Oligomenorrhea: Infrequent Periods

Oligomenorrhea is characterized by having a menstrual cycle that lasts more than 35 days or by a total of 9 or fewer periods throughout the year. Oligomenorrhea is a common menstrual abnormality in females. Generally, the menstrual cycle spans a period of 28 days on average, with a range of 21-35 days being considered normal.

Although irregular periods are common during menopause, postpartum, and perimenopausal phases and are generally regarded as normal, they are considered abnormal in other circumstances.

What are the symptoms associated with oligomenorrhea?

The most common symptoms of oligomenorrhea are:

  • Menstrual cycle longer than 35 days or more
  • Having 9 or fewer menstrual periods in a year
  • Light or scanty bleeding during menstruation.

Oligomenorrhea does not manifest symptoms of its own, but it can be an indicator of another underlying condition. Oligomenorrhea might be accompanied by a range of other symptoms, including:

  • Acne
  • Excessive hair growth in a male-like pattern (hirsutism)
  • Weight gain or difficulty losing weight
  • Light menstrual flow
  • Menstrual cramps and bloating during periods
  • Breast tenderness
  • Mood changes
  • Headaches
  • Impaired vision
  • Hot flashes
  • Vaginal discharge
  • Fatigue.

It is important to consider additional symptoms according to the underlying disease that causes oligomenorrhea.

What causes oligomenorrhea?

  • Hormonal imbalance: Various hormones (GnHR, estrogen, and progesterone) are produced by the brain and reproductive organs that are responsible to regulate the periods. If there is an imbalance, periods can become irregular. Often, this hormonal imbalance is the primary cause of oligomenorrhea.
  • Weight fluctuation: Significant weight loss or gain can affect menstrual regularity. In cases of extreme weight loss, the body might not have an adequate amount of fat stores to produce a sufficient amount of estrogen, leading to irregular periods. Similarly, rapid weight gain or obesity can also throw off hormone levels and result in oligomenorrhea.
  • Stress and lifestyle factors: Both emotional and physical stress can affect the hypothalamus-pituitary-ovarian axis and reproductive system adversely, which regulate the menstrual cycle. Chronic illness, travel, or drastic lifestyle changes can contribute to irregular periods.
  • Extreme exercise: Intense physical exercise, especially among athletes, can disrupt the normal menstrual cycle. This is known as exercise-induced amenorrhea, a type of oligomenorrhea that is due to the body’s response to extreme activity and low body fat ratio.
  • Sleep: Inadequate sleep and irregular sleep patterns can negatively impact hormone regulation and lead to oligomenorrhea. Proper sleep is essential for maintaining hormonal balance and overall health.
  • Alcohol consumption and excessive caffeine intake: Alcohol and caffeine can disrupt the hormonal balance, causing irregular periods.

What underlying conditions cause oligomenorrhea?

Oligomenorrhea is not a disease itself rather it is a symptom of numerous underlying diseases. The underlying conditions that cause oligomenorrhea include:

  • Polycystic ovary syndrome: 1 in every 10 women is diagnosed with PCOS across the globe. In PCOS, there is increased secretion of androgens that results in hormonal imbalance, leading to oligomenorrhea, weight gain, hirsutism, and acne.
  • Thyroid disorders: Increased or decreased levels of thyroid hormones (T3, T4) in hypothyroidism or hyperthyroidism alter levels of sex hormones. So, either increased or decreased activity of the thyroid might result in oligomenorrhea.
  • Pituitary tumors: The pituitary gland releases several sex hormones that regulate the menstrual cycle. Pituitary tumors cause abnormalities in the production and release of various hormones including prolactin and FSH leading to irregular menstrual cycle.
  • Androgen-secreting tumors: Androgen-secreting tumors of the ovary and adrenal glands cause excessive androgen secretion that disturbs the normal monthly cycle.
  • Cushing syndrome: It is characterized by increased levels of the cortisol hormone. Elevated cortisol suppresses the release of sex hormones from the pituitary, leading to irregular periods.
  • Prolactinoma: It is a benign tumor of the pituitary gland that causes hyperprolactinemia. Increased prolactin suppresses FSH and LH secretion. This disruption can disturb the menstrual cycle and may lead to conditions like oligomenorrhea
  • Premature ovarian failure: Also known as primary ovarian syndrome. Normally, the menstrual cycle ceases in the 40s or 50s, but in this condition, there is dysfunction or depletion of ovarian follicles before the age of 40.
  • Pelvic inflammatory disease: It is marked by infection and inflammation of female reproductive organs due to sexually transmitted bacteria, viruses, or fungi. It also may result in oligomenorrhea.
  • Ashermann’s syndrome: The uterus gets obstructed by scar tissue and adhesions that ultimately end up causing irregular menstrual cycles.
  • Congenital adrenal hyperplasia: In this condition, there is an absence of enzymes required to produce two important hormones, cortisol and aldosterone. As a result, the adrenal glands produce an increased amount of androgens (male hormone). The excess androgens interfere with the regulation of the normal menstrual cycle.
  • Eating disorders: Anorexia nervosa, which causes a decrease in estrogen, and bulimia nervosa, which results in electrolyte imbalance, impact menstrual cycles and disrupt them.
  • Chronic diseases: Conditions like diabetes or liver disease can disrupt hormonal balance, impacting menstrual regularity.

Contraceptives and medications

Some types of contraceptives, such as birth control pills or intrauterine devices (IUDs), can affect the normal menstrual cycle. Certain medications can also disrupt period regularity. These include:

  • Anti-anxiety
  • Anti-psychotics
  • Anti-epileptics.

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What are the complications caused by oligomenorrhea?

Oligomenorrhea itself may not be a serious health concern, the underlying conditions causing it can lead to further complications if not addressed. Some of these include:

  • Infertility: If oligomenorrhea is left untreated, it can cause difficulty in getting pregnant.
  • Endometrial hyperplasia: Irregular or infrequent periods can lead to endometrial hyperplasia, a thickening of the uterine lining.
  • Endometrial cancer: Endometrial hyperplasia, characterized by the continuous growth of the endometrial lining without regular shedding due to missed periods, can increase the risk of developing endometrial cancer.
  • Cardiovascular problems: Estrogen plays an important role in heart health. In oligomenorrhea, the levels of estrogen are disturbed, increasing the risk of heart-related issues.
  • Osteoporosis: Estrogen plays a critical role in preserving bone density. Ultimately, low levels of estrogen in oligomenorrhea result in osteoporosis, enhancing the risk of fractures.
  • Psychological disturbance: Menstrual irregularities are emotionally challenging and can result in anxiety and depression.

How to diagnose oligomenorrhea?

Diagnosing oligomenorrhea requires a comprehensive evaluation by a healthcare professional.

Medical history

The doctor will take a detailed history from you that includes your menstrual history, age of menarche, normal menstrual flow, number of pads used, menstrual pain, and also a family history of reproductive diseases or abnormalities.

Physical examinations

The doctor will perform certain physical examinations that are:

  • Abdominal examination: To check for tenderness, distention, any bulge, or abnormal mass.
  • Physical examination of the head, neck, and breast: To rule out any underlying disorder and to find out other related symptoms.
  • Pelvic examination: A rectovaginal examination to palpate any abnormal structure in the reproductive organs. A vaginal speculum examination is also done to identify any inflammation, growth, or scarring.

Lab tests

Certain laboratory tests will be carried out to determine the levels of hormones in the body, which will surely help to diagnose the underlying disease. These include:

  • FSH
  • LH
  • TSH (Thyroid-stimulating hormone)
  • Prolactin
  • Free testosterone.

Tests will also be done to check blood sugar levels:

  • HbA1c

Imaging studies

These help visualize any structural defects or other causes of oligomenorrhea. Imaging studies include:

  • Ultrasound: This is used for both pelvic and abdominal evaluations, helping to identify structural abnormalities in the ovaries, fallopian tubes, uterus, and cervix.
  • CT scan: Offers detailed images that can help identify structural abnormalities or tumors.
  • MRI: This imaging technique provides in-depth and detailed images that might not be obtained by other imaging tests.
  • Hysteroscopy: A thin tube (hysteroscope) is inserted inside the uterus through the vagina allowing for the direct examination of the uterine tube to identify abnormalities.

How to manage oligomenorrhea?

The management of oligomenorrhea depends entirely on the treatment of the underlying medical condition.

  • Lifestyle changes: Certain modifications in lifestyle can treat oligomenorrhea resulting from hormonal disturbances. These include eating a healthy diet, avoiding junk and fast food, managing stress, exercising, getting adequate sleep, and making behavioral modifications.
  • Weight loss: For women with PCOS, weight loss can be significantly effective in treating this condition.
  • Hormonal therapy: Oligomenorrhea due to hormonal imbalance involves therapies that aim to restore and stabilize hormone levels. This includes birth control pills and other hormonal medications.
  • Surgical interventions: Certain structural abnormalities require surgical interventions to treat underlying conditions.
  • Treatment of the underlying conditions: Ultimately, the most effective treatment is pinpointing and addressing the primary cause of oligomenorrhea.

What are the effective home remedies for oligomenorrhea?

Oligomenorrhea is a medical condition that is diagnosed and best treated by healthcare professionals. However, certain home remedies, including herbal treatments, prove to be beneficial for oligomenorrhea.

  • A healthy balanced diet rich in vegetables, fruits, and nuts
  • Regular exercise
  • Maintaining healthy weight
  • Eating iron-rich foods such as leafy vegetables and red meat
  • Reducing stress
  • Improving sleep habits.

Herbal remedies

These include:

  • Ginger tea
  • Cinnamon
  • Turmeric
  • Unripe papaya
  • Aloe vera.

When to seek medical advice?

If you notice any of the following symptoms, it is important to consult with a gynecologist for early diagnosis and effective management:

  • Menstrual cycles lasting more than 35 days
  • Missed periods
  • Severe pelvic pain
  • Inconsistent or unpredictable menstrual patterns.

Menstrual Portal also offers free online consultation, regarding all your menstrual health concerns.

Frequently asked questions

What is normal oligomenorrhea?

Oligomenorrhea is considered normal or physiological in specific conditions like menopause, the perimenopausal phase, after childbirth, and a few years after the onset of menstruation (menarche).

Can oligomenorrhea cause infertility?

The underlying conditions that lead to oligomenorrhea can be linked to infertility. If not treated timely, these conditions make it difficult to conceive and result in infertility. However, with proper management, menstrual cycles can return to regularity.

Can I conceive with irregular periods?

It is challenging to anticipate ovulation due to irregular periods, which makes conception a bit harder. In a normal menstrual cycle, ovulation occurs on the 14th day, but in oligomenorrhea, it is difficult to predict ovulation, so there is a hurdle in conceiving.

Consultation with a healthcare professional and seeking treatment can lead to regular periods, which will help in conceiving.

Does folic acid regulate periods?

In females aged 18-30, folic acid is inversely related to the length of the menstrual cycle. It helps to stabilize and lengthen the duration of the menstrual cycle, but only in this particular age group. Folic acid supplements are also beneficial during pregnancy.

Last medically reviewed on August 19, 2023.