Heavy Menstrual Bleeding, Improving Knowledge, Improving Lives
Ovulatory dysfunction as cause of Heavy Menstrual Bleeding

Ovulatory dysfunction 


  • Abnormal, irregular or absent ovulation.
  • Common in the extremes of reproductive life1
  • Causes may include polycystic ovary syndrome, obesity, anorexia, mental stress, extreme exercise1,2



  • Menstruation is often unpredictable and irregular (presentation ranging from amenorrhea and very light bleeding to extremely heavy bleeding episodes)1,2,3



  • Medical history of irregular menses4
  • Structural causes can be excluded by imaging and/or histopathological assessments1



  • Hormonal treatment (combined oral contraceptives, oral progestins, levonorgestrel intrauterine system)
  • If a specific cause is identified (i.e. thyroid disease), treatment should be directed
  • Life style modifications if applicable (i.e. obesity)
  • Other treatment options include NSAIDs and tranexamic acid

Ovulatory Dysfunction Library

Find more information and download materials on ovulatory dysfunction in the teaching and resources library.


  1. Munro MG, et al. Int J Gynaecol Obstet 2011;113:3–13.
  2. Whitaker L & Critchley HO. Best Pract Res Clin Obstet Gynaecol 2016;34:54–65.
  3. Munro et al, Int J Gynecol Obstet 2018; 1-16
  4. Munro MG, et al. BJOG 2017;124:185–9.
  5. Albers JR, et al. Am Fam Physician 2004;69:1915–26.

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