You’re trying to conceive and noticing signs of ovulation (hello EWCM 😉), but your ovulation tests keep coming back negative or with faint lines.
Your cycles are irregular, and you’re wondering if it's possible to ovulate twice without a period in between.
Perhaps, you have PCOS and are convinced you’re not ovulating at all. Or maybe you’re ovulating later or earlier than you think, but you’re just not sure.
Sound familiar?
As a fertility dietitian with over 20 years of experience, I help women improve their fertility and prepare their bodies for a healthy pregnancy—without drastic diets or unnecessary supplements.
Let’s explore why ovulation may not be happening, and what you can do about it.
On this page you will find:
What is ovulation and how does it work if you’re trying to conceive?
Ovulation is when an egg is released from your ovary into the fallopian tubes during a menstrual cycle. This is essential for conception. So if you’re trying to get pregnant, then it's important that your body ovulates regularly.
The brain and ovaries communicate directly through hormones. In the first phase of the menstrual cycle, oestrogen levels rise and the brain releases hormones called Follicle Stimulated Hormone (FSH) and Luteinising Hormone (LH). When FSH and LH rise (the latter is called LH surge), the brain signals to the ovary to release the egg.
When are you more likely to get pregnant?
It's possible to get pregnant by timing intercourse before ovulation (up to 5 days before and including the day of ovulation), although it's best to try every other day throughout the menstrual cycle. The reason is that many women struggle to identify their ovulation window.
The menstrual cycle length depends on the length of your follicular phase, the phase before ovulation. This causes your cycle to be short or long. It means your ovulation day shifts from cycle to cycle. And this is normal.
What is anovulation?
For some women ovulation doesn't happen every month (called oligo-ovulation), or not at all (called anovulation).
Anovulatory cycles (when you don’t ovulate) can impact both your past and future menstrual cycles. Research shows that even during cycles where ovulation does occur, women who’ve had anovulatory cycles may still experience hormone imbalances. This could mean there’s an underlying issue with the ovaries or brain affecting your hormone regulation.
Before we talk about the reasons for not ovulating, if your goal is to grow your family but it hasn't happened yet, despite having regular periods, then consider if it's due to male factor infertility rather than it’s you not ovulating (...or a combination of both).
How can I tell if I am ovulating?
It’s tricky, but there are a few methods:
Ultrasound scan
The gold standard to accurately detect whether you ovulate is daily, mid-cycle transvaginal ultrasound scans. Though, this isn't practical, so there are other methods to track ovulation but their accuracy is up for debate. Yet, having regular periods is a good sign of ovulating.
Physical signs and symptoms
Most of the time during ovulation you won't feel any change in your body. Sometimes you may notice:
Mild cramps on one side or middle of the lower tummy
bloating
nausea or sickness
mood changes
Or a distinct change in vaginal secretions (cervical mucous)
Basal Body Temperature (BBT)
BBT confirms ovulation after the event. When you monitor BBT, you expect a low temperature before ovulation, then a distinct rise of 0.2–0.3 °C following ovulation. Finally, to confirm ovulation, you want the temperature to stay high for at least 3 days.
This method cannot accurately predict the fertile window and it's possible to ovulate without the rise in temperature. Sleep pattern, alcohol intake, stress, fever, room temperature and the time you wake up in the morning all affect BBT, which makes it a less useful method when trying to conceive.
Ovulation Prediction Kits (OPKs)
OPKs are useful but not foolproof. They detect a rise in LH using urine strips before ovulation takes place. The onset of LH surge usually happens around 34 hours before ovulation (ranges from 22-56 hours), while the peak happens 10-12 hours before ovulation.
OPKs can predict ovulation if you have a regular standard cycle (e.g. 28 days), but making it difficult to pinpoint if you have shorter or longer cycles and if you're using tests with different sensitivity thresholds.
Testing from cycle day 7 maximises the chance of detecting your LH surge. But they can detect an LH peak after ovulation, providing a false end of your fertile window [see next question].
Hormone blood tests
A progesterone blood test 7 days after ovulation can confirm ovulation has occurred. Using a combination of hormones through blood tests (LH and Progesterone) is thought to be better than using OPKs alone.
Is it possible to ovulate for longer than a day?
If you’ve been testing with LH urine strips to determine when it's likely you will ovulate, then you may have noticed that sometimes you have more than one peak or that LH levels plateau for a couple of days in your cycle. Sometimes the LH surge only lasts 3 days and other times it takes longer than 5 days.
This doesn’t mean ovulation lasts longer. It's natural for the LH to pulse through the cycle. Often LH peak levels are detected on the day of ovulation or even occur after ovulation. For that reason, you could test negative (or with faint lines) on the LH urine tests and still get pregnant.
Can I ovulate without a period?
Yes, if you’re pregnant. Normally, 11-14 days after ovulation, your period would arrive. This is the length of your luteal phase of your menstrual cycle. If you’re not ovulating then your periods may be absent or irregular.
Can I have regular periods and not ovulate?
Yes, these cycles are called anovulatory cycles. Understanding anovulatory cycles helps you decide what's going on in your body and when to seek medical and professional advice.
Here is what you need to know:
Frequency of Anovulatory Cycles
You may have heard that you skipped ovulation but it's likely that you ovulated at a different time than you expected. In healthy women with regular cycles (<35 days), anovulation is rare- less than 4% of cycles. So this means no more than one anovulatory cycle per year.
A mid-cycle LH surge detects a higher proportion of anovulatory cycles (~18.6%) compared to serum progesterone taken in the luteal phase of the menstrual cycle. This difference is due to the methods used to detect ovulation (hormones via a blood test or urine test).
So if, following a blood test, progesterone levels are low and don’t confirm ovulation, then this could be due to the timing of the test. In this case consider if:
this was a prolonged cycle
the test was not done at the right time (i.e. 7 days post ovulation)
there is an underlying condition that impacts FSH levels or
you are the age over 40
Abnormal Uterine Bleeding
Even if your periods seem normal, you might not be ovulating, particularly if you're experiencing irregular heavy bleeding or spotting. This type of bleeding is called Abnormal Uterine Bleeding (AUB).
AUB due to anovulation or due to ovulatory disorders like PCOS, is often diagnosed after ruling out other causes. It needs to be resolved with lifestyle changes and medical management, as it can lead to endometrial hyperplasia or cancer.
It might be time to seek medical support, if you’re experiencing any of the following:
your periods are non-existent for 90 days or more
you had 3 consecutive irregular periods (longer than 35 days or shorter than 24 days)
you noticed spotting or bleeding in between periods or without a break
As a fertility dietitian, I can help you regulate your cycles naturally and improve ovulation through balanced nutrition.
Reasons for not ovulating (anovulation or oligo-ovulation)
Several factors can interfere with ovulation, but the predominant factor is hormonal imbalance.
Age:
For the first few years during puberty (when your period starts), and the years leading up to menopause or perimenopause (when your periods completely stop), it’s normal to have irregular periods. The maturity of the ovaries and the brain system influence the rhythm of the menstrual period.
Pregnancy:
If you’re pregnant your body is focusing on growing your baby. So menstrual periods and ovulation stop.
Breastfeeding:
If you’re exclusively breastfeeding there are disruptions in the hormones including LH. It affects the development of the follicles, preventing ovulation and the return of the menstrual cycle. The hormone prolactin also increases to support breastfeeding and may influence ovulation.
PCOS (Polycystic Ovary syndrome):
PCOS is linked with irregular or absent periods, high androgens (testostorone), insulin resistance and changes to FSH and LH levels. Many women with PCOS will experience no ovulation or irregular ovulation.
FHA (Functional Hypothalamic Amenorrhea):
FHA is a condition of absent periods as a response to chronic physical and mental stress. It often develops as a result of low body weight and/or excessive exercise. Less hormones are produced in the brain (FSH and LH), impacting ovarian function and preventing ovulation.
POI (Premature Ovarian Insufficiency):
POI signifies that there are few follicles in the ovaries or the follicles do not respond to hormones, so the eggs don’t mature. Effectively affects women entering menopause before the age of 40 and who are experiencing no periods for at least 4 months.
Thyroid Disorders:
Thyroid hormones can influence FSH and LH causing irregular menstruation and ovulation. Insulin resistance may also be present in both underactive and overactive thyroid, which may impact ovulation disorders in women. Correcting an underactive and an overactive thyroid improves your cycle and ovulation.
Lifestyle factors including diet, exercise, body weight and stress
A poor diet that is rich in fats, sugars and animal protein, along with a sedentary lifestyle and long-term stress, can lead to weight gain. Obesity causes hormonal imbalances and inflammation affecting fertility and the success of treatments like IVF.
Being underweight or over exercising (for more than 60 minutes per day) can also disrupt hormone regulation leading to missed ovulation. Women who are underweight, overweight or obese often have irregular cycles, with hormones like insulin playing a role in cycle's regularity. Obesity is linked with insulin resistance which is common in conditions like PCOS and hyperprolactinemia (elevated levels of prolactin).
Daily stress appears to disrupt the menstrual cycle by altering LH and FSH levels and suppressing ovulation, and is linked to insulin resistance.
What to do to help me ovulate naturally?
You can encourage regular ovulation with a few simple lifestyle changes:
Dietary changes to promote ovulation
Dietary patterns
A diet that is plentiful of vegetables, fruit, olive oil, oily fish and whole-grain foods with less alcohol and red meat consumption can reduce certain inflammatory markers and oxidative stress. These markers have been linked with ovulation disorders like PCOS.
So adopting a Mediterranean diet can help in restoring ovarian function and ovulation.
The role of healthy fats
While not eating enough fat may contribute to irregular or absent cycles, the quality of the fat is more important when it comes to promoting ovulation.
Healthy fats like omega-3s have been linked with higher progesterone levels during luteal phase and reduce incidence of anovulation. So eating oily fish, nuts and seeds can lower the risk of anovulatory cycles.
Wholegrains and Fibre
The type and quality of wholegrains can influence ovulation by their effect on insulin sensitivity. High insulin levels are linked with high androgens which impact the function of the ovaries.
Eating more brown rice, whole grain pasta, and bread can support ovulation more so than white rice or boiled potatoes. If you are over 30s, then increasing your fibre intake by 10gr per day can lower the risk of having problems with ovulation.
Plant protein
Protein that is derived from plants like beans, lentils, nuts and seeds promotes ovulation in comparison to diets that are high in animal protein (mainly red meat and processed meats).
A study showed that a high intake of lentils and beans is linked with high progesterone levels. So eating more legumes may lower the risk of anovulation by 47%.
Dairy
The link with dairy products like milk, cheese and yoghurts and ovulation is not clear.
One study found that eating more than one serving of full-fat (or high-fat) dairy products can lower the risk of infertility caused by ovulation problems. However, eating daily up to 2 servings of yogurt may increase the chance of occasional issues with ovulation.
Alcohol and Caffeine
There isn’t a clear link between drinking alcohol and caffeine and problems with ovulation. One study showed that having 2 or more energy drinks with caffeine can increase the risk of ovulation issues by 47%. But drinking coffee or tea (up to 200-300 mg caffeine a day) doesn’t affect ovulation.
Drinking 3 or more alcoholic drinks a week, especially around ovulation, can lower your chances of getting pregnant. Alcohol may affect hormone levels, particularly oestrogen, which can interfere with ovulation, though the evidence isn't strong.
If you’re trying to conceive, it's best to limit alcohol.
Lifestyle adjustments
Lifestyle changes including maintaining a healthy weight, being active and managing stress levels have a huge impact on your reproductive health and fertility.
Losing or gaining weight to healthy levels
Being overweight can affect your fertility. Losing weight can help balance your hormones and improve insulin resistance. If you’re not ovulating because of your weight, even losing as little as 2.5kg over 4-6 months can improve your menstrual cycle and increase your chances of ovulating and getting pregnant.
Losing an excessive amount of weight, like after weight loss surgery, improves the rate of ovulation, but it might affect other aspects of your fertility and pregnancy.
If you're underweight (BMI under 19), gaining weight to a healthier level can help regulate your ovulation.
Importance of regular exercise
Regular physical activity improves fertility, whether you’re overweight or not. Moderate exercise can help restart ovulation , especially for women with PCOS or other ovulation issues. It also helps improve insulin resistance.
But, it's important not to overdo it - too much exercise can negatively affect ovulation and your fertility. Exercising for 30-60 minutes a day can lower the risk of not ovulating.
The best type of exercise for restoring ovulation isn’t clear, but a mix of cardio and strength training might help. Research suggests the exercise plan may need to be adjusted if your BMI is lower than 35.
Sleep and its impact on hormones
While there’s no direct link between sleep problems and ovulation, poor quality and short sleep may affect your menstrual cycle. If you work shifts (including night shifts), you’re more likely to have irregular periods (varying up to 7 days between each cycle) which can change when you ovulate.
Getting enough sleep - about 7-8hrs a night- is important for your overall health and fertility. Establishing a good sleep routine can help improve the quality of your sleep.
Limit environmental exposures to support your hormones
Chemicals like PFAS and BPA, found in some products and packaging, can interfere with your hormones. While there’s no clear link to how these chemicals affect ovulation, reducing your exposure can help protect your reproductive health.
Try using bottles, containers, and cooking tools that don’t contain these chemicals. Reheat food in glass containers and avoid putting plastic containers in the dishwasher.
Supplements and Herbal remedies
A balanced diet is essential for our reproductive health, but there are individuals who may benefit from additional supplements. Supplements can cost an arm and a leg, so before you invest your hard-earned cash, check out below the evidence of various supplements in supporting ovulation.
Folic Acid and other B vitamins
Taking a prenatal that contains enough folic acid and other B vitamins can help protect against ovulation problems. Having adequate folate from food and supplements can lower the chance of missing ovulation. Your blood folate levels might also affect the progesterone level later in your cycle (during your luteal phase).
There’s no solid evidence that extra vitamin B6 or B12 supplements influence ovulation. One study found that eating foods rich in riboflavin, Vitamin B6 and vitamin B12 don’t affect ovulation either.
Vitamin D
Vitamin D is important for making reproductive hormones and keeping your menstrual cycle regular by acting directly in the ovary. Although we don’t fully understand how it works, low vitamin D levels may lead to lower oestrogen levels and longer menstrual cycles. This can cause late ovulation. You can check your vitamin D levels with a blood test. [link to fertility blood testing].
Inositol
Inositols are natural compounds that help manage hormones like insulin, thyroid hormones and those related to reproduction ( FSH and LH). You can find them in fruits, beans, seeds and nuts.
Inositol may help regulate menstrual cycles, improve ovulation and lower insulin resistance and androgen levels in women with PCOS. While iInositols are generally safe, they can sometimes cause digestive issues like diarrhoea or nausea. It’s important to talk to a professional to find the right dosage and type of inositol that suits your needs.
CoQ10
Coenzyme Q10, or CoQ10, is an antioxidant that may help protect eggs in the ovaries from damage (oxidative stress). Research shows that for women with PCOS, taking CoQ10 for just 8 weeks can improve insulin resistance, lower testosterone levels and increase FSH, which can support ovulation. Although it’s safe to take, it's important to consult a dietitian to find the right dose for you.
Other supplements
There are some other supplements that claim to promote ovulation including;
Vitex (chastebbery)
Maca Root
Ceylon cinnamon
Mucinex
Yet, there isn’t much research available on how effective these supplements are for ovarian function and ovulation.
When to seek support from a fertility dietitian and nutritionist?
It’s time to consult a fertility dietitian for professional support when:
You’ve tried all the supplements under the sun, made simple changes to your diet and lifestyle but you still have no clue how to increase your chance of conception.
You have PCOS, a thyroid condition or diagnosed with other conditions that causing hormone imbalance and your periods have gone missing for months.
You’re trying to lose weight to help bring on ovulation and nothing seems to work.
If you feel it's time to seek professional support to regulate your cycles naturally and speed up your TTC journey, I’m here to help. Let's work together to create a personalised plan that nurtures your health and fertility.
Dr Katie Psarou, PhD, MSc, BSc (Hons) RD MBDA
UK Registered Fertility and Maternal Health Dietitian