An irregular menstrual cycle can be experienced by women every once in a while. The irregularity may be a missed period or an early or late menstruation, which is normal and can be totally expected. However, when menstrual cycles are at long intervals, women could be having a condition called as oligomenorrhea.
In the duration of the menstrual cycle, a woman has to go through a period of fertility, which happens every month. The normal and usual menstrual cycle of women is at 28 days length. However, it can vary with time and also on person-to-person. During the menstrual cycle, the uterus lining becomes thick. If sperm is present, then the egg released from the ovaries will get fertilized. In the absence of sperm, a woman undergoes menstruation, which is followed by a repetition of this cycle every month. In some stages of life, many women experience irregular periods.
An irregular period is a change in the normal menstrual cycle. The period can either occur earlier, later, or at very long intervals. Most teenagers experience irregular menstrual cycles after their first menstrual cycle. But after a year or two, the cycle tends to normalize. An irregular period can also be experienced after pregnancy or when switching to a new contraceptive pill. Periods become irregular in premenopause and later stop altogether at menopause.
Oligomenorrhea is the medical term for occasional or light menstrual flow. In oligomenorrhea, women experience irregular or infrequent menstrual periods, which can be lesser than six or eight per year. In this condition, women may go days or even weeks before their normal menstrual cycle starts. A common rule is to consult the doctor after three missed periods.
Young women mostly have a normal menstrual cycle when they reach 16 years old. However, if women’s periods tend to become infrequent or irregular, then there are chances that they might be suffering from oligomenorrhea. Some women with this condition have a difficulty in conceiving or have infertility issues.
- Abnormal gap between menstrual cycles
- Heavy bleeding
- Pain during or before menstrual periods
- Less than 9 menstrual periods in a year
- 35-day gap between periods
- Heavy bleeding in between menstrual cycles
- Unpredictable cycle that can lead to infertility
- Easily broken bones or fractured bones
For women who experience oligomenorrhea that is related with the female athlete triad can experience the following symptoms:
- Frequent fractures, especially in the bones of the hips, lower legs, or spine
- Extensive restrictive diet
- Abnormal eating behavior
- Abnormal rhythm of the heart
- Low blood pressure
- Hormonal Imbalance - The estrogen and progesterone are the two types of hormones found in the body. These hormones control the female reproductive system. Hormonal imbalance can lead to such occurrences if these hormones are not present in right quantities in the body. A hormonal imbalance is considered as a cause for oligomenorrhea. There is an increased risk of heart-related disease and osteoporosis if the estrogen levels are low.
- Use of Oral Contraceptives - This is also based on hormonal changes. The body will find a difficulty in controlling the normal menstrual cycle if there is an abnormal hormone level in the body.
- Polycystic Ovary Syndrome (PCOS) - It is known to be one of the common causes of oligomenorrhea. In this condition, the body creates more androgens than it does, which causes the ovaries to be filled with cysts and can cause menstrual irregularities such as excessive bleeding to amenorrhea and oligomenorrhea.
- Chronic Illnesses - Chronic diseases such as diabetes and osteoporosis as well as estrogen-secreting tumors can affect menstrual cycles.
- Lack of Synchronization - To stimulate the process of ovulation, the hypothalamus, pituitary gland, and ovaries must send messages to each other. A lack of synchronization among these three can result in irregular periods. Sometimes, missed periods are caused when their messages get confused. Usually, this problem resolves on its own. However, sometimes, a kick start is needed to help things get going.
- Inflammatory bowel disease (IBD) and other bowel disorders accompanied by weight loss, abdominal pain, and diarrhea can cause irregular periods. It can also be due to diabetes.
- Uterine disorders such as uterine fibroids, adenomyosis, uterine polyps, and endometrial hyperplasia can cause irregular menstrual cycles.
- Irregular menstrual periods can also be caused by thyrotoxicosis, Prader-Willi syndrome, or Graves' disease.
To diagnose this condition, the doctor should be informed about the menstrual irregularities. The doctor will conduct a complete physical examination and take one's medical history. The doctor can also screen for eating disorders. Various tests are done to establish the hormone levels and to rule out other conditions. These tests include a Pap test, pelvic examination, pregnancy test, and specific blood tests.
- Family History - Women should mention about the time they had their first period, how frequently their periods have been occurring, as well as any health problems during childhood or infancy. If a woman is aware of a family history of irregular periods, then she should mention it to the doctor. She should also inform the doctor if she experiences other signs or symptoms such as discharge from the breasts, adult acne, headaches, impaired vision, and facial or chest hair. The doctor will also ask about any medications, herbs, and vitamins used by the patient, as well as ask if one is recently stressed, if recent gynecological procedures have been performed, if there are any changes in the diet, a change in one's weight or exercise patterns, or any illnesses.
- Examination - The doctor will conduct a physical examination of the face, neck, abdomen, and breasts.
- Testing - The doctor may request for blood tests to be done. Such tests will measure the levels of hormones in the body. To check for any hypothalamic or pituitary gland abnormalities in the brain, the doctor might ask to carry out an MRI test. If the doctor suspects any chromosomal abnormality, then he may suggest a chromosomal analysis. A pelvic ultrasound may be recommended to identify any abnormalities of the cervix, vagina, and uterus.
Oligomenorrhea can be a symptom of other health conditions and diseases. For this reason, other underlying medical conditions should be diagnosed first. Most of the time, adolescents, menopausal, and premenopausal women do not require any kind of treatment.
Since a majority of the cases are linked to hormonal imbalances, the treatment plan should also be associated with the hormones.
- Oral Medications - Oral medications can help balance the level of hormones in the body. Once these hormone levels are balanced, the menstrual cycle will return back to normal. This would take over a period of a couple of months. As a treatment for oligomenorrhea, some doctors prescribe birth control pills to treat hormonal imbalances. The synthetic hormones present in these pills will help control the functioning of the reproductive system of women. Once the course of birth control pills is completed, menstrual cycles would return back to normal. Pills are known to regulate menstrual dysfunctions. Although these pills can be used to treat oligomenorrhea, a woman’s body should manage to normally return to having menstrual cycles. Anti-androgen medications are given to those who have high levels of androgen. This is done to encourage ovulation. Some factors that could pose a problem are excess weight gain, being underweight, lack of exercise, and poor health. If these issues are taken care of, then women having irregular periods can be completely cured without any medical intervention.
- Reducing Environmental Stress - Environmental factors can also cause menstrual irregularities. Women should consume a healthy diet, maintain proper body weight, and avoid stress. Athletes with oligomenorrhea are recommended to have a nutritious diet.
- Surgery or Therapy - These procedures are done in rare cases to deal with malfunctioned glands, which are the causes of hormonal imbalance. Sometimes, alternative treatments such as natural hormone replacement, acupuncture, dietary changes, and nutrition counseling are recommended.
- Bromocriptine - Oligomenorrhea can also be due to hyperprolactinemia and tumors, which could be treated by bromocriptine or by surgical removal of the tumor.
- Polycystic ovary syndrome (PCOS) - The usual treatment of PCOS would include the use of hormonal drugs or injections. This can help regulate the menstrual cycle and cause an ovulation.
- Eating Disorder - An eating disorder also leads to oligomenorrhea. Such condition is usually treated with the help of psychotherapy and medical treatment. An overweight woman is advised to reduce weight according to her body mass index (BMI).
- Alternative Treatment - Alternative treatments are based on the cause of the condition. If laboratory tests indicate a hormonal imbalance, then natural hormone replacements are recommended. Glandular therapy is a therapy in which balance is brought about in the glands, which are involved in the reproductive cycle. These glands include the hypothalamus, thyroid, ovaries, renal glands, and the pituitary gland. Certain Western and Chinese alternative medicine can also be effective.
- Coriander - Boil one teaspoon of coriander seeds in two cups of water. Boil it until the water is reduced to half. Strain it and drink it three times a day. Drink it one week before menses.
- Carrot - Drink one glass of carrot juice daily for three months.
- Fennel - In one glass of water, soak three tablespoons of fennel overnight. The next morning, strain it and drink the water. Drink it daily for one month.
- Papaya - Make unripened papaya juice and drink it daily for three months. Drink it one week before menses and not during the menses.
- Sesame seeds - Dry roast sesame seeds for 4-5 minutes. Grind the seeds with 1 teaspoon jaggery and make a fine powder of it. Have this mixture daily on an empty stomach. It should be consumed 15 days before menses.
Other helpful herbs include dong quai (Angelica sinensis), chaste tree (Vitex agnus-castus), and black cohosh (Cimicifuga racemosa). These herbs are regarded as emmenagogues, which are substances that can help stimulate menstrual periods. Meditation, guided imagery, and visualization also can relieve emotional stress and help in treating oligomenorrhea.
Models, professional athletes, and dancers, especially ballet dancers, are most prone to oligomenorrhea. Since they undergo vigorous physical training, strict diet, and weight restrictions, they are inclined to have menstrual irregularities. Women or girls who perform strenuous exercises or are suffering from anorexia nervosa are at an increased risk of having irregular periods. Even women with a female athlete triad, hormonal dysfunctions, chronic diseases, and those who have certain drug addictions are also at risk of menstrual problems.
The following risks and complications may develop due to late periods:
- Cardiovascular diseases
- Uterine cancer
Women having oligomenorrhea also have fewer chances of pregnancy. The reason is that having an irregular menstrual cycle makes conception quite difficult. Hence, oligomenorrhea can become a serious issue for those who want to become pregnant. That is why it is very important to get treatment for such condition. Medications can increase a woman's chances of conceiving by restoring the body’s ovulation.
Women with oligomenorrhea, even those with PCOS have been successfully treated with hormone therapy. They have restored their fertility, begin ovulating during menstrual period, and have frequent periods. The outlook of this condition is poor in women who show no response to the hormones or have existing conditions that lead to oligomenorrhea.
Women who experience oligomenorrhea can have a difficulty in conceiving and may need to take fertility drugs. The usual complications of oligomenorrhea are osteoporosis, cardiovascular diseases, and repeated bone fractures. These complications tend to increase later in life. Women having irregular periods are also more prone to develop uterine cancer. Female athletes who develop osteoporosis or bone loss in their early 20s and late teens are at a higher risk of developing arthritis.
Adequate protein, essential fatty acids, fresh fruits, vegetables, and whole grains should be included in a woman's diet. A healthy balanced diet becomes very important for women who regularly engage in strenuous exercises and those who have other nutritional deficiencies.
A nutritionist should be consulted to check on the diet followed by female athletes. It should be checked whether they are eating a proper and balanced diet, which will help them maintain a healthy weight for their height. Women who are involved in sports such as softball, weightlifting, or basketball are at a lesser risk of developing eating disorders than those who participate in dance and other sports. To lower the risk of osteoporosis, athletes must take vitamin D supplements on a timely basis.
Prevention of Oligomenorrhea
Oligomenorrhea can be prevented only in women with a low body fat to weight ratio. A low body fat to weight ratio keeps them from maintaining a regular menstrual cycle. For female athletes, less vigorous training schedules and adequate nutrition might help in preventing oligomenorrhea. Oligomenorrhea caused by a hormonal imbalance cannot be prevented, but can be corrected.
Having irregular periods is not usually a cause for concern in teenagers who have just begun their menstrual cycle. However, oligomenorrhea in an adolescent or teenager should still be noted and investigated. Parents should be caring and should offer emotional support to their daughters, especially those who are away from their homes for the first time or those who are loners. During the freshman year, such individuals may be at risk of developing the female athlete triad.