Often, ovulation only receives attention in the context of fertility and contraceptive choices, but a growing body of research is finally expanding the conversation.  As it turns out, evidence is showing that the process of ovulation has a vast array of positive healthy consequences for women’s bodies that extend far beyond reproductive health.

So, even if your main health concerns happen to be something other than fertility, chances are that your ovulatory process is more important than you think. And based on past trends in medicine, I would imagine that mainstream medicine will soon be recognizing and incorporating this wisdom into practice.  (Although, to be realistic, advances in research can take as long as 11-17 years to be integrated into conventional medical practice.)

Does the idea of gaining health benefits from ovulating surprise you?

Men generate testosterone every day, so you might think women do something similar, but it doesn’t work that way.

Instead, women’s bodies make hormones in surges: a pulse of estradiol leading up to ovulation and an even bigger pulse of progesterone secreted during ovulation itself.

And, over the course of a lifetime–whether during the maturation of the menstrual cycle that takes place over approximately 12 years after puberty, or during the middle of the fertile reproductive years, or during the hormonal transition of perimenopause – the multi-faceted health benefits of ovulation are many.

 Benefits of Ovulation

Healthy ovulation is the only way for women’s bodies to naturally produce a significant amount of progesterone, which has myriad benefits across the body-mind system. The benefits of ovulation include:

• The progesterone secreted by a healthy egg is known to help decrease inflammation throughout the body. Anti-inflammatory effects are far-reaching and include reduced body pain (joint pain such as in rheumatoid arthritis and other conditions), immune strength and resolution of infections (including COVID and other viral infections), support for brain health including improved recovery from concussion and traumatic brain injury (TBI), and diminished swelling and fluid retention .

• Healthy ovulation is protective against inflammatory hormones like cortisol and testosterone, which can promote weight gain, susceptibility to acne, and changes in hair.

• Progesterone in general supports improved skin tone and elasticity.

• Healthy levels of ovulatory progesterone help women’s bodies regulate immune function. This includes having a balancing effect against allergies and counteracting the allergenic/histaminergic effects of estrogen. Progesterone also decreases susceptibility to autoimmunity, which is why some women have an increase in autoimmune diagnoses in the post-partum period when progesterone is low and why there may be an increased risk of autoimmunity in conditions of chronic, prolonged stress that interrupt ovulation. Progesterone is also protective against viral illnesses, which is why some women experience increased colds, flus, and sickness symptoms the week before their cycle when progesterone dips.

• Progesterone stimulates key glandular signaling in the brain that impacts the health of the rest of the hormone system including supporting healthy thyroid function.

• Natural ovulatory progesterone is healthy and protective of breast tissue whereas synthetically derived progestogens like those found in the mini pill may increase risk of breast cancer

• Healthy levels of progesterone, again linked to ovulation, are also known to promote better quality sleep and reduce insomnia.

• Progesterone is calming for the nervous system, helping to stabilize an anti-anxiety neurotransmitter in the brain known as GABA.

• Healthy progesterone associated with ovulation is also thought to promote neuroplasticity, or resiliency at the level of the neural networks. This impacts women’s ability to have a healthy stress response and adapt well to stress with learning and change. Some women are much more sensitive to fluctuations in this type of progesterone-brain signaling and may experience intense mood fluctuations during the week prior to their cycle, e.g. PMS or PMDD. These intense mood changes can be made much worse if ovulation is either not occurring naturally, suppressed via birth control, or skipped.

• A healthy balanced level of progesterone can protect the body against certain cancers as well as prevent the growth of fibroids, polyps, and other endometrial lesions.

Put simply, ovulation is important for healthy immune and metabolic systems, stabilized mood, glowing skin, an adaptive stress response, as well as normal periods and reproductive health. And, there are both short-term (month-to-month) and long-term (lifelong) benefits to ovulatory progesterone.

The Long View: Lifelong Benefits to Ovulatory Cycles and Natural Progesterone Exposure

• It’s been determined that the rhythm and maturity of the menstrual cycle develops slowly over the course of about 10-15 years after puberty. During this time, a system of intercommunication and steadiness develops across the mind-body landscape. (The hypothalamic-pituitary-ovarian axis, or HPO axis, to be precise.)

• Over time, healthy regular ovulation builds up a ‘metabolic reserve’ in the body, protecting it from developing insulin resistance and helping to boost muscle gains.

• Long-term exposure to ovarian hormones across the lifespan supports healthy bone density, stimulates bone formation and protects against severe osteoporosis.

What Does This Mean About Choosing Among Contraceptive Options?

Perhaps you are already aware that the hormones in the birth control pill don't replace the hormones that the body makes naturally. Instead, they mask and suppress them.  The period at the end of a birth control pill pack is not a real period; it's simply a withdrawal bleed from no longer being exposed to the synthetic hormones in the pill pack. That means that the brain, skin, nervous system, mood, metabolism, bones, cardiovascular system, motivation, inspiration, and creativity are not being influenced by the hormonal cycles of naturally occurring estrogen and progesterone.

 

The synthetic progestogens in the combined birth control pill and the hormonal IUD are not the same as natural body-identical progesterone. Synthetic progestogens have been found to have slightly inflammatory effects in the body increasing susceptibility to everything from acne and allergies to weight gain and autoimmunity.

 

If that’s not enough, there are landmark studies showing that taking hormonal birth control pills as a teenager can cause a clinically significant increase in the likelihood of anxiety and depression. This makes so much sense when you read about the benefits of ovulatory progesterone (above) and imagine depriving an adolescent brain and nervous system from those influences.  The mood changes are typically detected about 12-18 months after the initiation of the hormonal birth control pill, just long enough to make the need for a new SSRI prescription a year-later appear to be unrelated.  Another longer-range study suggests that the use of hormonal birth control pill in adolescence impacts brain plasticity in long-lasting ways that may increase the likelihood for anxiety and depression into adulthood.

Often in my practice, I’m asked the questions about whether hormonal birth control is a good option.  Honestly, it’s a very personal choice and not one that I feel comfortable making for someone else.  But I do love sharing information. And, at this point, we have such a breadth of information about the health benefits of ovulation – which is either suppressed or partially suppressed by many forms of hormonal birth control – that I think the mainstream recommendations around ‘the pill’ should be accompanied by a much more thorough and empowering conversation.

Of note, some of the newer versions of synthetic progestin-eluting IUDs do not completely suppress ovulation, especially after you get through the first year after implantation.  They are not without other considerations and side effects but may be a less suppressive option.  There are also other methods worthy of consideration.

How Does All of This Impact the Process of Perimenopause and Menopause?

The average age of menopause is typically 51 years. Menopause is defined by 12+ months without a menstrual cycle; however we know that the perimenopausal process of gradual hormonal transition, begins many years prior. 

In my practice, I like to expand our timescale for understanding the gradual process of hormonal transition to include possible signs and symptoms arriving anytime between 37-55 to better appreciate the nuance and subtlety taking place. That’s because, in general, the rhythm and regularity of ovulation may become more susceptible to disruption, less stable, until it becomes less and less frequent and then obsolete. 

In fact, the body’s exposure to progesterone starts to decline during hormonal transition of perimenopause before the decline in estrogen.  Some of the effects of declining progesterone related to irregular ovulation during this time may include the following:

• Increased perceived stress.

• Increased risk of depression and anxiety.

• Lighter sleep/insomnia, especially in the middle of the night.

• Symptoms associated with fluctuating or relative excesses of estrogen including hot flashes, migraines, heavier cycles, breast pain.

Perimenopause is a vulnerable time–literally ovulation has become more vulnerable–but it’s important to know that it won’t last forever.  (Also, many women report feeling better than ever after it’s over; something to look forward to.)  This stage of hormonal transition is a good time to be especially protective of boundaries, access to rest, and nervous system regulation.  While ultimately the arrival of perimenopause and menopause is influenced by genetics, it may be helpful to observe practices that support ovulation for as long as it is still happening (see below).

 

On the bright side, some of the new research validating the health benefits of progesterone has helped clinicians better understand and support symptomatic women during perimenopause. If you are going to look into hormone replacement therapy:

• Look for a prescriber willing to recommend body-identical, oral micronized progesterone capsules (not a synthetic progestin) for effective treatment.

• And, choose dietary, lifestyle, and botanical therapies that help minimize hormonal fluctuations in the meantime.

Obstacles to Ovulation: More Common Than You Think

The concept of ‘ovulatory disturbance’ – or lifestyle factors and stressors that may potentially interrupt this natural process in women’s bodies – is becoming more recognized.  The data is showing us that disturbances are much more common that we originally recognized. See below to learn about many potential interferences that may prevent regular healthy ovulation including:

 

• Hormonal Birth Control: While effective in preventing pregnancy, many forms of hormonal synthetic birth control pills disrupt natural ovulation, impacting various bodily systems.

• Undereating, Over-exercise, and Carbohydrate Restriction: In response to insufficient nutrients coming in, the body makes an adaptive energy-conserving decision to pause reproductive cycling.  If prolonged, this process leads to a condition known as hypothalamic amenorrhea (HA).  Monthly bleeds may disappear. More than likely ovulation is impacted as well.

• Polycystic Ovarian Syndrome (PCOS): PCOS is a condition characterized by lack of ovulation, the presence of cystic structures on the ovaries, and/or hyperandrogenism (increased testosterone-related hormones). Symptoms may include irregular/long cycles, increased body hair and/or acne, and/or weight gain. Comprehensive treatment of PCOS helps treat the root causes and restore balance can help regulate ovulation.

• Environmental Toxins + Endocrine Disruptors: Chemicals like BPAS, phthalates, parabens, and forever chemicals in products like personal care products, home goods, cleaning products, and plastics can act as ‘xenobiotics’ or ‘xenoestrogens’ that interfere with hormonal detoxification, ovulation, and fertility.  Choose organic, body-safe, self-care products like shampoos/conditioners, soaps, lotions, make-up, etc. Ditch all synthetic fragrances, perfumes, and colognes, and products with added synthetic scents (some of the worst offenders — leave those scented garbage bags and air freshners on the shelves please). Opt for food and water stored in glass rather than plastic. And buy fragrance free organic cleaning products.

• Smoking: Both cigarettes and marijuana negatively affect ovulation and fertility. 

• Excessive Prolonged Stress: Chronic stress impacts ovulation by up to 70%. 

• Choose Health Omega 3 Fats and Avoid Processed Foods and Trans fats: A Harvard University study illustrated that each 2% increase in the intake of trans fats (processed cakes, pastries, candies, processed foods, fried foods) increases the risk of ovulatory infertility by 73%. Shop the perimeter at the grocery store and skip the packaged foods.

• Poor Sleep: Altered melatonin (our sleep-promotion hormone) can interfere with ovulation.

• Thyroid disease: Untreated hypothyroidism is correlated with interferences in ovulation, irregular menses, subfertility, and higher rates of miscarriage.

• Nutrient deficiencies: Lower levels of nutrients such as zinc, selenium, iodine, and vitamin D can impede ovulation.

Take-Aways for Women’s Health?

• Let’s Shift the Paradigm: It’s really important that we embrace the idea that the menstrual cycle is a sign of health and a key indicator of balance in women’s bodies, not just a process to be tolerated, suppressed, or regulated. Of course, conditions and scenarios may arise that definitely warrant judicious use of synthetically-derived hormonal regulation, such as the oral contraceptive pill, but perhaps, their use should be much more carefully considered than has been conventionally practiced. Just imagine an alternate medical reality in which the answer to contraceptive choice and reproductive health for men was simply to prescribe a synthetically-derived medication that interfered with testosterone production. Essentially, that’s what we’ve been led to believe as the medical norm.

• Consider Ovulation as the Main Event of the Cycle: Ovulation, which happens in the middle of the cycle, is the most important physiologic event in the monthly cycle, not the monthly bleed. For many people, this happens imperceptibly . . . but with practice and attention, it’s possible to bring more awareness and attunement to this process.

• Understand the Power of Natural Progesterone

• Look Out for Signs of Progesterone Withdrawal During Ovulatory Disturbances or Perimenopause: Natural body identical progesterone may be a healthy option in some cases.

• Know that the Cycle is About More Than Fertility: Ovulation is not just important for fertility and/or reproductive health. It is an overall indicatory of health as well as a generator of health for our brain, mood, muscles, metabolism, bones, cardiovascular system, breasts, digestion, and thyroid.

• Chart Your Cycle: Think of it this way: the combined mini-pill suppresses women’s ovarian hormones and quiets the cycle, basically in order to make women’s bodies consistently the same all month long. However, the natural state of an ovulating body is to fluctuate and change. One way to reclaim empowerment of your health and symptoms is to build body literacy, tracking and charting signs of ovulation (cervical mucus, basal body temperature changes) and your menstrual flow and become the expert in your body’s fluctuating needs. From there, you can start to listen to your body’s needs and become responsive rather than suppressive. Amazingly, the American Congress of Obstetricians and Gynecologists (ACOG) started recommending menstrual cycle charting and tracking for young women in 2015. Early signs of a possible sea change?

• Embrace Nutrient, Botanical, Dietary, + Lifestyle Options: There are so many different evidence-based options to help re-establish healthy ovulation and work towards a comfortable, symptom-free menstrual cycle. These options may take a bit more time, but the empowerment, health benefits, and freedom from a cascade of symptoms (and polypharmacy) is very often worth the effort.

REFERENCES

• Cho, M.K., et al. Thyroid dysfunction and subfertility. Clinical & Experimental Reproductive Medicine, 2015. 42(4). PMID: 26816871.

• Chavarro, J.E. Dietary fatty acid intakes and the risk of ovulatory infertility. American Journal of Clinical Nutrition, 2007. 85(1). PMID: 17209201.

• Johansson T, Vinther Larsen S, Bui M, Ek WE, Karlsson T, Johansson Å. Population-based cohort study of oral contraceptive use and risk of depression. Epidemiol Psychiatr Sci. 2023 Jun 12;32:e39. doi: 10.1017/S2045796023000525. PMID: 37303201; PMCID: PMC10294242.

• Kloss, J.D., et al. Sleep, Sleep Disturbance and Fertility in Women. Sleep Medicine Reviews, 2015. PMID: 25458772.

• Munster K, Schmidt L, Helm P. Length and variation in the menstrual cycle--a cross-sectional study from a Danish county. Br J Obstet Gynaecol 1992; 99(5):422-429.

• Pizzorno, J., et al. Environmental Toxins and Infertility. Integrative Medicine, 2018. 17(2). PMID: 30962779.

• Schliep, K.C., et al. Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study. Epidemiology, 2015. 26(2). PMID: 25643098.

• Yen, Y-J., et al. Early- and Late-Luteal-Phase Estrogen and Progesterone Levels of Women with Premenstrual Dysphoric Disorder. International Journal of Environmental Research & Public Health, 2019. 16(22). PMID: 31703451.