Anovulation

If the preovulatory surge of LH is not sufficient, anovulation can occur. The pre-ovulatory surge of LH is linked to the positive feedback of the pre-ovulatory estrogen peak. Lack of ovulation leads to failure in the development of the corpus luteum and subsequent production of progesterone.
Infertility is defined as a year of unprotected intercourse without achieving pregnancy. Infertility occurs in about 10% of the population. The probability of anovulation or luteal phase defect causing infertility is 20% 40% and 3% to10%, respectively. Functional infertility occurs as a result of several conditions. Rising estrogen and progesterone levels inhibit LH and FSH. Corpus luteum degenerates and becomes refractory to LH. Finally, withdrawal of progesterone (estrogen) occurs and results in endometrium deterioration and menstruation.

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome is a common condition (4% to 10% of America women of reproductive age) that accounts for approximately 8% of anovulation cases. PCOS is used to describe a group of clinical presentations characterized by bilateral polycystic ovaries potentially combined with amenorrhea, anovulation, infertility, insulin resistance, truncal obesity, and hirsutism. Hormone imbalances may include hypothalamus, pituitary, ovarian, adrenal, insulin excess (Syndrome X), androgen excess, and prolactin excess.
Other endocrine disorders that can mimic PCOS include adrenal and ovarian cancers, Cushing’ s disease, and hyperthyroidism or hypothyroidism.

Premenstrual Syndrome (PMS)

PMS is described as a group of symptoms that include mood swings, hypoglycemia (food cravings), depression, bloating, and other complaints occurring during the luteal phase of the menstrual cycle. With the onset of menses, the symptoms usually disappear.
Progesterone deficiency, increased estrogen, or estrogen/ progesterone imbalance can all trigger PMS. Factors associated with an increased ratio of estrogens/progesterone include a history of pregnancy, abortion, tubal ligation, hysterectomy, oral contraceptive use, and anovulatory cycles. Other factors implicated in the etiology of PMS are Western lifestyle, decreased hepatic production of estriol, excessive aldosterone production, dysinsulinemia, hyperprolactinemia, and calcium and magnesium deficiency.

PMS Symptoms

PMS symptoms have been divided into four groups:

PMS-A: Anxiety, including nervousness, irritability, and sudden mood swings.
PMS-C: Cravings, including typical hypoglycemic symptoms, such as headache, dizziness, and brain fog, which are better from eating carbohydrates.
PMS-D: Depression as well as crying, insomnia, and poor memory.
PMS-H: Hyperhydration resulting in bloating, edema, and weight gain.

Amenorrhea

Functional secondary amenorrhea or oligomenorrhea is defined as the failure of a woman with periodic menses to experience menstruation for 6 consecutive months. The association between high intensity athletic training and menstrual disturbances may be attributable in part to altered nutritional intake and body mass and in part to exercise- and competition-induced stress.48 One study observed that salivary progesterone levels change with age, that lower progesterone peaks were recorded in women aged 18 to19 and 40 to 44 years, and that women experienced a gradual increase in peak progesterone levels from age 20 to 39.49

Clinical Studies

Luteal Phase Defects
Patients with prolonged, unexplained infertility experienced a high frequency of luteal phase defects, including pre-ovulatory progesterone peaks, interruption of progesterone secretion during the luteal phase, and high progesterone levels at the beginning of menstruation. Researchers recorded a correlation of 0.71 (10 of 14) between low progesterone levels and luteinized unruptured follicle cycles. Another study of 50 infertile women with regular menstrual cycles of normal length revealed low progesterone levels in subgroups with three menstrual patterns: cycles with luteinized unruptured follicles, cycles with an early luteinizing surge, and normal controls.