, taking certain drugs or reducing the volume of the body. Lack of ovulation is typical for the period breastfeeding.
Will there be monthly if there was no ovulation?
Anovulation is usually observed. amenorrhea (complete absence of menstruation) or oligomenorrhea (scanty menstruation, the duration of which ranges from 2 hours to 2 days). And also long delays are possible.
Sometimes it also happens that menstruation is coming with the same intensity, not giving cause for alarm. In this case, it is quite difficult to fix the problem. And only when planning a pregnancy, when for a long period conception does not occur, many women will find out about this deviation.
Availability menstrual flow depends on the thickness of the endometrium. It is a tissue covering the area of the uterus. With the successful conception, the ovum is attached to the formed mucous membrane.
If this does not happen, the endometrium is rejected during menstruation. Estradiol influences its growth. With its lack of a functional layer of the uterus does not increase to the desired thickness. As a result, there is a weakening of menstruation or bleeding is completely absent.
To confirm the presence or absence of ovulation using special methods. These include:
- Ultrasound procedure (folliculometry).
Some women are guided only by indirect signs of ovulation. The result in this case is erroneous. Pain sensations lower abdomen may indicate not only the release of the egg, but also a developing genital disease or inflammatory process.
The appearance of the discharge of the type of egg white is due to the growth of estrogen. But this does not always indicate that ovulation has taken place. Follicles can grow in size, but not burst in the end. This happens when polycystic ovary syndrome.
In no case do not need to engage in self. Restore ovulation can only qualified specialist. In each individual situation a certain dose of hormones is selected.
Most often the drugs are pills. One of the most popular is Proginova. Injections are sometimes prescribed. Additionally recommended to use vitamin therapy.
There are popular methods of treatment of anovulation. They represent a variety of herbal. Taking decoctions based on them without a doctor's prescription is not recommended. Vegetable components are not as harmless as it may seem at first glance. Some of them contain large phytohormone doses, tannins and flavonoids. During treatment, it is important to adhere to a specific dosage.
Anovulation equate to infertility. Despite this, it is successfully amenable to adjustment. A large number of women with such a diagnosis repeatedly became the mothers of healthy babies. To do this, it is enough to identify the deviation in time, and perform recommendations of specialists.
The cycle of menstruation and its features
The menstrual cycle of each woman of reproductive age consists of three interconnected parts. The total cycle time varies from 21 to 35 days, but minor deviations are possible. The starting point of the menstrual cycle is the first day of the appearance of bleeding. After the monthly period, the growth of follicles begins, in each of which an egg cell matures. This phase is called follicular. With the normal functioning of the female reproductive system, it lasts 14-16 days.
After 10–12 days of the cycle, a dominant follicle can be detected by ultrasound. A viable egg matures in it. In rare cases, there are several such follicles. The moment the egg leaves the follicle is called ovulation. It occurs in the middle of the menstrual cycle.
The last phase is luteal. During its course in the female body creates favorable conditions for the attachment of the embryo. In the area of the bursting follicle, a corpus luteum is formed, which produces progesterone. This hormone loosens the endometrium, preparing it for implantation. If the egg is not fertilized, progesterone is reduced, which causes rejection of the uterine layers. After this, the next menstrual cycle begins.
How to determine whether ovulation was
There are several ways to determine fertile days. They are used both individually and in combination with each other. The period of increased fertility is determined when planning pregnancy and in order to diagnose gynecological diseases. Conclusions are made after a study of at least 3 months. The main methods of diagnosis include:
- basal temperature measurement
- ultrasound monitoring
- use of ovulation tests,
- calendar method.
The basal temperature is measured rectally, immediately after waking up. On the basis of the data obtained, a chart is drawn up, which makes it possible to understand exactly when the egg cell matured in the previous cycle. In the follicular phase, the temperature is approximately at the same level. During ovulation, it decreases sharply and then gradually increases. Temperature retraction in the luteal phase indicates implantation of the embryo.
The definition of ovulation by ultrasound is called folliculometry. It includes several visits to the ultrasound room during the entire cycle. On average, it takes 3-4 visits to a specialist. Before ovulation, the size of the dominant follicle exceeds 18 mm. The egg inside such a follicle is considered fully ripe. The last time an ultrasound scan is performed 3–4 days after the date of the alleged ovulation. The fact that the follicle ruptured, said the presence of the corpus luteum and fluid in the peritoneum.
The calendar method is suitable for women who are confident in the absence of problems with the reproductive system. For three months, a woman should record the menstruation data in a separate notebook. From the total duration of the menstrual cycle takes 14 days. The resulting number indicates the day of the cycle, in which the woman is the maturation of the egg. The result will be the most reliable subject to the regular menstrual cycle.
After childbirth, the woman has no menstruation, therefore, indirect signs help to determine ovulation. These include the following:
- increased sexual desire
- the appearance of mucous secretions
- stifling sensations in the ovaries,
- tenderness and enlargement of the mammary glands,
- exacerbation of olfactory receptors.
Sometimes after childbirth during the ovulation period, discharge appears that can be confused with menstruation. With ovulation, they are not so abundant. A woman can only find a few drops of blood on the laundry. Discharge accompanied by malaise and pain in the lower abdomen. Blood during ovulation is considered a rare event. It occurs as a result of damage to the blood vessels.
Is it possible to ovulate without menstruation, the causes of this phenomenon
Many women are interested in whether ovulation can occur without the onset of menstruation. This pathology is quite common. Most often, it provokes hormonal disorders. Prolonged absence of menstruation is called amenorrhea. In most cases, ovulation does not occur with amenorrhea. But under the influence of some factors, the ovaries may suddenly begin their work. As a result, a viable egg matures.
A vivid example of the presence of ovulation in the absence of menstruation is the lactation period. Menstruation during breastfeeding is absent due to increased prolactin. Amenorrhea continues for several months. A woman cannot predict whether ovulation will happen. It depends on adherence to the principles of breastfeeding and the speed of recovery of the reproductive organs. Usually, after the onset of ovulation, the menstrual cycle is fully restored within a few months. The main reasons for anovulation include:
- sclerocystic ovaries,
- lack of hormones for maturation and rupture of the follicle,
- low ovarian reserve
- infectious and inflammatory diseases,
- thyroid dysfunction,
- toxic poisoning of the body.
Signs of possible pathologies
Anovulation occurring against the background of a regular menstrual cycle is difficult to detect. But you can suspect its presence on a number of grounds. These include the following:
- no pregnancy for more than a year
- lack of pulling sensations in the middle of the cycle
- discharge in the first phase of the cycle does not differ mucous structure,
- decrease in sexual desire
- no fall on the basal temperature chart.
When anovulation changes the level of hormones in the blood. It often occurs on the background of polycystic or ovarian failure. There may be a lack of estrogen in the first phase and a shortage of progesterone in the second. An ultrasound may show a partial or complete absence of the corpus luteum in the ovary. In some cases, cysts form at the site of the follicles.
When to see a doctor
A timely visit to a gynecologist helps to prevent the development of serious diseases of the reproductive system. For the treatment of irregular menstruation requires an individual selection of drugs, which can only carry out a specialist. To the gynecologist should contact in the following cases:
- violation of the menstrual cycle,
- the absence of the desired pregnancy throughout the year
- bleeding not related to critical days
- pain in the lower abdomen.
Before treatment therapy, the necessary hormone tests are taken. An ultrasound examination is performed to determine the structural changes in the uterus and appendages. After determining the cause of anovulation, drugs are selected or laparoscopic surgery is performed. Surgical intervention is required if ovulation is absent due to the thickened ovarian membrane.
Opinion of doctors
Doctors believe that ovulation can be restored with the help of medical drugs. Therapy aimed at normalizing fertile function is called ovulation stimulation. It involves taking estrogen and progesterone. In the first half of the cycle, the eggs are grown to the desired size. Then put HCG injection, contributing to the rupture of the shells of the follicle. After the fact that ovulation has been confirmed by ultrasound, progester-containing agents are prescribed. Stimulation of the reproductive function helps women to become pregnant with anovulation in 30% of cases.
What is anovulation?
Anovulation is a condition in which there is no development and release of the egg due to a number of reasons. In this case, the cycle is called anovulatory. Anovulation may be a consequence of the complete or partial functional immaturity of the female germ cell or the impossibility of its progress through the fallopian tube after the rupture of the dominant follicle.
With anovulatory cycle, menstruation may or may not be present. Many women are concerned about the question of why ovulation was in this month, but not monthly. For those who are scrupulous about their health and plans to have children, this phenomenon forces us to immediately turn to a specialist.
Is the menstrual cycle possible without ovulation?
The presence of menstruation is evidence of sexual maturity of a woman and readiness to conceive. However, for fertilization to occur, ovulation is necessary, because without it there is nothing to fertilize. Thus, the presence of menstruation is not a guarantee of pregnancy, it is possible only if there is a finished egg.
The female cycle takes place in three successive phases, each of which plays a different role in the preparation for conception. At the very beginning, the layer of the old uterine lining is separated to update the endometrium. At this time, there is an active production of estrogen. It also starts the growth and maturation of several follicles, one of which will become a cell ready for fertilization.
She goes on a 10-14 day cycle for fertilization. If it happens, the future embryo is attached to the wall of the uterus, if not, the body waits until the beginning of a new cycle. The end of the cycle takes place with the predominance of the hormone progesterone.
In any healthy woman, some cycles pass without an egg. Normally, they are 1-3 per year. In this case, the cycle is usually not broken, and the discharge comes on time.
Can there be monthly, if there is no ovulation, a woman can find out herself. To do this, just keep track of your condition. Significant changes in the body indicate the onset of ovulation. These include:
- characteristic variations in basal temperature,
- change in vaginal mucus discharge:
- increase in sexual desire,
- sensitivity and some swelling of the nipples.
Anovulation, in most cases, has little effect on the nature of menstruation. If there is no ovulation, will the monthly ones be normal? They may be more scarce, with a slight shift in timing. With age, the number of cycles without an egg cell usually increases, but menstruation continues on the same schedule.
What measures need to be taken
The answer to the question whether there can be menstrual periods without ovulation is very important. After all, the majority of women monitor women's health and the possibility of conception for menstruation. And their natural course and terms are insufficient for the onset of pregnancy.
If the desired conception does not occur, and the monthly go normally, it is worth checking whether there is regular ovulation. To do this, you can keep a graph of basal temperature and monitor the nature of the cervical mucus in different phases of the cycle.
If you find gaps in ovulation, you must try to adjust the lifestyle. Sometimes this is enough to regain the ability to conceive. It is necessary:
- abandon exhausting diets, with excessive thinness to increase body weight, eat regularly and fully,
- stop smoking and drink alcohol
- rest and walk more
- look at the drugs used and adjust the medical therapy of existing diseases,
- with overweight try to lose weight without harm to health.
Very often, these simple measures are enough to return the possibility of conception. You need to understand that the question of whether the monthly if there was no ovulation is not the main one. Regular lack of ovulation may indicate impending infertility. However, for some women, this does not affect the cycle.
The absence of ovulation is sometimes indicated by the nature of menstruation. They may become irregular, delayed, or come twice a month. The type of discharge can also change - be scanty and brown or too long and abundant.
In order to take measures in time and prevent infertility from developing, you need to contact a gynecologist. The doctor will prescribe the following studies:
- Folliculometry. This is an ovarian ultrasound. It helps to identify the following follicle disorders - atresia, luteinization, persistence, absence. Also used to identify cysts.
- Research vaginal discharge.
- Blood tests for hormones.
- Ultrasound of the thyroid gland.
- CT and MRI of the skull.
- Testing the growth of LH (luteinizing hormone).
- Patients should independently create a basal temperature chart.
According to the results of research, they determine the places of violations of the production of hormones and diseases of these organs. Further prescribed drug therapy. Self-medication is prohibited. The endocrinologist also deals with the treatment of hormonal disorders. Together with the gynecologist, the treatment tactics is chosen.
The reasons why this happens
Anyone who is planning to become a mother is looking forward to a delay. The absence of menstruation is the first signal of a successful conception. Some, on the contrary, are afraid when it does not come in time.
If there is such a situation, when one strip appears on the dough, hCG shows zero, then you need to find out the cause of the failure. Perhaps there was no ovulation, and the delay makes itself felt.
Surely, not everyone keeps track of whether the follicular capsule burst in a particular month. Accurate results will help to know the ultrasound. The reasons for the onset of menstruation are as follows:
- pregnancy. You can not clearly be confident in the anovulatory cycle, so it is better to play it safe and do a test. Conception is also possible with late ovulation, when the couple absolutely did not plan the moment,
- postpartum recovery. In this period, the arrival of red secretions is hampered by an excess of prolactin. Even if breastfeeding is not carried out, then monthly periods are unlikely to appear on the 28th day after the birth of the baby. Most likely, they will be observed in 6-8 weeks. Each organism works purely individually. When a young mother decides on feeding, the follicle may even mature, but the menstruation does not occur,
- puberty. MC is often unstable since the beginning of the first blood discharge. Otherwise, it is necessary to consult with the gynecologist-endocrinologist,
- hormonal disbalance. Anovulation or its late arrival affects the duration of the second phase,
- stress. Even short-term stress often disrupts hormonal balance. In such situations, recorded prolactin jump. It, in turn, blocks the maturation of the nuclear centers, as a result of which failure occurs,
- abrupt climate change. Internal processes are affected both by staying in hot countries and in countries where cold weather is predominantly
- physical exercise. This is not about jogging, shaping or yoga. Only extreme loads cause damage.
- diet. Lack of ovulation and delay will be felt during exhaustion, since, against this background, estrogen will not be produced in sufficient quantities. This hormone needs a fatty layer. The state of affairs correct the normalization of the diet,
- abortion. Both abortion and spontaneous miscarriage often provoke displacement of the MC.
What diseases can we talk about?
The delay in menstruation due to the lack of ovulation is also observed in a number of gynecological and endocrine diseases. These include:
- pathologies of the urogenital system (endometritis, endometriosis, adnexitis, salpingitis),
- common diseases (adrenal glands, high blood sugar, thyroid gland),
- gonorrhea, genital tuberculosis,
- PCOS. This pathology leads to hormonal failure, neglected disease is a harbinger of infertility. An indicator of the presence of the disease is considered to be an excess amount of testosterone in the blood,
- use of certain drugs. Tablets have a similar effect, and it leads to violations
- climacteric dysfunction. It is fixed after 40 years when reproductive abilities are practically reduced to zero. Anovulation makes itself felt more and more often, and the cycles become not constant,
- emergency contraceptive measures. This subsection deals with medical abortion. Of course, such a method is safer, but with frequent use of it there are some consequences,
- stop taking OK. Then it may take 2-3 months for the follicles to begin to mature on their own and regular bleeding occurs.
When the problem is not related to the physiological nature, the attending doctor is entitled to appoint additional examinations:
- keeping a basal temperature chart
- giving blood tests for hormones
- Ultrasound of the ovaries and uterus,
- consultation with doctors of a different profile.
Opinions of doctors and treatment methods
If the bleeding does not come on time, then you should not panic. Perhaps this is a one-time phenomenon and an intermittent failure. When the secretion does not occur regularly, and pregnancy tests are negative, then you need to visit the gynecologist's office. A timely inspection will help identify problems at an early stage and eliminate the progression of serious ailments.
The doctor for the diagnosis must first examine the internal state of the patient. Initially, pelvic ultrasound is done to eliminate any unwanted changes. Blood donation will help determine the condition of the pituitary gland. On the folliculometry, the uzist will track whether the follicles, including the dominant ones, are formed, and whether a full-fledged egg cell is finally produced. Often you have to do an MRI of the brain.
If it is clear that blood secretion does not occur not because of the incorrect work of reproductive functions, then you need to visit other specialists, as a nutritionist, therapist, endocrinologist, psychotherapist. It is important to remember that the absence of menstruation is a serious and alarming signal.
If we talk about treatment, it is aimed at eliminating the source of the problem. In addition to specific appointments, you should try to maintain a healthy lifestyle, namely:
- walk more often on the street
- walk more
- eat right,
- be able to relax
- Do not recycle in the office
- do sport,
- avoid stressful situations and overwork.
How to treat pathology?
Depending on the results of the study, physicians prescribe antibiotics, hormones, hemostatic agents, vitamins. When the case is severe, you may have to resort to surgery.
In modern conditions, ovulation can be stimulated. Before this process, a woman should undergo a full examination. Its results will help doctors prescribe the right drugs with a minimal amount of side effects. Often, the normal output of the NRC ensures the timely start of a new MC. The basic analysis here will be blood for the main group of hormones.
At the same time, do not be upset if anovulation is determined. This phenomenon is permissible 2-3 times a year in women of childbearing age.
Causes and signs of lack of ovulation
In the body of a healthy woman of reproductive age, the ovulatory phase is present in each cycle. In order of the norm, only 3-5% of all cycles can be anovulatory in nature. If the cycle of anovulatory and the maturation of the egg due to certain circumstances does not occur, you should think about a possible failure in the hormonal system or the development of diseases of the genital organs.
Among the main reasons for the appearance of the cycle without the ovulatory phase should be highlighted:
- the beginning of the lactation period in a woman when the baby eats only breast milk,
- violation of the synthesis or insufficient production of sex hormones (in particular estrogen),
- pathologically increased prolactin synthesis or high levels of male sex hormones,
- thyroid and adrenal gland diseases,
- inflammatory diseases of the pelvic organs of infectious and non-infectious nature,
- genetic predisposition
- toxic effects on the body, including tobacco smoking and alcohol abuse.
To determine the absence of ovulation at 100% is possible only by applying laboratory and instrumental methods of research. But at the same time, a woman who knows her body well can at least suspect anovulation.
The most reliable signs of the lack of maturation and release of the egg include:
- the absence in the middle of the cycle of an increased amount of characteristic volatile mucous secretions from the genital tract,
- menstrual bleeding irregularity: their absence for several cycles in a row or, on the contrary, the appearance of menstruation 2 or more within 1 month,
- lack of temperature jump in the graph of basal body temperature measurement. Normally, in the middle of the cycle, a sharp rise in numbers to a value of 37 ° C is observed,
- excessively long (more than 7 days) and abundant or short (less than 3 days) and insignificant monthly.
NOTE! Signs of lack of ovulation can be signs of serious diseases of the reproductive system, and therefore, when they appear, it is recommended to immediately consult a doctor.
When ovulation can occur without menstruation
Practical gynecology is often encountered in cases where ovulation can occur without menstruation. Thus, for a woman who lacks physiological bleeding, pregnancy becomes a pleasant surprise. The absence of menstruation during ovulation can be due to several reasons: it can be both physiological processes and pathological, associated with impaired health.
The main physiological reasons for the absence of menstrual flow include:
- Lactation period - at this time there is a depression of the synthesis of estrogen, responsible for the maturation of the eggs. During regular breastfeeding, when the baby receives only breast milk, prolactin is actively produced and estrogen production is inhibited. Menstruation is usually absent. But with the gradual introduction of complementary foods, the ratio of these hormones is aligned, and subsequently shifts to estrogen. With the normalization of the level of these hormones, the female body receives a signal of the readiness of a new conception. Under the action of estrogen maturation of the eggs occurs with their subsequent release from the follicles. In spite of this, the uterus itself, including the endometrium, does not always have time to reorganize, and therefore menstruation may be absent altogether or be so insignificant that the woman will not even pay attention to them.
- In women in the period of preclimacterium, a cycle failure with progressive irregularity is often observed. In some cases, there is a lack of several menstruation in a row for several months. Despite this, ovulation often occurs. Since menopause occurs in all women at different ages, sometimes too early, this factor must also be paid attention to.
- Long-term use of contraceptives can trigger the development of hormonal imbalance, which, however, disappears after the end of their use.
The following are among the frequent pathological causes provoking the absence of menstruation:
- inflammatory diseases of the pelvic organs of bacterial, fungal or viral genesis affecting the uterus or appendages,
- noncommunicable diseases of the reproductive system: myoma and other neoplasms,
- operations and traumatic injuries of the genital organs in history,
- endocrine pathologies of the thyroid gland or other organs of internal secretion, which cause the development of ovarian dysfunction,
- polycystic ovary syndrome, in which there is an active production of the male sex hormone testosterone, disrupting the reproductive system, including the maturation of the eggs and the formation of the endometrial layer. In this case, the female sex cell can mature and even leave the follicle, but this does not guarantee its usefulness, and also does not ensure the onset of menstruation,
- overweight or underweight.
In addition to the reasons, there are a number of factors that, either alone or together, can trigger cycle failure and the absence of monthly physiological secretions. Among them: excessive and excessive physical exertion, psycho-emotional overstrain or exhaustion, irregular and unbalanced diet.
The possibility of pregnancy in the absence of menstruation
Pregnancy, of course, can occur even in the absence of menstrual flow. After all, if there is no menstruation - this does not mean that ovulation did not occur and the mature sexual cell did not come out of the follicle.
Gynecologists distinguish such a thing as amenorrhea. It is characterized by the absence of physiological bleeding for several months in a row. Allocate:
- True amenorrhea - there is no full development of the egg. Accordingly, without medical intervention, pregnancy is impossible,
- False - the egg matures and goes into the fallopian tube, but due to certain reasons there are no periods. In this case, pregnancy is possible.
How to determine if ovulation has occurred
In addition to the subjective signs that a woman may experience during ovulation (viscous mucous secretions, engorgement of the mammary glands, an increase in appetite, the appearance of puffiness, deterioration in the quality of the skin, etc.) there are also those that are 100% reliable.
The most informative methods for determining the development, maturation and release of the egg include: ultrasound of the ovaries for several days in a row, determining the level of progesterone in the blood, ovulation test that can be done by each woman at home. The essence of the latter is similar to a pregnancy test, the only difference is in hormones, the presence of which this test determines.