Ovulation Is the Main Event of the Menstrual Cycle

Anovulatory cycles and pill bleeds.A menstrual cycle is, by definition, an ovulatory cycle in which ovulation is the main event and progesterone is made.

Any other kind of bleed is either an anovulatory bleed or a pill-bleed — neither of which are real menstrual cycles. Ovulatory cycles are the only way to make progesterone which is important for general health, not just for making a baby.  

An ovulatory menstrual cycle has a follicular phase and a luteal phase

The follicular phase is the pre-ovulatory phase when estradiol is made. The luteal phase is the post-ovulatory phase when progesterone is made. It looks like this.

The follicular phase ranges from seven to 21 days or 32 days for teenagers. It’s the variable part of the menstrual cycle. In contrast, the luteal phase is almost exactly fourteen days (ten to sixteen days) and does not vary.

If you add up the variable (follicular) phase to the fixed (luteal) phase, the duration of a healthy menstrual cycle is anywhere between 21 to 35 days or 45 days for teenagers.

👉Tip: To determine the length of your menstrual cycle, start counting from your first day of proper flow. That’s “day 1.” The days of light spotting that lead up to the proper flow are the final days of the luteal phase of the previous cycle.

Progesterone is the “period-lightening” hormone so if there’s no luteal phase, the result can be a period that’s too heavy or goes on for too long (see below).

An anovulatory cycle has no luteal phase and no progesterone

An anovulatory cycle does not have a luteal phase or progesterone. Instead, it has only a long follicular phase and estrogen and then eventually a breakthrough bleed. It looks like this.

Other names for anovulatory cycles include:

  • hormone imbalance
  • estrogen and progesterone imbalance
  • dysfunctional uterine bleeding
  • ovulatory dysfunction
  • unopposed estrogen
  • breakthrough bleeding
  • estrogen dominance (a term I don’t use).

Over time, anovulatory cycles can lead to endometrial thickening, endometrial hyperplasia, or uterine polyps. 

Causes of anovulatory cycles

Possible causes of anovulatory cycles include:

How do you know if a cycle is an anovulatory cycle?

Signs of an anovulatory cycle

A cycle shorter than 21 days

Counting from “day 1” to “day 1,” a healthy menstrual cycle is anywhere from 21 to 35 days (45 days if you’re a teenager). A cycle shorter than 21 days is almost always an anovulatory cycle.

A cycle longer than 45 days

A cycle longer than 35 days or (45 days for teenagers) is either 1) a very long follicular phase or 2) an anovulatory cycle. It’s not possible to have a luteal phase longer than 16 days except with pregnancy and the rare situation of a corpus luteum cyst.

A bleed that lasts more than seven days

A healthy period lasts two to seven days and loses no more than 80 mL of menstrual fluid over all the days of the period. If you bleed for more than seven days, it’s probably an anovulatory cycle. The flow with an anovulatory bleed can be light, normal, or heavy.

A cycle with no sustained temperature rise

Progesterone causes basal body temperature to rise by half a degree. That’s why healthy ovulation results in a sustained temperature rise during the entire luteal phase. If temperatures don’t rise, it’s a good indication that ovulation did not occur.

👉🏽 Tip: You can also confirm ovulation with a blood test for serum progesterone, but only during the two-week luteal phase. There’s no progesterone during the follicular phase, so if you have a long follicular phase, you’ll have no progesterone for most of your cycle. Read The right way to test progesterone.

How to treat anovulatory cycles

If you’re not ovulating, the solution is to figure out “why not” and treat that.

  • If the underlying problem is PCOS, identify your PCOS type and treat that.
  • If the underlying problem is undereating, eat more food and carbohydrate for at least six months.
  • If the underlying problem is high prolactin, treat that.

I discuss other treatments in my books Period Repair Manual and Hormone Repair Manual.

Pill-bleeds are not periods

Finally, a bleed on the pill is a withdrawal bleed from contraceptive drugs. There’s no ovulation or even attempt at ovulation so there’s no estradiol or progesterone. It looks like this.

A pill-bleed is not a menstrual cycle.

If you do a blood test for estradiol and progesterone while on the pill, you will have almost none.

Ask me in the comments.

104 thoughts on “Ovulation Is the Main Event of the Menstrual Cycle”

  1. I saw my period on the 26-30 of June and later on the 9-10 of July when is my ovulation date and how will I know my next period time?

  2. Please ma I’m diagonsed with PCOS and this my snytoms seized menstruation, milk discharge from breast right one and hair on face , after taking birth control pills excluton.

  3. I’m afraid I am being misdiagnosed, I’m 28 and I’ve never had a natural period. I was diagnosed with insulin resistance PCOS but all those tests were normal, metformin, Victoza and spironolactone didn’t work. I went to a specialist and he said I had adrenal PCOS but with high testosterone and elevated DHEAs. Since I had a massive pulmonary embolism I cant have estrogen. Cyclic progesterone has slowly decreased in being sufficient in regulation of flow. I suspect maybe a pituitary problem but I’m not having luck with any doctors to work with me. Not sure what I do from here.

  4. Dr. Briden-
    So interesting that the spotting doesn’t count as period! I’m 45 1/2 and for the past year my “period” has been just 2 day of light flow; with 1 day spotting before and 3-4 days spotting after. The spotting is extremely light, and it’s darker brown.
    I’ve been using progesterone cream and it’s helped my PMS a lot (no more sore boobs and water retention); but my period is still so light. Regular, every 25-26 days, but very light. Is this just a sign of perimenopause? I do think I could be eating more, I eat very healthy but don’t track how much; since I don’t eat processed food, and I don’t eat a lot of fats, could it be that this is why my period is so light?

  5. Dr. Briden, I currently take DEBLITANE (Norethindrone Tablets USP, 0.35 mg) for birth control. I don’t believe it ever suppresses my ovulation because my periods are still regular and right on time (just a little lighter now). Is it possible this mini pill can be just as good as other options like an IUD or non-hormonal methods of contraception?

    • most progestin-only pills (mini-pills) do suppress ovulation — ie. your regular cycles are likely to be anovulatory.
      Have you tracked temperatures to confirm that you’re ovulating?

      • I had not thought of it but will start doing so to make sure I’m getting the important benefits of ovulation. Thank you for your reply, I appreciate it.

  6. Thank you for sharing such an amazing information with us. I found it very useful and wonderful blog. Keep sharing such blogs with us.

  7. Hello Lara! I enjoy your blog very much. I am 42, blessed with four children and would love another. My cycles just returned in March 2021 (breastfeeding two year old) and are suddenly markedly shorter (10 day follicular phase, 13 day luteal only with use of natural
    Progesterone cream). I did the day 3 draw and also five draws in last luteal
    Phase. My doctor is having me take vit D/k2, fish oil, NAC, CoQ10, DHEA but my ovulation day keeps getting earlier and now past two cycles am spotting pre-period. She suspects hypothyroidism and will be investigating that, but is hypothyroidism something that can cause such sudden cycle changes? My temps confirm ovulation. I exercise moderately daily, healthy BMI, no alcohol or caffeine or tobacco. Any general thoughts? Thank you!

  8. Thank you for sharing the 3 signs of period which is not really a period. This blog really helped me a lot. Looking forward to your upcoming blogs.

  9. Thank you so much for all the wonderful information! I’m learning so much from you. I had HA for over 12 years and finally have regained my period through diet and lifestyle changes. However, my cycles are long (38-45 days, and sometimes longer) but I’ve been ovulating consistently. What are possible causes for delayed ovulation? Is the fact that I’m ovulating each cycle evidence that I’m finally eating enough to meet my needs, despite the fact that my cycles are long? Or is the delayed ovulation a sign that I still need to eat more? Thanks!

  10. Im a little confused about the anovolation cycle. Do you need to have a constant rise in the temperature in the second half of the cycle?my temperature usually is low in the beginning of the cycle,than it goes down one day and then it rises half a degree but it doest keep it high… is it condidered ovulation? (With mucus and positive lh test combined). I mean only the temperature doesn t go high as it should for several days:/ im confused… thanks a lot for your help.

  11. Dear Lara! Your research us so very valueablue – thanks so much for that.
    I am recovering from Hypothalamic Amenorhea and after 15 months I finally got a bleed this week (Yay!!). However my Obgyn said it was an anovulatory cycle. We had an appointment one week before the bleed which showed an ovulation-looking Cervix, 8mm lining and an 12mm dominant follicle + some other smallers.
    Progesterone was already elevated.(from 0.1 to 1.68ng/ml).
    The day the bleed started LH, FSH + Estrogen were extremely low and Progesterone back to 0.1 but the egg was still there (now 13mm).
    My question to you: Is there any possibility I ovulated shortly before the first appointment. Or is there no way the other eggs would still be ij the ovaries then??
    I cannot find research to this anywhere. Heeelp.
    Need some hope!!!

    • because your progesterone was only 1.68ng/ml, it does sound like an anovulatory cycle, which is pretty normal when recovering from HA. You hopefully will soon progress to ovulatory cycles.

      • Is it completely fine to have periods on its own, as I have Hypothalamic Amenorhea n I get my periods once in 3 months or 4 months. This is been the pattern of my periods since my puberty. I’m 32 years old now, or this needs treatment.

      • Thanks a lot for your reply, Lara.
        I wonder why the bleed happened then as I had no signs of high Estrogen the days before but rather was veeery low energy & no mucus (and usually anovulatory bleeds are Estrogen induced bleeds, aren’t they?)
        How can the Progesteron rise so much without ovulation – can it be produced by something else than the corpus luteum?

        • Progesterone does vary day to day but needs to be at 1.8 ng/mL (5.5 nmol/L) to indicate ovulation. I wouldn’t worry about it too much; if you’re eating enough, you’re likely to be moving towards ovulatory cycles.

  12. I have recently been diagnosed with PCOS, due to having over 25 follices across both ovaries. I was on the pill for 15 yrs without having a break, I have now been off the pill for 4 months. It seems ive been having anovulatory cycles, and looks as though I have thick lining/maybe polyps in my uterus. I do not have any pain/periods are painless. My periods have been 27 DC, then 36 DC, 34DC. My gyno asked me to go bck on the pill to force a withdrawal bleed to clean me out, and that when I was to TTC she would give me medication to try and make me ovulate. I did not start taking the pill again as I do not want to go down that path again… Is it possible I have post-pill PCOS? I feel like my body needs more time to adjust after being on the pill for so many years. I see my gyno in 2 months to check my uterus again. I had my spleen removed 3 yrs ago due to a bleeding disorder, I am not sure if this is causing issues with my body /hormones as well.

  13. Hi Lara, my period is constantly 36-48 hours long only. It’s a ‘normal’ amount for 24-36 hours then the last 12 hours is only spotting. Is this normal? I am 27 and am on no birth control. Thanks 🙂

  14. Hi! I normally have 28 to 30 day cycles with a 4 day bleed. If you have a month where the bleeding was much lighter than normal, does that mean you didn’t ovulate?

  15. Hello ,
    I am writing to you for advice.
    I gave birth 1 year ago. my cycles are around 36 days. I have a little acne and a fairly large pilosite.
    I have a normal hormonal check-up.( testosterone , dhea , delta , lH Fsh progesteron but low œstrogen)
    I bought your book to try to reduce my cycles and improve my skin. I have been taking zinc for 3 months. and this month I wanted to take peony liquorice. only I still haven’t ovulated (days 26). should i keep taking it? I would really like to be able to shorten my cycles. do you have any other advice?
    I take magnesium, I am slim and sporty. I eat very balanced.
    I am sorry for my English but I am French 🙂

    thank you in advance for advice. I have not found such a competent naturopath in France

  16. Hello there!

    What should I do about my low morning temperature? (Around 35,97-36,2 c). I have pcos and a fibroid in my uterus wall. I have irregular periods and spottings and my blood is very “mucusy”, I bleed little and for long around 10 days. I have myself come to the conclusion that I probably lack progesterone, I am probably not ovulating and I am guessing that I don’t really have a luteal phase. Do you have any recommendations on how I can regulate all this in a more natural way? I have lost faith in conventional medicine in this area and would like to have a more holistic approach🙂

    Love the work you do, good job🙏😊

    Best regards,

    • Dr Lara,
      As many other ladies have already commented, I too am so thankful for your book! I an learning so much!

      I have a question, and would be so grateful for any advice you could offer.

      To summarise: My 18 year old daughter always had light, irregular periods. Our Endocrinologist just sent us home with a prescription for birth control and subsequently progesterone to “ turn off and then reset the pituitary” I am reading your book and am just over half way through it. I have read and many many articles here about the pill. I don’t want to give her hormonal birth control! But I am so confused.

      Below is the long story with details:
      I am dealing with HPA axis dysfunction.
      My daughter, who is 18, just had her first visit to my Endocrinologist yesterday. Out GP referred thinking she had Thyroid problems. From what I’ve learned reading your book, I don’t think she’s ever had proper periods, only anovulatory cycles. (I have to order a thermometer still, I couldn’t find one anywhere) Yesterday at my daughters appointment the Dr agreed that she most likely didn’t ovulate. Her thyroid is fine. Her progesterone was “very low” (doctors words) on day 13, of a 33 day cycle. (She was spotting Around day 13)

      While speaking I was pleased to learn that the Dr knew of your book and liked it. She is treating me with just supplements diet and sleep. So, I was encouraged thinking she was prone to treat as naturally aa possible. When we left with my daughter I thought she had given simple and good meds. When I looked it up she had prescribed birth control pill for 3 months, then progesterone day 16-21 and Clomid day 5-9.

      I am so confused and frightened and don’t know what is best. I wonder if we should rather try to sort out why she isn’t ovulating.
      Something you said about intolerances and allergies made me think.
      My daughter had serious reactions from a baby (even in breast milk) and a child to salicylates in food. It affected her digestion and nervous system. She was under Dr care for 3 years trying to find the problem. She ended up needing hernia repair from the effect of the sensitivity. After the Dr.s said they couldn’t find an answer, We found the source ourselves by elimination diets.

      Over time, she was gradually able to handle more of the problem foods. She has not had many of the old symptoms for a long time and hasn’t stayed as strictly on her diet, although we are careful. When I read about your patients’ periods correcting once allergies were removed, I was very interested. I was thinking maybe her sensitivity has prevented her period from working properly all this time. I did mention the food sensitivities to the Dr, but she did not discuss it or seem to think it was pertinent.

      Now, I don’t know wether to give her the pill and see, or reach out to the Dr. and ask for time to try diet first. Or to seek out a naturopath (I found two) I do feel my current Dr Does lean toward more natural, and we have a good relationship, but I am shocked and confused now. My daughter is concerned that she won’t be able to have children one day, and her greatest desire is to be a wife and mommy.

      We have already been working to remove toxins and being attentive to healthy diet. I have been off sugar and grain for years, my daughter has been off sugar for as long but just stopped all grain for the past 5 months. We eat other healthy carbs. I became concerned about too little starch so added sweet potatoes and brown rice. We do eat raw, cultured cow milk. I am considering the milk as an issue. But her salicylate diet is very restrictive.
      I am trying so hard, but feeling overwhelmed!

      Please, if you have any advice for me I would be incredibly grateful!

  17. I’m 43 & trying for a second naturally. I had 2 miscarriages end of 2018. I just listened to your podcast with Dr Mariza yesterday & it just clicked that my bbt is not as high as it used to be during my luteal phase. I think I still ovulate, I use test strips to verify & observe mucus & bbt. Last year my gyno tested my prolactin twice & it was above normal but she said she wasn’t concerned. What tests should I get done to fix my bbt temps & prolactin?

  18. Hi Laura, I’ve just finished your book and feeling empowered with knowledge but also confused by my PCOS. I’ve lost weight due to low carb and fasting for 2 years but now my periods are non existent. I believe low carb is working for what I think was my insulin resistance…should I increase my carb as your advice states here?
    I’ve increased fat in my diet and reduced exercise to exclusively yoga. It’s been nearly two months since these changes. Should I continue this way for a while longer?

  19. Hi Lara,

    I love your book so thank you. I’m coming to you in desperation after not being able to identify my problems explicitly from the book. I’m 34 and have always had light periods. My periods were also very regular (around 27 days) and I haven’t been on birth control for about 5 years. Since September, they have got so light I barely bleed at all. This month all I
    have had is some very very light spotting which was very dark brown instead of my period at day 32. I also have breast pain around when my period is due. I have been stressed with work and wondered if this may have impacted on them although other wise nothing has changed. I don’t think I meet the criteria for PCOS although I do have Rhumatoid Arthritis. No thyroid issues and had blood tests at start of period in December which were reported to be normal. I started Vitex last month and take b vitamins, magnesium and zinc supplements. Do you have any advice? Could this be related to stress?

  20. Hi Lara! I’d love some advice…

    I believe I have anovulatory cycles – I got my period back in May 2019 after being on implanon (which was taken out October 2018) and previously the OCP since 17 (I’m 26 now). I track my cycle and my temperature and do not seem to get a normal rise in my BBT.

    I don’t believe I have PCOS (I have normal androgens) or hypothalamic amenorrhea (I don’t under eat, I eat plenty of carbs, and I do bleed every month)

    My cycles are irregular – ranging from 13 to 36 days. The last 3 cycles have been long (34, 36 and 32 days). When my cycle is short my period is light, when it’s long it’s heavy. I bleed every month (since May 2019).

    I do not have high androgens (testosterone, SHBG, and DHEAS all normal). I have no symptoms of hyperandrogenism.

    I do not under eat and eat plenty of carbs. I have been vegan for 7 years however I eat a nutritionally balanced diet, I eat a good amount of protein, fats and omegas, I supplement iron, B12 and zinc. I don’t eat excessive amounts of soy (I eat tofu 1-3 times a week, I don’t drink soy milk, I have no other soy products). I exercise regularly but not excessively. I don’t have iodine, B12 or zinc deficiency they have been tested recently.

    I had a glucose tolerance test and my BG actually went down after the drink (4.1mmol/L fasting, down to 3.7 1hr after, then back to 4.0 2hrs after). My fasting insulin was 4mU/L.

    My prolactin is normal.

    My LH levels are ever so slightly lower than my FSH levels.

    My progesterone levels on my last blood tests were 1-2nmol/L however the latest day my progesterone was tested that cycle was on day 17 (I got all my hormones tested on days 3, 10 and 17) and that cycle was 34 days long. So potentially it was too early to detect progesterone.

    My oestrogen that cycle went from 100pmol/L on day 3, to 120 on day 10, to 260 on day 17.

    I had low TSH on my most recent blood test and normal T3 and T4. I had no antithyroglobulin the previous time it was tested (the time before my TSH measured low).

    I have a pathology form to get another 2 blood tests but I’m not sure what day I should test on. I don’t get ovulation symptoms and my cycles are irregular. My last cycle was 32 days so I was thinking of testing on day 25?

    I’m confused as to what’s going on as it sounds like neither PCOS nor HA. I know you don’t agree with a vegan diet but do you really think it’s causing my anovulatory cycles? Especially seeing as I don’t eat excess amounts of soy and supplement my nutrients?

    I’m more than happy to pay for a consultation with you if you prefer as I know this is a very long comment and potentially a complex answer!

    I really appreciate any help.

    Thank you!!

  21. Hi Lara! First off, your book is fabulous and over the past couple years I have been practicing FAM and learning all I can about my own cycles. I am a college distance runner and in high-school struggled with disordered eating (before I knew anything about my cycles) lost my period, was put on HBC by my doc and remember being miserable, cranky and all that fun stuff. Definitely did not understand those hormonal bleeds were NOT periods.

    Fast forward, I have a far better relationship with food, back at a healthy weight and taking more recovery when I need it from running/training but I definitely feel like hormones are not where they should be. I struggle with cyclic bloating that is very painful in lower belly (have tried to deduce what foods could be causing it aka potntially gluten seems to be a contender and ) and with the help of Daysy + FAM practice have seen what appears to be many anovulatory cycles. No temp spikes 🙁 I do notice however what could be ovulation signs with incredibly egg white and stretchy CF and Cervix softness. My cycle however does seem short, my last periods being only ~ 20 days apart (the cycle before that about 25 days). I do still bleed but according to my temp on daysy i am not seeing a temp spike that stays up.


  22. Hi! After tracking my temperature for some months i have found some pattern i dont know how to interpret, maybe someone could help? After a consistent rise in temperature around the time of ovulation that lasts around 3 days, temperature suddenly falls back to preovulation values… Any idea?
    Thanks and cheers!

  23. Hello! Thank you for all your amazing blog posts and wonderful information. I came off of hormonal birth control in january, and my last two periods have been extremely heavy and crampy. I think I might have a hormonal imbalance, low progesterone. BUT my question for you is actually how to define the first day of my period/cycle. I always have one day of light period. It is not spotting, because my spotting is brown-ish. My light period is clear blood, and I always have on day of this before I get one or two days of heavy bleeding and cramps, and then a few days with medium and light bleeding.

    So, do you really say that this first day of clear, light bleeding is not my period, and should not be regarded as my first day of the cycle?
    My first day is actually the one where I have superheavy bleeding and cramps and all?

    This is totally new information for me! And also very important, as I use Daysy and need to plot my bleeding correctly on this device.

    Would you please confirm if I got this right?

    Lots of love from Norway <3

  24. Hello, is it normal/common to have an anovulatory cycle after a miscarriage/D&C? I had a miscarriage and D&C one month ago and am confident I did not ovulate, yet began a period type bleed yesterday (first bleed since spotting ceased 3 weeks ago). I still have very faint positives on OPKs. I am having HCG level checked tomorrow. Thank you.

  25. I’m pretty sure I’m having anovulatory cycles but I’m breastfeeding and 8 months post partum. Could that contribute to this? This is my second pregnancy but I got pregnant after just 2 “cycles” so it’s hard for me to tell if this is normal for me or not. I’ve had short “cycles,” one super long 2 week bleed, and now random spotting after having my regular 6 day period. I didn’t see post pregnancy as an option so I wondering what I can do to get my cycles back on track.

  26. Can suboxone lead to anovulatory bleeding and missed periods? I’m a former heroin and methadone user and they gave me erratic, probably some anovulatory cycles. Is there evidence to suggest opiodes(in particular suboxone) can lead to anovulatory cycles and missed periods? Are some of my cycles anovulatory from it? Since suboxone my cycles have regulated some, butnow I’m on day 39 of one long cycle after 4 somewhat normal ones.

  27. Hi Dr Lara, i am disappointed to see no response from you on my query. Unlike many other women who have asked for specific advice based on their personal situation/symptoms, I was simply asking for clarification on one of the things you said in your book. Whilst the information provided in your book is useful, I am not entirely sure how helpful it is if the advice is not 100% clear. In this specific case, the advice you give on Vitex is not clear at all and I would expect more detailed information from a qualified naturopath. I understand you may not have time to address this query here now, but please make sure you clarify the point above in a revised edition of your book if there will ever be one. Im sure this will be appreciated by future buyers of your book who would otherwise be left confused.
    Kind regards,

    • Hi Debbie,

      Apologies for my slow response. I’m getting so many comments on the blog lately that I’m quite behind in responding to comments.

      The way I prescribe Vitex is to schedule the five days off from the first day of the cycle (even with a longer cycle), but if there is no cycle, then 25 days on and 5 days off.

      I’d actually thought that was in the book so I’m glad you pointed out that it is not.

  28. HI Lara. I’ve got your book but I’m confused. I’ve got PCOS .yesterday was my 81st day of my cycle and I started bleeding, very light, bright red blood .My nipples are sensitive and I feel some strange tiny pain in my ovaries or uterus. It can be ovulation and then I will have normal period or its sth else? I dont know which phase it is and what kind of supplements should I take.I’m 33 years old ,struggling to have regular cycles because it affects my mood veeery much (i have got pmdd) please help

  29. Hi I removed Hormonal IUD 1.5 years ago and my cycle has not yet returned to normal. Went from 60 days down to 43 days but it stayed at that for a whole year already. Was taking vitex but didn’t help at all. I just noticed my period last a lot longer that before went from 5-10 days now. And also I get blood clots from small to medium but I feel so uncomfortable. Don’t know what to do feeling like going to the Dr will be my only option at this point. I don’t want to put any more toxins in my body and would like to do this naturally but don’t know what to do.

  30. Hi lara,
    I am trying to understand why i haven’t had a period now for 8 months.
    (I’m 27 so not menopause!)
    – i haven’t been on the pill for 7 years and had regular periods ever since coming off it – had 3 months of no periods, they came back for 4 months and now disappeared for the last 8..
    – i don’t have elevated testosterone or abnormalities when blood tests come back – except for not producing progesterone
    – i don’t have thyroid issues following tests for that.
    – i did go through a fairly stressful time about 5 months ago but less so now.
    – i take ovasitol in the hope that helps + have a low carb / sugar free diet

    Let me know if there is any advice you can suggest! Thanks x

  31. Dear Doctor Laura.. I’m 50 and having major period problems.. In December my period lasted for nearly 7 weeks..a pelvic usg showed fibroids and ovarian cysts…I changed my diet and drank carrot juice daily… The bleeding stopped… Now april 1st it started again and bleeding for 4 weeks… I’m so frustrated… This has been very hard on me… Now have severe iron deficiency anemia…I don’t want a hysterectomy… But I’m at my final straw…. Any thoughts?

  32. Hi, my daughter has had 3 periods now (is just 13 nearly 14) and had a period accompanied by two severe migraines, one on day 1 and one a5 days later (the bleeding had stopped) that lasted 3 days. A further two days after the migraine stopped she seems to be having another bleed. I read about bleeds not being a period but am confused what that may mean for my daughter.
    Could you point to a relevant article or perhaps your book covers this?
    Many thanks

  33. Hi Dr. Briden. Back in March I had a 39 day cycle and then in April it went back to my normal cycle (~27 day). I had that period on the 7th. But I started having another period yesterday (4/22). Could this be an anovulatory cycle? My bleeding is not spotting and feels and looks like my normal period bleeding. Thanks!

  34. I’m confused bc I think am having peri menopausal anovulatory cycles (sometimes), have confirmed v early ovulation via ultrasound, like Day 5-7, other cycles… but I’m currently having a cycle with no temp rise, and started very dark brown spotting with some mucus on cycle day 26, still going 6 days later…? so is this low or high progesterone/ estrogen…? I’m not pregnant (though would love to be). Am trying for one more baby…

  35. Thank you SO MUCH for all of your articles. They help me to understand my body so much better and are gonna be a great help for my future career as helping other women (I’m currently studying to become a naturopath).

  36. Hi Dr Lara,
    Thank you so much for writing a book that is so educational and easy to read! I do have a question when you talk about how to take vitex in chapter 7 – you mention taking 5 days off after 25 days if we have no period, and 5 days off when we get our period if we have periods. As I have long cycles that usually last longer than 35 days, would you recommend I stop Vitex after 25 days or should i continue until I get my period regardless of how long my cycle is?
    Thank you for your help,

  37. I have a quick question. I read your book and I love it! I’ve been off of hormonal birth control for a month now and have some confusion on if it’s even possible to ovulate yet. If it takes 100 days for the follicles to develop and the pill suppresses it, is it even possible to have a normal period within 3 months of getting off birth control?

    In my case, I’ve seen fertile fluid, my temperature started rising a few days later and I would think that means I’m having a normal cycle but the 100 day thing threw me off. Could you please offer some clarity on that?

    • yes, sounds like you ovulated and had a normal cycle and yes, it is possible to ovulate shortly after coming off the pill.
      It happens because there can be some development of ovarian follicles while on the pill. But not all the way to ovulation.

  38. Hi Lara!

    I had been on birth control for 8 years until Oct 2018 and I got my first period ( I think it was) in Jan (after withdraw bleed 1 week after) I don’t remember my periods before birth control except that they were heavy and the cramping was quite bad so I was put on the pill to help.

    I have changed pills over the years and the last one I had, the effect seemed to have lessened as I was still cramping and bleeding even with such a high dose.

    The question I have however is that it has skipped February and I have Vitex Agnus ready to be taken but should I see a doctor first or start the Vitex to help? I have searched high and low in your wonderful book but I have not come across an answer yet. Thank you!


  39. Hi Lara. I am 47.5 and want to conceive. I have been measuring BBT for exactly 4 years now. Unfortunately, that also tells me that I probably haven’t been ovulating for the past 7 months. My cycles have become: too long, too short, no temperature rise. In fact my temp is now sometimes lower than it used to be in the follicular phase, and can be like that for the whole month (feel bad).

    Is there anything i can do to restore ovulation for the sake of ICSI?
    In fact, i would very much like to have a consultation with you, if that is possible.
    Please let me know trough any channel. (I live in Europe, i suppose you live in Australia).
    I do have your book and a lot of information, but I guess what i need, is a personalized consultation.
    I am taking 10mg progesterone now day 16-25 , for the second cycle, but my obgyn is not a fertility expert….

    Kind regards, Renata

  40. Hi Lara,

    I read your book and it has been so helpful as I came of Yasmin in august. Thank you so much, love your work!! My cycle finally returned five months off the pill. The first luteal phase was only nine days, then I got my period. I ovulated again on day 14. Sure of this because I have been using a fertility monitor. Now, 18 days later there is still no sign of my period and all pregnancy tests are negative. Could this long luteal phase be caused by a corpus luteum cyst? Any other plausible explanation? Only symptoms I have had is spotting and cramps nine days after temperature shift.

    Thank you!

    • Went to the doctor and found many corpus luteum cysts. In your book you write that they can be the result of thyroid disease. Will go and check my thyroid as I have very low temperatures as well.

  41. I have PCOS, which was diagnosed around 12 years ago, and treated with a low dose mini pill. For the past 2 years I have been off the pill and working on changing my lifestyle to treat Inflammatory PCOS – according to previous blood tests I had very low progesterone. Now, thanks to my lifestyle I have a period every month for the first time in my life and what seems like a normal cycle. I have since been diagnosed with Endometriosis, which you explained in your article can be the case when you treat PCOS. My question is, however, if I am having a regular 29 day ish cycle with 4-5 days bleeding, can I assume that I have normal progesterone levels now? If I treat my Endo with an anti-inflammatory diet and supplements as you suggested, is there a chance I will have normal minimal pain cycles, and a good chance of concieving in the future? Thanks

  42. Hi Lara, your articles are fantastic and really clarify a lot of the inaccurate terms that are bandied about on this topic. You are also the only specialist I’ve been able to find who talks about the importance of ovulation for health, outside the context of trying to conceive.

    In a nutshell my question is: if I am still having anovulatory cycles 18 months after coming off hormonal birth control, which I used for over a decade since menarche, what can I do to get my body ovulating?

    Some background for those who might find my story useful: I’m 29 years old and was on hormonal contraception (various pills, then Depo-Provera injection, then the Mirena) from age 17 to age 28. I’ve been on the copper IUD for 18 months now since having the Mirena removed, but haven’t ovulated since then. To be honest, I don’t know that I’ve ever ovulated in my life given that I started on the pill during menarche.

    I discovered this when working with a functional doctor and a reproductive endocrinologist in an attempt to get to the bottom of various symptoms: hair loss, cystic acne, depression, inability to lose excess body fat, water retention, luteal phase spotting, long periods and severe bloating/GI woes. These had been going on for years really, but had worsened during my third year with the Mirena, which is why I switched to the copper IUD. The symptoms have continued even with the copper IUD.

    Over the last four months I have been tracking BBT and cervical mucus, and using OPKs from day 11 of my cycle onwards. No signs of ovulation so far. I tested serum progesterone on day 21 (my cycle is 28 days) four months in a row, and readings were all under 1 ng/mL. I had two scans over that four-month period, which revealed that I don’t have PCOS, have good ovarian reserves, and that my uterus and ovaries are fine.

    I have a healthy BMI, eat plenty and very healthily (organic, whole foods, mainly plant-based), exercise regularly but not obsessively, and sleep well.

    I’m not trying to conceive right now, though I might want to in the future. For the time being I just want to be healthy and rid of these symptoms.

    So, assuming years of hormonal birth control are the culprit behind anovulatory cycles, how do I help my body start ovulating? Should I try Femara or Clomid? Should I just wait? I’ve been recommended bio-identical progesterone cream, vitex or dietary changes – but as you astutely point out, there is a difference between low progesterone levels despite ovulation, and near-zero progesterone due to a lack of ovulation (which appears to be my case). I don’t see how the cream, vitex or dietary changes could trigger ovulation on their own – or could they? What would you recommend?

    I’m not enjoying these low progesterone symptoms and would like to have the possibility of having children in the future, so I’m keen to fix this now. Any insight would be hugely appreciated!

    Thank you!

    • yes, it’s possible you have never yet ovulated in your life but I suspect it’s not far off. Are you seeing any fertile mucus? because if so, it means your body is trying to get there.

      On consideration is the plant-based diet. I have found that a vegan diet does not seem to have enough zinc and iodine to support ovulation. With my vegan patients, I often prescribe my zinc+iodine “ovulation cocktail” that I also describe in Period Repair Manual.

    • Hi Jennifer! We seem to have similar stories. I was put on BC at age 18 due to irregular periods (a few months in between each one) and have been on it for 12 years. I stopped at age 30 once I was ready to start ttc. I haven’t had a period on my own since stopping and it’s been 10 months. I have cysts on my ovaries but my hormone levels don’t match typical PCOS. I also don’t have HA because I have enough estrogen and FSH/LH, so I feel I’m in this weird category that doesn’t quite fit either diagnosis. As a result, natural treatment options aren’t clear to me, there are so many and I’m not sure which one would help me ovulate. I also have this feeling that I maybe never ovulated before! Lmk if you’d like to connect – [email protected]

    • Holy moly, are you me? Your story sounds just like mine, save for some diagnoses that got labeled at various times. I was diagnosed with endometriosis at 16, and hashimoto’s at 28. Some tests that were done in my teens showed that my prolactin levels were high-ish, which adds up with the hashimoto’s. It might be worthwhile to check it out and see how that lines up with your symptoms. The problems I encountered for getting the diagnosis was that my TSH was fine 90% of the time, so it wasn’t grounds to test other thyroid hormones. When it wasn’t fine, it was retested 6 months later, when it became normal again. Without abnormal results, no further tests were pursued. It wasn’t until a doctor at a walk thought “why not, let’s test for antibodies”, and there they were. Now, with an abnormal test result, a full profile was taken of my thyroid and it was under active.

  43. Hi Lara,
    what could be possible causes for irregular periods + feeling stressed out/problems with sleeping? (the latter only since last year)
    All hormones are normal. Could there be deficiencies in vitamins?

  44. Hi Laura, I love your articles and guidance! I feel I don’t fit any of the 4 types of PCOS. My hormone levels are normal, I have PCO, and no period/ovulation for 9 months since stopping BC. I was irregular as a teenager and my Gyno put me on the pill, and I was on it for 12 years. I agree we should be treating the root cause, but my
    Challenge is knowing what that is since my bloodwork doesn’t show point in any specific direction. Are there other potential root causes?

    • When you say your hormones are “normal,” is your LH high or low compared to FSH? Because that will give you a clue as to whether it’s really PCOS or whether you’re not getting a period because you’re not eating enough. See my blog post Maybe it’s not PCOS.

      • I took provera to induce a bleed so I could get bloodwork on a specific cycle day. I was tested on CD 5 and my FSH was 9 and LH was 10. My endo said my LH should have been lower than my FSH, but my LH and FSH ration wasn’t like typical PCOS and she said my imbalance was very small. So she diagnosed me as “pco like” but not really she said.

  45. Hi Lara,
    I’m 25. I’ve been struggling with PMS symptoms like increased anxiety/panic attacks, nausea, mood swings, fatigue, acne, etc. beginning a couple days after ovulation is complete all the way up until my period (it usually lasts 7-10 days). I recently started reading your book and am so grateful for all your helpful advice. I just started taking Magnesium and I’m planning to take Vitamin B6 from ovulation until period time. I recently came across DIM and was wondering if you think this could be helpful for me? I feel fine in the first half of my cycle, it’s just the second half of my cycle that causes me to feel terrible- this started within the last year. I’ve never taken any kind of birth control (crazy I know, but I’m grateful after reading your book). I never had acne as a teenager but now I can painful cystic acne, especially before my period. I have come across supplements that contain DIM, Vitex, B6 and Magnesium and I’m wondering if this could be beneficial for me? We don’t have many holistic doctors in my area unfortunately and doctors are quick to jump to wanting to put me on birth control. Any thoughts would be appreciated!!

  46. Hello Lara,
    first of all, thank you for your work.
    I am tracking my temperature for 5 months now and I realized that I am not ovulating because there is no temperature rise. I’ve made a blood test and everything it’s OK (prolactin, cortisol, TSH). I have 25-27-day cycle and I usually bleed for 4-5 days. My gynecologist prescribe me an homeopathy remedy (Platina) but I am still wondering why I am not ovulating at this point. Thank you for your help!

  47. Dear Lara, thank you so much for your wonderful work! I am 30 and I am almost only having anovulatury cycles since I am 18 (that’s when I started tracking my temperature). At the moment I am taking mikronized oral Progesteron in the second cycle half to protect my uterine lining and prevent heavy bleeding. The progesterone works well for the bleeding but of course I would prefer to ovulate (also I am starting to try to receive). The problem is, I don’t know the root cause (I was on the pill from 16-18years, since then no hormonal birth control and I don’t have PCOS – no elevated androgens, no insulin resistance, normal levels in oral glucose tolerance test, cycle has normal length with and without Progesteron, i have hypothyroidism without autoimmune disease but the hormone levels are consistent on l-thyrox and the endocrinologist says that it should not influence the cycle). My endocrinologist called it follicular persistence.
    I read your book (and many other books…) and I try to stick to the main tips regarding sleep, food etc.
    I don’t know if this issue (follicular persistence) is important for more people, but maybe you could write something about this one day (and the main strategies to address it). I would be so happy about it, because I can’t really find any literature on anovulation apart from the reasons you namend above (but obviously it exists).

    Thank you so much! Best regards, Sarah

  48. Doctor Lara, could you please tell me if urinary incontinence has anything to do with hormones?
    I’m a 26 year old woman with PCOS, and I experience urinary incontinence after my period.
    I experience frequent urination and a little incontience every day, but it’s the worst after my period. On the other hand, before my period my bladder is capable of holding more urine.
    I read some woman experience incontince during or before periods, because estrogen lowers, but too me it happens the contrary.
    You have any idea what could cause this, and what I can do about it?

  49. Hi Lara! I am a 23-years old I have irregular periods since the first time I started menstruating. First period was when I had 14 years, the next started half a year later – it was irregular since the beginning. At high scholl, my cycle was sometimes 40 days, sometimes 60 day. I´ve never been on pill, though I suffered from bad acne during high school, but I knew the bad sight of hormonal birth control. Now my acne is much better, but I still have acne mostly on my cheeks, line close to the neck. I suffer from long cycles and when I have cycle longer than 40 days, I sometimes have kind of eruption or rash on my face that clears up after bleeding comes.

    I tried inositol, herbal teas and tinctures for gynecological problems, primrose oil and many more, but nothing helped me, so I started to think that the problem is somewhere deeper.

    I started with fertility awareness method few months before and I know that during some cycles I have ovulation (cycles that are usually 34 days long), but quite often I don´t ovulate and have cycles 45-55 day long. During these long cycles, I sometimes have bleeding also during the cycle that lasts about 6 days, it is not heavy, just a little spotting of blood with red and sometimes brown or black colour. I said that to my doctor, but she just mentioned it is PCOS because of the ultrasound check and said me I must be on a low carb diet, but my androgen levels are OK and I don´t have symptoms of androgen excess (only acne), so according to your book, my diagnosis doesn´t have to be a PCOS. (I am also not insulin resistent). I am wondering more about inflammation, because my doctor test my thyroid and thyroid hormone levels were in normal, but he found a lot of thyroid antibodies there. He also told me that I had to overcome mononucleosis sometimes, but I didn´t realized it. I was at endocrinologist and she controlled my thyroid, but she found ou that it is not damaged and is completely fine, so these antibodies haven´t destroyed it yet.

    My question is: I want to realize the advices you give in the book: stop eating gluten, wheat, cow´s dairy. Start supplement magnesium, zinc, berberin. But my question is, can be thyroid antibodies connected with my intolerance to gluten and my thyroid can be OK?
    I don´t have any digestive problems, but I have an iron deficiency (anemia) that worsens.

    Thank you, Lara, I will be very grateful if you find time to answer my question. Thank you for the things you do for women.

    With best wishes,

  50. “It’s not possible to have a luteal phase longer than 16 days.” – that’s absolutely not true! A normal LP can go anywhere from 10-18 days, and a LP of at least 19 days either means you’re pregnant or you have an ovarian cyst. I’ve been having cysts every cycle and they cause me to have a LP that goes from 25-28 days. Please read the book ‘Taking Charge of Your Fertility’ for more info on this – and you’ll learn how to chart your cycle, too!

    • Thanks for commenting. Yes, I have read Taking Charge of Your Fertility (and even mention Toni’s book a couple of times in Period Repair Manual).

      And yes, a corpus luteum cyst is an uncommon reason to have a longer luteal phase. As is pregnancy (which I thought went without saying– but yes, I should amend that).

      On pages 47 and 102 of Taking Charge of your Fertility, Toni pretty clearly states that the corpus luteum has a lifespan of “12 to 16 days” and “Luteal phases are typically 12 to 16 days.” So, for all intents and purposes, the luteal phase cannot be longer than 16 days. I stated it that way to try to correct the widespread misconception that the luteal phase is the second half of the cycle–no matter how long the cycle.

  51. Hi Lara,
    You’re website seems to be a great find for me! The only thing that I haven’t found much on is bleeding while nursing. I’ve had a few “normal” periods, but some too long and some too short over the past 8 months. I have also had issues staining. My baby is 10 mos now and exclusively and frequently breastfeeding. I I figured anovulation may be a culprit, but now what? How come so many women don’t ovulate AND don’t bleed? How does breastfeeding affect this? Is the best plan of action to restore a healthy period or try to not get one at all?

  52. I have tried tracking ovulation with temperature, and have several times seen an apparent rise indicating a luteal phase, but generally my temperature fluctuates all over the place and I can’t make much sense of it. It ranges from 96.0 to 98.0, rarely making it as high as 98.0, up and down, usually without a noticeable sustained rise. I’ve tried identifying a thyroid issue with a few doctors and even tried prescription thyroid hormone without any help. I am going to have my selenium checked. Any other ideas? Thank you, Lara.

  53. Hi Dr. Lara –

    If cycles are generally 35 days (6-7 day period) combined with polycystic ovaries and elevated AMH, would that look more like an anovulatory cycle picture ? I’m on the thin side (5’4, 117 lbs) and do not have elevated androgens or insulin resistance (based on 1 hour glucose tolerance test). My doctor isn’t sure if it’s PCOS or hypothalamic amenorrhea, so I’m keeping sugar low but still eating moderate carbs (brown rice, sweet potatoes). I also just got off birth control 8 months ago and had a few cycles be 37 – 40 days but they are normally 34-35 days.

    Thank you!

    • A 35-day cycle and 6-day bleed sounds pretty normal! What is the symptom that you or your doctor are concerned about?

      (You can confirm ovulation by tracking your temperatures.)

      • It seems the elevated AMH and polycystic ovaries on my most recent ultrasound are the only red flags. I just had my bloodwork and ultrasound redone after quitting birth control about 8 months ago.

        I’ll try temperature tracking as well! Thank you!

        • Neither AMH nor polycystic ovaries are symptoms or signs that anything is necessarily wrong.

          Do you have any symptoms or problems? For example, are you trying for pregnancy and not succeeding? If you’re ovulating (you can tell by temperatures), then it could be a male issue.

          • We have not started trying, but will likely in the next 3 – 5 years (I’m 30 now). I do not have any common PCOS symptoms (I’m thin, no cystic acne, no dark facial hair). The only issue I have been dealing with was hair loss after I was put on birth control (Yaz) in my 20s. Im off now and am trying to recover my hair. I noticed since stopping birth control my skin and hair can get oily if I have a few days where I’m not eating well (like after a vacation). I eat well anyway, so I just try to limit sugar to keep that in check.

  54. Hi. I came off the pill in March 2017 having been on it on and off for 10 years. My periods before being on the pill were regular and this is the same during my breaks. Since then, I had 2 one day bleeds in the December and following June, then finally what appeared to be a ‘normal period’ in November which lasted 4 days. I am 31, normal BMI and have had multiple hormone tests (all of which continue to be in the normal range) and an ultrasound. Based on my temp and CM charting and a positive OPK strip, I think I ovulated this month and am now on day 11 of my luteul phase. I was wondering if you had any recommendations of how I can speed along this recovery time?

    Thank you

  55. Thank you for the graph detailing the anovulatory cycle. I’m in perimenopause and have had more than several of them. I can usually tell from cervical mucus and cycle length (long!),but I’ve always wondered what my estrogen was up to during the cycle. I’m very hesitant to use any progesterone. I’ve had bad experiences with it and don’t want to take it. I swear my “pms” isn’t as bad when I don’t ovulate. I was diagnosed with a luteal defect long ago, and I think it has something to do with progesterone, even though at the time of diagnoses I was regularly ovulating. I wish perimenopause were easier, but after 4 years of it, I’ve simply accepted that I’m going to be uncomfortable for a while and some day this unpredictable difficulty will end.

    • thanks for your comment. Certainly, it’s possible to get through perimenopause without taking natural progesterone. Read Rescue Prescription for Perimenopause.

      but just to clarify, When you say you’ve had “bad experiences” with progesterone, do you mean natural micronized progesterone like a cream or Prometrium? or do you mean a progestin drug?

      And yes, the withdrawal from progesterone plays a role in PMS. So, if you make no progesterone, there will be no PMS. Unfortunately, there could be other symptoms like heavy periods and sleep issues.

      • Oh thank you for your reply! I’ve only taken natural progesterone cream. It gave me sore breasts. I think it might have made me more moody and emotional, also. I didn’t find that it did anything good. This is at1/8 to 1/4 tsp per day, Source Naturals brand, like 10mg to 20mg/day. I’m afraid to go to my doctor for Prometrium. He would give it to me, but he doesn’t seem particularly intuitive regarding hormone therapy. Also, I’m in the US and don’t have health insurance, so I just deal the best I can – I can’t afford doctor visits or hormone tests. You are absolutely correct about the heavy periods and sleep issues.

        • Breast pain from progesterone can be a sign that progesterone is not the right treatment. It can also be a sign of underlying iodine deficiency. Check out my blog post Why I prescribe iodine for breast pain.

          And just to clarify, progesterone cream is bioidentical progesterone, just at a lower dose than prometrium capsule.

          • I’m going to re-read that post and go back to your book for more reference. I have breast pain even without supplemental progesterone, but it was worse while taking it. I greatly appreciate your reply.

  56. Hi Lara. Thank you for all this useful information. I’m changing my GYN because she won’t discuss and provide options other than taking BC/IUD. I’m 49 and periods are irregular. Some months I feel like I’m ovulating like I did in my 20s/30s with lots of cervical mucus and then other cycles so long ( 50 days?) before seeing a period. I’m taking the mag/ taurine supplements and progesterone cream ( 1 pump) nightly. Seems to help with night sweats but I’d like to try the bioidentical progesterone. Also there is a history of breast cancer in my family… does progesterone protect the breasts? Your information has helped me more than any doctor I’ve seen so far.

    • The current consensus is the natural progesterone is NOT a risk for breast cancer. There’s even some evidence that it may prevent breast cancer, but that is not yet conclusive.

      The progesterone cream is bioidentical progesterone. But, a capsule (Prometrium) is often more effective for the sleep disturbance and heavy periods of perimenopause.

  57. I would be interested to know Lara what you think of a 67yr old woman who finished menopause 17 years ago, having sore breasts suddenly for 7 weeks then having a week long mild bleed …I am gobsmacked by this…how could it be?

  58. Could I ask a slightly off topic question? My 25 year old daughter gets quite painful cramping but it starts right after her period / flow ends. Is there a name for this? Is it abnormal? She has had a copper iud for three years and this has occurred for approximately two years. If this is not the place to ask you this question, is there another forum or time / place I could ask you? Do you do sessions with patients via skype? Many thanks, Marie Ehman

    • Did she check with her doctor?
      Cramping after the period ends could just be from the IUD or it could be a sign of an underlying condition such as infection or endometriosis.

    • Yes, Daysy is one way but its main advantage is its algorithm for avoiding pregnancy.

      If you simply want to know whether you’re ovulating or not, you can use a simple inexpensive thermometer.


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