Usually most cases of anovulation respond positively to medical treatment which consists in the administration of ovulatory stimulating drugs. Clomiphene citrate -Serophene, Clomid, Milophene are among the most common drugs.
If anovulation’s underlying cause doesn’t positively respond to medical treatment the currant physician has to recommend surgery in order to reestablish patient’s normal reproductive parameters.
Also rare medical cases like pituitary macro-adenoma, which presents severe and unresponsive to medication symptoms – diplopia, bitemporal hemianopsia and severe headaches- require surgical treatment.
Surgery prevails when an ovarian or adrenal neoplasm whether malignant or benign is detected, the most common surgical procedure in these cases is exploratory laparotomy, but also resection and staging can be prescribed.
When the underlying cause of anovulation is the polycystic ovary syndrome PCOS surgical procedures- ovarian drilling and wedge-resection- have up to 80% post surgery positive results.
Dilatation and curettage surgery is also used in the rare cases of acute bleeding which don’t respond to traditional therapy. If acute bleeding and blood loss lead to profound anemia the only option remains hysterectomy surgery.
If the systemic problem is related to obesity and weight loss could trigger curative improvements bariatric surgery is performed. Other procedures which can also bring benefits to the patient’s condition are simple or vertical banded gastroplasty, gastric banding surgery and vertical stapling surgery along the less effective roux-en-Y gastric bypass operation.
If the patient’s body mass index – BMI- rises above 35 and anovulation traditional medical care failed, the overweight must be considered, in itself, a life-threatening condition and recommends the patient for surgery.
In the various complications associated with anovulation and its treatment the gynecologist must collaborate with other specialists: with neurosurgeons if the patient suffers from nonresponsive microadenoma; with psychiatrists, psychologists and nutritionists if the patient suffers from a dimorphic disorder combined with bulimia or anorexia.
Moreover if anovulation is caused by an endocrine disorder the currant physician must consult with endocrinologists to find the best medical treatment for disease such as Cushing syndrome, overt type II diabetes mellitus, Sheehan syndrome, refractory-thyroid, and Addison diseases.
General surgeons, gynecologists, oncologists, reproductive endocrinologists and specialists in infertility usually have to join their efforts in order to solve some of the most complicated cases.
Anovulation entails other related metabolic derangements – as insulin resistance, cardiovascular risk – that require a well balanced low-carbohydrates and low-cholesterol diet combined with a cardiovascular exercise program in order to obtain post operatory maximum results.