Can you ovulate but not get a period?

I have heard/read in quite a few places now that it is possible to be ovulating regularly but not getting a period, or folks think they are ovulating but not getting that monthly bleed.

THIS IS NOT TRUE. If you ovulate, you will either have a period or be pregnant (okay there are a couple other small caveats, see below.)

Ovulation without getting a period is feasible only under very limited circumstances:

• On a hormonal IUD/implant. The hormone doses are low enough that they do not affect the reproductive system in general; locally the hormones prevent buildup of the uterine lining and thus many on the hormonal IUD/implant will ovulate but not get a period.

• A physical abnormality that prevents bleeding, such as Asherman’s syndrome or a reproductive system defect that does not allow for discharge of the uterine lining.

• If pregnancy occurs on the first post-amenorrhea ovulation.

  
  

Barring that, the mechanism does not seem plausible. If you are not having a period, then you are almost certainly not ovulating. Keep reading to learn more!

What happens in a normal menstrual cycle?

1. The egg-containing follicle starts growing at the beginning of the cycle and the uterine lining is thin.

2. As egg/follicle growth and maturation continues, estradiol is secreted.

3. The estradiol leads to an increase in the thickness of the uterine lining. The lining continues to thicken as the dominant follicle is selected and proceeds to maturation.

4. When the egg/follicle is mature, the increased estradiol leads to release of a large amount of luteinizing hormone (LH), your surge, that causes ovulation.

The increased estradiol also leads to a thickened uterine lining, that will shed later in the cycle if you are not pregnant.

And while it may be true in a small minority of cases that the lining does not respond to estradiol and get thicker (this IS the case with the Mirena IUD), in a normal menstrual cycle the lining will thicken.

My suspicion is that if someone’s lining did not respond to estradiol by thickening, that would always have been the case and they would never have gotten a period – primary amenorrhea.

It IS possible to have an LH surge that does not lead to ovulation, particularly in HA recovery or return to fertility postpartum. This is one reason that using a method of tracking ovulation that allows for confirmation of ovulation after the fact is so useful! (Learn more in No Period. Now What "Tracking Ovulation and Family Planning" Chapter)

What happens after ovulation?

After ovulation, progesterone and estrogen are secreted by the cells that surrounded the now-released egg, maintaining the thickness of the lining and causing other changes that prepare the lining to accept an embryo.

If no pregnancy occurs, progesterone drops and the lining is shed.

If progesterone levels are lower than normal, the lining is shed earlier.

But there will almost certainly be a bleed of some amount.

What else might be happening?

If you are getting changes in cervical mucus each month that seem to indicate ovulation, but no bleed, it is possible that your body is trying to ovulate but not quite succeeding. 

If that’s the case, or if you are not having ovulation symptoms at all… Consider whether you might have hypothalamic amenorrhea (HA). (Asherman’s syndrome should also be ruled out.)

It's not unusual to have some hormonal cycling before period recovery that can feel like you're getting PMS (pre-menstrual syndrome), or patches of fertile-like cervical mucus.

You might want to consider tracking your temperature, or using various options to test for hormones (e.g. ovulation predictor kits) to get some more information on what's going on. Chapter 17 in No Period. Now What? covers tracking and confirming ovulation.