menstruation-issuesFor many women, “the period” simply means vaginal bleeding without regard to the pattern of bleeding. In this sense, it is possible to bleed without ovulating, but the bleeding will be irregular. This is known as dysfunctional uterine bleeding or anovulatory bleeding. Anovulatory bleeding varies in flow, duration, and schedule, and often is mistaken for a menstrual period.

When ovulation doesn’t occur, progesterone is not produced, however estrogen-induced endometrial accumulation continues indefinitely. Progesterone normally balances the effects of estrogen. As a result of this unopposed estrogen, shedding of the thickened endometrium is irregular, happening when it can no longer maintain itself. This pattern is known as estrogen breakthrough bleeding, which results in delayed and unusually heavy periods. A pattern more commonly experienced by peri-menopausal women is estrogen withdrawal bleeding. As estrogen levels decline in the peri-menopause, the endometrium develops inadequately. In this case, irregular shedding results in spotting between periods, or light, frequent, and/or short menstruation.

Many women experience anovulatory bleeding at one time or another during their menstruating lifetime. This condition is more common among girls during the year or two after their first period and among women nearing menopause. Anovulatory bleeding is diagnosed by a women’s health care provider or gynecologist after other causes of irregular uterine bleeding have been eliminated through tests and/or diagnostic procedures.

Early diagnosis and treatment of anovulatory bleeding is essential. Possible complications include iron deficiency anemia, infertility, osteoporosis, and endometrial cancer. With appropriate management, normal menstruation can often resume. Treatment generally includes hormonal regulation with birth control pills or progesterone supplementation.

Lastly, even though women can have bleeding without ovulation, they still need to use birth control if they want to be protected from pregnancy. Timing of ovulation is unpredictable, so it makes sense to be protected.