After 10 years of being on hormonal birth control, Victoria and her husband decided to try for a baby. But for the next year of her life, she didn’t have any ovulation symptoms—no discharge or basal body temperature changes, no breast soreness or tenderness. Nothing. As a teenager she was never taught about ovulation and its function in the female body, so everything she learned was from a simple Google search. For many months she was unsure whether she was even ovulating at all. It’s estimated that about 25% of female infertility cases in the United States are caused by anovulation, which is when an egg doesn’t release from your ovary at all during the appropriate part of your cycle.
Some women are able to solve the issue of anovulation in a short amount of time, but not everyone is so lucky. Thankfully, after a whole year of frustration and concern, Victoria finally did get pregnant naturally. She feels fortunate that she had a happy outcome because thousands of other women have been presented with a different ending.
Hardly any woman gives ovulation much thought at all until she’s ready to have a baby. After all, what’s the point of ovulating if you don’t want to get pregnant? This common thought has largely arisen from the fact that most women were simply not taught anything about their hormonal cycle at a young age, other than the fact that you bleed once a month, and if your period is late or a no-show, you might be pregnant. In January 2023, I surveyed 1,055 women ages 18 and older, and 82% of them said they were never taught about ovulation by a parent or doctor while growing up. The women who participated in my survey who that were taught about ovulation only knew basic information, such as it happens every month, it’s the time when an egg is released, or that it’s the only period of the month you can fall pregnant. Some women said they learned about ovulation in Catholic school, from books they were given during their teenage years, or from the basic health class they were required to take in 5th grade. But these women were most certainly in the minority.
An overwhelming number of responses in my survey indicated that the vast majority of women weren’t taught a single thing about ovulation in their youth, which left many of them thinking that ovulation wasn’t really all that important if they didn’t don’t have an interest in getting pregnant any time soon. However, ovulation is incredibly important for women in their childbearing years, regardless of whether they want to remain childless or give birth multiple times.
Ovulation Is the Main Event
The phase of our cycle that always generates the most attention is menstruation. In fact, most women simply see their cycle as broken up into two phases: menstruating, and not menstruating. We’re even at a point where many women have been convinced that they don’t need to menstruate if they don’t want to. This is coupled with the rise of hormonal birth control methods that either eliminate a woman’s period altogether or significantly reduce the frequency of it. The response to this is excitement and thrill—after all, it sounds pretty great to avoid four days of bleeding and discomfort.
Clinically, when patients of mine don’t ovulate, often because of birth control, they crash over time.
This same logic has been applied to ovulation. Many women believe there’s just no point to it, especially if they don’t want to get pregnant. But to understand ovulation is to truly understand your hormones and overall health.
Dr. Charlie Fagenholz, frequency medicine and functional medicine doctor with many years of clinical experience, explains the very basics of ovulation. “In simple terms, what is happening is an egg is released from the dominant follicle within an ovary into the fallopian tube where it can become fertilized by sperm,” he says. “This is the point of the cycle where females can get pregnant.”
Julia Glanz, registered hormone dietitian and strength & conditioning coach, adds some color: “From a physiological standpoint, ovulation is when one of the matured follicles in your ovaries releases an egg. The egg travels through your fallopian tube and into your uterus. After the egg is released, the follicle closes and forms a structure called a corpus luteum. The corpus luteum is a gland that makes progesterone (and some estrogen).”
To fully understand the role of ovulation, we have to take a step back and take a bird’s eye view of our entire menstrual cycle.
“There are two main phases of your menstrual cycle: the follicular phase and luteal phase,” Julia explains. Day 1 of your period, which is considered the first day of bleeding, marks the beginning of your follicular phase. This lasts until you begin ovulation. Phase 2 is the luteal phase, which begins the day after ovulation and lasts until your next period starts.
“The main goal of the follicular phase is to promote follicle growth and prepare your endometrium lining to receive an egg, which is released from ovulation,” Julia continues. “Follicle-Stimulating Hormone (FSH) starts to rise and as the name describes, this hormone stimulates a few follicles to grow and mature.”
Each follicle contains one egg, and as follicles grow, they produce estrogen, which “stimulates the uterine lining to thicken.” When your estrogen reaches a certain threshold, your brain releases something called luteinizing hormone (LH), and a surge in LH triggers ovulation.
When ovulation ends, your luteal phase arrives and lasts about two weeks. During the first several days of your luteal phase, the goal is to “support the thickened endometrium lining in preparation for a potential fertilized egg – whether or not you are trying to conceive.” Julia says this is because your endometrium lining is the very thing that provides the nutrient supply for the potential fertilized egg.
To understand ovulation is to truly understand your hormones and overall health.
“Progesterone is the main hormone responsible for continuing to support the endometrium lining. Progesterone peaks around 5-7 days after ovulation,” she continues. “If there is no fertilized egg, your hormones estrogen and progesterone will then start to decline. The decline in hormones happens during week 2 of the Luteal Phase. When your hormones decline to a certain point, it causes your endometrium to shed – this is when your period begins.”
All of these hormonal fluctuations may sound arbitrary, but they are incredibly important and shouldn’t be dismissed. The rise of estrogen and progesterone in the body does much more than just prepare you for pregnancy. According to Dr. Charlie, they promote muscle development, blood sugar balance, heart health, immune system health (think anti-cancer), inflammation reduction, and brain health. He says these hormones even create good metabolic health, so if you’re on a weight-loss path in your childbearing years, ovulating is particularly important.
“Ovulation is the main event of your menstrual cycle,” Julia adds. “Hormonally, right before ovulation, you get a peak in estrogen and testosterone. The peak in these hormones can give you a boost in energy and mood.”
Dr. Poppy Daniels, an OBGYN, says rising estrogen can increase libido and increase healthy vaginal secretions. She also describes the importance of the rise of progesterone for both your menstrual and mental health.
“Progesterone has a calming effect on the brain,” she tells me. “I call it the ‘mood stabilizer’ hormone. Without it, women have more mood problems, irritability, PMS, heavier/clottier periods etc. If there is inadequate progesterone [or] a luteal phase defect, then pregnancy is unlikely or more likely to result in a miscarriage or a chemical pregnancy.”
Even if you’re not planning on getting pregnant, ovulating regularly is important, because without ovulation you don’t get that natural peak of progesterone. This could lead to a host of issues, such as higher levels of anxiety and insomnia, irregular periods, heavy or painful periods, spotting or light periods, or lack of periods (amenorrhea), according to Julia. Additionally, Dr. Daniels refers to progesterone as “the key mood and sleep hormone.”
You might think that synthetic hormones could easily replace your body’s natural progesterone, but that’s not the case. “Synthetic progestins in birth control cannot reproduce these effects in the body,” Dr. Daniels describes. “In fact, they have the opposite effect on mood. Studies have shown that ALL forms of synthetic hormonal birth control increase the risk for anxiety and depression, but progestin-only contraceptives have a higher risk, especially in adolescents.”
“Clinically, when patients of mine don’t ovulate, often because of birth control, they crash over time,” Dr. Charlie describes. “They feel like shells of themselves, so to speak. Their immune system function decreases, they have mental and emotional issues like anxiety and depression, they gain weight, lose all libido, and usually experience headaches or migraines among other symptoms.”
Ovulation is the main event of your menstrual cycle.
Regardless of what your plans are for future pregnancy, ovulation is a necessary bodily function that contributes to a vibrant, healthy life during your childbearing years. It’s concerning at best that conventional medical doctors hardly, if ever, mention the importance of ovulation to their female patients who come to them with questions or health issues.
With contraception more available and accessible than ever in the United States, it was estimated in 2017 that 65% of women between the ages of 15-49 were taking some form of contraception, and 14% of those women were taking the birth control pill. Surely that number has increased over the last six years. The main feature of the pill that is hardly ever spoken about (not even by the doctor who is prescribing it) is that it halts ovulation by shutting off the communication between your brain and ovaries.
“What’s happening is that since there is a consistent supply of estrogen, your brain does not send the necessary signal (Follicle-Stimulating Hormone) to your ovaries to make more estrogen,” Julia says. “This results in no signal to your brain to release Luteinizing Hormone, which means Luteinizing Hormone doesn’t trigger ovulation.”
So for all the years that women are on the birth control pill, they don’t get all the hormonal advantages that come with ovulation, including the natural peak in progesterone that helps with mood, immunity, muscle development, less likelihood of mental health issues, healthy libido, etc. It’s no wonder Dr. Charlie says that so many of his patients who don’t ovulate regularly feel like “a shell of themselves.”
Roughly 68% of the women I surveyed have taken the pill at some point in their life, and out of those women, about 25% said they noticed they had trouble ovulating naturally once they stopped taking the pill. Amanda had her first period at 11 years old and was put on the pill at 18. She decided to come off the pill at 22 years old and didn’t get her period for four months in a row. Soon after, she was diagnosed with polycystic ovarian syndrome (PCOS). Julia says our body has “an innate ability to restore regular, healthy ovulation after coming off the birth control pill,” but it could take a long time for your body to ovulate again regularly. For some women, it can take a couple months, but for others, they have to wait a lot longer. Even for the women who do ovulate again fairly quickly after coming off the pill, their general menstrual cycle is so irregular that it’s nearly impossible to predict when they’re ovulating and when their period will arrive.
Danielle told me she had “irregular ovulation cycles following years of oral contraceptive.” After getting off the pill, she only bled one or two times over the course of eight months. She was also showing signs of PCOS and her blood work showed high testosterone levels, and yet she had never had any symptoms prior to the pill that would indicate PCOS. Danielle got pregnant about eight months after throwing away the pill, but during that whole time she never established a regular menstrual cycle.
Just about any conventional medical doctor or OBGYN will tell their patients that the pill doesn’t disrupt your natural hormones or menstrual cycle, and that when you come off the pill, you will simply ovulate again. Simple as that. But countless women have indicated otherwise.
Another woman named Mary Jo didn’t have a menstrual cycle for a whole year after coming off the birth control pill, and she says she certainly struggled with regular ovulation. When Katie came off the pill, she couldn’t ovulate normally to her knowledge, and her periods would last anywhere from 30-60 days. Shelley said her menstrual cycle and ovulation were so erratic after getting off the pill that she was never able to determine which days she was going to ovulate unless she checked her mucus or suddenly “felt a higher sex drive than usual.”
The birth control pill isn’t the only cause of disrupted ovulation.
Hundreds of other women told me similar experiences, reporting Hashimoto’s symptoms, periods every two weeks, cervical pain, fatigue, excessive bleeding, bad acne, and crazy emotions when they got off the pill. All the while, they were never able to confidently determine when their body was going to ovulate.
The Dark Side of Estrogen Dominance
The birth control pill isn’t the only cause of disrupted ovulation. In fact, Dr. Charlie says if his female patient isn’t (or hasn’t been) on the pill, the most common cause of hormonal imbalance is estrogen dominance.
“[Estrogen dominance] essentially is what birth control creates, but you can also get into this state due to our toxic environment,” he explains. “So many components of our environment have estrogenizing effects on us. This includes foods, pesticides, plastics, drinking water, furniture, beauty products, and the list goes on.”
All the toxins we consume on a regular basis lead to “destabilization of hormones and clogged detox pathways.” And if we aren’t able to detox, Dr. Charlie says “nothing in our body will function properly.” Being in an estrogen dominant state also commonly leads to fungal infections in the body such as Candida albicans, which creates a gut dysbiosis that leads to “every metabolic disorder known to humanity.”
Estrogen dominance is often referred to as a cause of fertility issues and anovulatory cycles. Women who are suffering from this issue may have a period each month, but they could lack ovulation altogether. It’s important to note that estrogen is a wonderful hormone that our body needs for a variety of healthy functions, but we need proper amounts of progesterone to keep estrogen in check, so to speak. Elevated estrogen and low progesterone go hand in hand, so the disruption of the balance between the two can lead to a host of health issues in addition to disrupted or absent ovulation, such as uterine fibroids, extreme mood swings or irritability, visible acne, breast tenderness, disproportionate weight gain around your hips, heavy and painful periods, and insomnia. “Also, if there is no balance of progesterone and estrogen, irregular bleeding is more common,” Dr. Daniels adds.
Estrogen dominance is not a medical term that is used by conventional doctors, so you may not get much recognition from your OBGYN if you ask them for ways to treat estrogen dominance, but Dr. Charlie says he treats patients with estrogen dominance on a regular basis so it’s something that is requiring more and more attention.
However, estrogen dominance isn’t the only other cause of ovulation issues. “A few reasons why you might not ovulate may be due to high levels of stress, undereating, high androgens as seen in PCOS, high prolactin, low thyroid hormones,” Julia adds. “Ovulation and getting your period are both markers of health. If you are missing either one consistently, it’s worth seeking a professional that can help you further look into the root cause of why that’s happening.”
Hello, Ovulation, My Old Friend
Our bodies are fascinating, mysterious systems that are capable of great healing if we simply give them the right tools. Women must understand that no matter how many years they were on the pill or how long they struggled with estrogen dominance, they can return to a healthy menstrual cycle and regular ovulation again one day. A crucial part of the puzzle is believing that you will get there one day.
“Coming off hormonal birth control and getting pregnant right away can sometimes lead to inadequate progesterone support and miscarriage,” Dr. Daniels says. This is due to the fact that your body has a lot to catch up on hormonally, so it might take a while to get back to equilibrium. Dr. Charlie says the first step is to detox your body and get rid of all the disruptors in your life.
“Now this requires a complete change in lifestyle,” he says. “Your diet should consist of fresh organic produce, healthy fats, and well-sourced meats and seafood. Essentially a Mediterranean diet. There is so much information out there about seed cycling and eating certain foods for different parts of your cycle, which all have benefits, but in my opinion, it is more important to change your overall diet first and foremost. The goal is for you to actually eat a healthy diet everyday, and if you add too much change too fast, it gets overwhelming and you are more likely to fall off the wagon.”
Julia regularly posts useful tips on how to add more fiber and nutrient-dense foods to your diet. In one of her reels, she shares the five foods she eats daily: chia seeds, Brussels sprouts, extra-virgin olive oil, pasture-raised eggs, and some kind of potato. She also encourages women not to fall for the low-carb fad. Carbohydrates are especially important for women’s hormonal cycle, and she says going low-carb can actually slow down your metabolism.
For women who are coming off the pill and want to regain healthy ovulation, Dr. Daniels recommends eating a whole foods, nutrient-dense diet with as much organic food as you can. She recommends eating healthy fats, as sex hormones are made from cholesterol, sleeping well, actively managing stress, and developing a healthy mindset.
Women coming off the pill should eat a whole foods, non-GMO, organic if possible diet high in healthy fats (sex hormones are made from cholesterol), work on adequate sleep & active stress management (improves growth hormone production and balances cortisol), a healthy mental attitude is important.
Never give up hope that your body will heal itself.
In addition to a healthy diet, Julia recommends some supplements. “For anyone currently on or coming off the birth control pill, it's important to prioritize repleting your body with essential nutrients that birth control depletes, including B vitamins, Vitamin C, magnesium, selenium and zinc, which are also essential for supporting your natural hormone production,” she recommends.
“High quality prenatal vitamins are necessary as most people's diets are not perfect,” Dr. Daniels adds. Yes, even if you don’t want to get pregnant, taking prenatal vitamins can be very helpful during your childbearing years.
“Next, keep your detox pathways open,” Dr. Charlie suggests. “To do this, cleaning out gut dysbiosis like fungus, bad bacteria, viruses and parasites is a must. This is usually accomplished with herbs and diet change.” He often recommends two supplements called Inspiracell and Schisandra Supreme, as well as artichoke extract.
“Also make sure you are exercising and sweating often. Sweating is one of the best ways to detox naturally on top of good hydration and having bowel movements everyday,” he adds.
Never give up hope that your body will heal itself. Leah struggled with both disrupted anovulation and estrogen dominance after coming off the pill. She even had excessive hypertension, excessive sweating, and intense mood swings. But suddenly at 44 years old, she got pregnant. Casey didn’t ovulate for 11 months after she finished taking the pill, but finally in the 12th month she was thrilled to see she was pregnant. Lydia was only 18 when she was put on the pill, and after trying three different kinds of hormonal contraception, her period disappeared for a while. After getting off the pill altogether, she took advice from various health experts online and did everything she could to restore her natural cycle.
“I was able to completely get off the pill and now I have regular periods without having to take any medication!” she told me.
Whether you want to get pregnant or you simply want to feel and look your best during your childbearing years, ovulation is your friend. Don’t take it for granted. And never lose hope of your natural, cyclical ovulation being restored one day.
Love Evie? Sign up for our newsletter and get curated content weekly!