10 Treatments for Anovulation
1. Clomifene citrate (clomid) is usually the first line of medical treatment; it’s an anti-estrogen that blocks estrogen receptors in the hypothalamus and this increases the amount of follicle stimulating hormone (FSH) and luteinising hormone (LH) the anterior pituitary produces, which should stimulate one or more dominant follicles to full development and ovulation.
- These drugs can only be used in medical conditions where the hypothalamic-pituitary axis is functioning, such as polycystic ovary syndrome (PCOS)
- 70% of women with PCOS ovulate in response to clomid and 40-60% conceive within six months, with about 10% having twins and 1% having triplets
- Triggering ovulation with clomid should be carried out with access to ovarian ultrasound monitoring as there’s a risk of hyper-stimulation syndrome (OHSS)i
Possible side effects of clomid are hot flushes, mood swings, nausea, breast tenderness, insomnia, increased urination, heavy periods, spots, weight gain and OHSS. The Committee on Safety of Medicines in the UK recommended that clomid shouldn’t be taken for over six months, and clomid is also linked to thinning of the womb lining, and an increased chance of ectopic pregnancy, miscarriage and developing LUFS.
2. Chinese medicine has been used to promote fertility and to trigger ovulation for centuries. Research studies show Chinese herbal medicine (CHM) is highly effective when used for anovulation related infertility, without any significant side-effects:ii
- CHM is 1½ times more effective than clomid at increasing ovulation
- CHM more than triples pregnancy rates compared to standard drug treatments; pregnancy rates of about 60% within 4 months compared to 30% using standard fertility drug treatment or IVF over a 12 month periodiii
- Miscarriage rates with CHM are 20% of those associated with clomid
- CHM also dramatically improves the quality of cervical mucus (an extremely important factor for natural pregnancy) compared to clomid
3. Metformin is an insulin-sensitizing agent that’s used to treat diabetes, and it’s used in the treatment of PCOS(often alongside clomid) as insulin-resistance is an important part of PCOS development. Metformin has been a very important addition to PCOS management, with two reviews showing that it reduces menstrual irregularity and improves ovulation rates. However there are natural alternatives that are as (or more) effective without the side-effects and better for general health.
Possible side effects of metformin are nausea, vomiting, diarrhoea, abdominal pain, a metallic taste, itching, and allergic reactions, which can lead to an intolerance to the drug and high dropout rates.
4. N-acetyl-cysteine (NAC)