NEWS | homepage | LIST OF ALL TOPICS | MUM address & What does MUM mean? | e-mail the museum | privacy on this site | who runs this museum?? |
Amazing women! | the art of menstruation | artists (non-menstrual) | asbestos | belts | bidets | founder bio | Bly, Nellie | MUM board | books: menstruation and menopause (and reviews) | cats | company booklets directory | contraception and religion | costumes | menstrual cups | cup usage | dispensers | douches, pain, sprays | essay directory | extraction | famous women in menstrual hygiene ads | FAQ | founder/director biography | gynecological topics by Dr. Soucasaux | humor | huts | links | masturbation | media coverage of MUM | miscellaneous | museum future | Norwegian menstruation exhibit | odor (olor)| pad directory | patent medicine | poetry directory | products, current | religion | your remedies for menstrual discomfort | menstrual products safety | science | shame | slapping, menstrual | sponges | synchrony | tampon directory | early tampons | teen ads directory | tour of the former museum (video) | underpants directory | videos, films directory | Words and expressions about menstruation | Would you stop menstruating if you could? | What did women do about menstruation in the past? | washable pads
More articles by Dr. Soucasaux: Anatomical drawings - Anovulatory cycles - Archetypal aspects of the female genitals - The breasts: some morphological aspects - Colposcopy - Comments on the corpus luteum and related aspects - Comments on some anatomical and symbolic aspects of the female pelvis - The curious relations between androgens and estrogens in women - Drospirenone Oral Contraceptives - Due to prohibition, Brazilian women don't have access to modern medicinal abortion - Endocrinology of menstruation - The Fallopian tubes - Female sexual response - The Gräfenberg Spot (G-Spot) - The Gynecologic Palpation (descendant of "The Touch") - Gynecological assistance: the three basic areas - Gynecology and Gynecologic Surgery - Gynecologist versus obstetrician: what lies behind the combination? - "Gyneco-obstetric-surgical" stubborness and the perpetuation of one of the greatest mistakes of women's medicine - Hypermenorrhea and/or Menorrhagia (Prolonged and/or Excessive Menstrual Bleedings) - Hypertrichosis, Hirsutism and Androgenic Manifestations in Women - Mayer-Rokitansky-Kuster-Hauser (MRKHauser) Syndrome - Menstrual toxin: An old name for a real thing? - Nature and the ovaries - On the Intimate, or Small-Scale, Mechanisms of Menstruation - On the Strange Nature of the Ovaries - Oral hormonal contraceptives (the "Pill") - The Ovaries: Some Functional and Archetypal Considerations - Peculiarities of the Female Genitals' Sensory Innervation - Physiology of menstruation - Polycystic ovaries syndrome - The Possibility of Becoming Pregnant, Its Implications for Women, and Abortion - Premenstrual congestion of the breasts - Premenstrual syndrome (PMS) - The Psychology of Gynecology part 1 (part 2) - Psychosomatic and symbolic aspects of menstruation - Psychosomatic gynecology - Some Details on the Function of the Hypothalamus-Pituitary-Ovaries Axis - Stanislav Grof's Perinatal Matrixes of the Unconscious and Women's Medicine - Symmetric Patterns in the Female Genitals - Thoughts on Female Sexual Psychology - Uninterrupted use of hormonal contraceptives for menstrual suppression: why I do not recommend it - The uterine cervix - Uterine contractility - The Uterus and the Female "Passive-Active" - Women's corporeal consciousness and experience - Women's Experience of the Breasts - Women's Undesired Pregnancies and Women's Right to Abortion and see his Art of Menstruation


Anovulatory Cycles

Dr. Nelson Soucasaux , Brazilian gynecologist

As far as the occurrence or non-occurrence of ovulation in the course of their cycles is concerned, women present both ovulatory (biphasic) and anovulatory (monophasic) cycles.

In the ovulatory cycles the complete follicular development and transformation takes place, resulting in the growth of a mature follicle, ovulation and formation of the corpus luteum. These cycles are considered biphasic because they present a follicular (estrogenic) and a luteal (progesteronic-estrogenic) phase. Along the follicular phase, the ovary produces mostly estrogens, while along the luteal one it produces progesterone and estrogens.

In the anovulatory cycles obviously there is neither ovulation nor formation of the corpus luteum. They are monophasic, because these cycles present only the follicular phase, characterized by variable degrees of persistent estrogenic production.

The recently described cases of "LUF" (luteinized unruptured follicles), despite also constituting a kind of failure in the ovulatory process, must not be included in the usual category of anovulatory cycles because their histological and endocrine features differ too much from the ones already mentioned, since they are similar to those of the ovulatory cycles (Note 1, below).

In this way, whenever I speak of anovulatory cycles I mean the specific kinds of ovarian and menstrual cycles that exhibit only the follicular phase, in which there is neither ovulation nor formation of the corpus luteum. Endocrinally and histologically they are monophasic cycles. Only follicles in variable stages of growth and involution can be found in the ovaries throughout these cycles.

Anovulatory cycles (monophasic) are physiologically normal soon after menarche, and are part of the process of maturation of the hypothalamus-hypophyseal-ovaries axis (or hypothalamus-pituitary-ovaries axis). This maturation is considered complete with the establishment of regular ovulatory cycles. Even so, we must remark that the occurrence of anovulatory cycles intermingled with the ovulatory ones is frequent and normal along the fertile years of a woman's life. We can say that there are women who ovulate more often, while others ovulate less often.

In the absence of hyperestrogenism, hyperprolactinemia, hyperandrogenic syndromes and the usually named "polycystic" pathologies of the ovaries, the occurrence of occasional anovulatory cycles with a regular duration intermingled with the ovulatory ones is considered normal (Note 2). We must also remark that in the years that precede menopause, ovulation gradually becomes less frequent and even rare, and the anovulatory cycles predominate again.

There are the more varied possible patterns of follicular growth in the anovulatory cycles, with or without the formation of the mature follicle (or follicle at the third stage of growth). The duration of these cycles also can vary greatly, from the average 25-35 days up to short cycles (less than 25 days) and long ones (35 to 50 days, or even more). Therefore, there are several kinds of anovulatory cycles.

Though anovulatory cycles often tend to be irregular and exhibit variable patterns of follicular growth, there are also the common anovulatory cycles, characterized by the formation of a mature follicle (or almost mature) and duration within the limits of normality. Anovulatory cycles of this kind are relatively frequent throughout the menacme (the menovulatory period of women's lives) and, due to their characteristics, they are not perceived as such by women, who are ignorant of them. Usually they only can be detected through a careful gynecologic study.

In these cycles the mature follicle may reach its usual size, but there is a failure in the ovulatory mechanism that results in the absence of the hypophyseal ovulatory peak of LH (luteinizing hormone). Because of this, there is no follicular rupture and the growing follicle persists as such for more 10 to 14 days, after which its process of follicular involution and atresia (death) begins. This results in the sudden fall of the estrogenic levels and the consequent coming of menstruation. Botella Lusiá remarks that in the common anovulatory cycles, "...the atresia and decay of the follicle takes place in such a way that the menstrual rhythm does not alter" ("Tratado de Ginecologia, Tomo 3 ­ Enfermedades del Aparato Genital Femenino," Editorial Científico-Médica, Barcelona, 1965). Nevertheless, there are also reports of regular anovulatory cycles in which signs of mature follicles cannot be detected.

On the other hand, long-lasting anovulatory cycles are often related to the prolonged persistence of mature follicles or to the usually named "polycystic" pathologies of the ovaries. Several endocrine disorders in the hypothalamus-hypophysis-ovaries axis are responsible for chronic anovulation, long-lasting cycles (oligomenorrhea) and amenorrhea.

It is also important to remark that though many anovulatory cycles progress normally and without problems (mostly the ones named common anovulatory cycles), a considerable number of these cycles characterized by absence of ovulation tend to be associated with several degrees of relative or absolute hyperestrogenism, a condition that cause endometrial hyperplasia and hypermenorrhea (excessive menstrual bleeding).

Chronic anovulation ­ which is different from the normal occurrence of some anovulatory cycles intermingled with the ovulatory ones ­ is obviously associated with infertility, as well as hyperestrogenism and endometrial hyperplasia. Endometrial hyperplasia requires special medical attention in order to prevent the possible development of endometrial cancer.


Note 1: There are cases of luteinization of follicles that do not ovulate, condition known as "LUF" (luteinized unruptured follicles). This is a very special sort of failure in the ovulatory process in which, despite the absence of follicular rupture and ovulation, the unruptured follicle becomes luteinized under the action of the LH (luteinizing hormone), giving rise to the corpus luteum. In such cases both the production of progesterone and the duration of the luteal phase of the cycle may be normal. Cases of "LUF" constitute, therefore, a very special kind of ovulatory failure with biphasic cycles.


Note 2: a) Hyperestrogenism: excessive production of estrogens or excessive estrogenic activity; b) Hyperprolactinemia: a disorder characterized by an excessive production of prolactin; c) Hyperandrogenic Syndromes: disorders characterized by an excessive production of androgens; d) As to the so-called "polycystic" pathologies of the ovaries ("polycystic ovaries syndrome"), I have some personal reservations about the use of the term "polycystic" for such disorders. I think they would be much better defined as "polymicrocystic ovaries."


Most of the text above are excerpts from my book "Os Órgãos Sexuais Femininos: Forma, Função, Símbolo e Arquétipo"("The Female Sexual Organs: Shape, Function, Symbol and Archetype"), published by Imago Editora, Rio de Janeiro, 1993. For more information on the book see page http://www.nelsonginecologia.med.br/orgaos.htm , from my Web site www.nelsonginecologia.med.br .

Copyright Nelson Soucasaux 1993, 2002

___________________________________________________

Nelson Soucasaux is a gynecologist dedicated to clinical, preventive and psychosomatic gynecology. Graduated in 1974 by Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Brazil, he is the author of several articles published in medical journals and of the books "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology") and "Os Órgãos Sexuais Femininos: Forma, Função, Símbolo e Arquétipo" ("The Female Sexual Organs: Shape, Function, Symbol and Archetype"), published by Imago Editora, Rio de Janeiro, 1990, 1993.

Web site: www.nelsonginecologia.med.br

Email: nelsons@nelsonginecologia.med.br


NEWS | homepage | LIST OF ALL TOPICS | MUM address & What does MUM mean? | e-mail the museum | privacy on this site | who runs this museum?? |
Amazing women! | the art of menstruation | artists (non-menstrual) | asbestos | belts | bidets | founder bio | Bly, Nellie | MUM board | books: menstruation and menopause (and reviews) | cats | company booklets directory | contraception and religion | costumes | menstrual cups | cup usage | dispensers | douches, pain, sprays | essay directory | extraction | famous women in menstrual hygiene ads | FAQ | founder/director biography | gynecological topics by Dr. Soucasaux | humor | huts | links | masturbation | media coverage of MUM | miscellaneous | museum future | Norwegian menstruation exhibit | odor (olor)| pad directory | patent medicine | poetry directory | products, current | religion | your remedies for menstrual discomfort | menstrual products safety | science | shame | slapping, menstrual | sponges | synchrony | tampon directory | early tampons | teen ads directory | tour of the former museum (video) | underpants directory | videos, films directory | Words and expressions about menstruation | Would you stop menstruating if you could? | What did women do about menstruation in the past? | washable pads
More articles by Dr. Soucasaux: Anatomical drawings - Anovulatory cycles - Archetypal aspects of the female genitals - The breasts: some morphological aspects - Colposcopy - Comments on the corpus luteum and related aspects - Comments on some anatomical and symbolic aspects of the female pelvis - The curious relations between androgens and estrogens in women - Drospirenone Oral Contraceptives - Due to prohibition, Brazilian women don't have access to modern medicinal abortion - Endocrinology of menstruation - The Fallopian tubes - Female sexual response - The Gräfenberg Spot (G-Spot) - The Gynecologic Palpation (descendant of "The Touch") - Gynecological assistance: the three basic areas - Gynecology and Gynecologic Surgery - Gynecologist versus obstetrician: what lies behind the combination? - "Gyneco-obstetric-surgical" stubborness and the perpetuation of one of the greatest mistakes of women's medicine - Hypermenorrhea and/or Menorrhagia (Prolonged and/or Excessive Menstrual Bleedings) - Hypertrichosis, Hirsutism and Androgenic Manifestations in Women - Mayer-Rokitansky-Kuster-Hauser (MRKHauser) Syndrome - Menstrual toxin: An old name for a real thing? - Nature and the ovaries - On the Intimate, or Small-Scale, Mechanisms of Menstruation - On the Strange Nature of the Ovaries - Oral hormonal contraceptives (the "Pill") - The Ovaries: Some Functional and Archetypal Considerations - Peculiarities of the Female Genitals' Sensory Innervation - Physiology of menstruation - Polycystic ovaries syndrome - The Possibility of Becoming Pregnant, Its Implications for Women, and Abortion - Premenstrual congestion of the breasts - Premenstrual syndrome (PMS) - The Psychology of Gynecology part 1 (part 2) - Psychosomatic and symbolic aspects of menstruation - Psychosomatic gynecology - Some Details on the Function of the Hypothalamus-Pituitary-Ovaries Axis - Stanislav Grof's Perinatal Matrixes of the Unconscious and Women's Medicine - Symmetric Patterns in the Female Genitals - Thoughts on Female Sexual Psychology - Uninterrupted use of hormonal contraceptives for menstrual suppression: why I do not recommend it - The uterine cervix - Uterine contractility - The Uterus and the Female "Passive-Active" - Women's corporeal consciousness and experience - Women's Experience of the Breasts - Women's Undesired Pregnancies and Women's Right to Abortion and see his Art of Menstruation