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How is failure of ovulation treated?

Initial measures are aimed at correcting any cause of hormone imbalance due to stress, weight loss due to eating disorder, excess weight, and abuse of alcohol or drugs.   Abnormal function of the thyroid gland is corrected. Lifestyle modification is recommended for overweight or anorexic patients. Polycystic Ovarian Syndrome (PCOS) will be ruled out and is common in overweight patients. Weight loss can be very difficult for patients with polycystic ovarian syndrome.
 These actions may be curative and normal ovulation resume.  Interestingly, if weight loss is the problem, periods often start when a woman’s body reaches the weight she was when the periods first started

Drug treatments
First line treatments for ovulatory failure include medications such as clomifene citrate (Clomid) and FSH. Clomid competes with estrogen receptors at the hypothalamus (the part of the brain which controls many bodily processes without our knowledge) causing it to stimulate the pituitary gland to increase production of FSH.  It is taken for five days in each cycle starting within the first seven days.  Commonly, day 2 to day 5 or day 5 to day 9 is recommended but there is little difference in effectiveness.  It is probably fine to start as soon as you are sure that your period has started.  Whilst taking the tablets, you might feel a bit “menopausal” as the brain is registering a lack of estrogen. 
 We will usually administer clomid for three ovulatory cycles, with some way of assessing whether it works.  This might be a basal body temperature chart or blood tests for progesterone.  The National Institute for Clinical Excellence (NICE)   recommends that follicle tracking should be employed (although there is no more risk of multiple pregnancy than with spontaneous ovulation).  We may then use another three months at the same dose or if it is unsuccessful at producing ovulation, a higher dose,  If pregnancy does not occur within six months of ovulation produced by clomifene, it is not worth continuing with this therapy in most cases.  Only 1% of the pregnancies produced with clomifene occur after this time. 
Follicle Stimulating Hormone (FSH) is usually the next step. This is an injection.  Dependent upon the patient's diagnosis, FSH may be combined with intrauterine insemination for three cycles.  The risk of multiple pregnancy is much higher than with clomifene and Follicle Tracking is essential.
For patients with PCOS, metformin may be prescribed.

Sometimes elevated prolactin levels may cause ovulatory failure. Prolactin is the hormone responsible for stimulating breast milk production in pregnancy. Abnormally high levels are caused by stress and the stress of having blood taken is often enough to cause a rise.  It is not usually of clinical importance until it is above 100 µg/L and periods have stopped.  If a high level is found, it is important to exclude a pregnancy.  Many anti-psychotic medications and SSRI or SNRI drugs are known to increase prolactin production. 
Treatment is usually medication with dopamine agonists such as cabergolinebromocriptine (often preferred when pregnancy is possible), and less frequently lisuride. A new drug in use is norprolac with the active ingredient quinagolide.
Sometimes hyperprolactinaemia is caused by a benign tumour in the pituitary gland which may be removed or treated with medication.

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