What is Oligomenorrhea?
Oligomenorrhea is a condition where a woman has irregular and inconsistent periods. It’s normal for the menstrual cycle to change a bit when a woman first starts menstruating, after giving birth, or when she is nearing menopause. However, if the menstrual cycle lasts more than 35 days or if a woman has only four to nine periods in a year, then it’s considered oligomenorrhea.
Before a woman develops oligomenorrhea, her menstrual flow should be normal. Understanding and monitoring these changes is crucial for maintaining reproductive health.
What Causes Oligomenorrhea?
Oligomenorrhea often signals that there might be an underlying medical condition, as it represents an abnormal menstrual cycle with infrequent periods. Here are some possible causes of oligomenorrhea:
– Polycystic ovarian disease: a hormonal disorder causing enlarged ovaries with small cysts on the outer edges.
– Ovarian tumors that produce male hormones (androgens): these can disrupt the balance of hormones in your body.
– Adrenal gland tumors that produce male hormones: similar to ovarian tumors, these can disrupt hormone balance.
– Cushing syndrome: a condition caused by high levels of the hormone cortisol in your body.
– Hyperthyroidism: an overactive thyroid that can affect menstrual cycles.
– Prolactinomas: noncancerous tumors of the pituitary gland that can produce high levels of prolactin, affecting menstrual cycles.
– Hypothalamic amenorrhea: a condition where your hypothalamus (a region in your brain) slows or stops releasing a hormone that controls the menstrual cycle.
– Pelvic inflammatory disease: an infection of the reproductive organs, usually caused by a sexually transmitted infection.
– Asherman syndrome: a rare condition characterized by scars or adhesions in the uterus.
– Uncontrolled diabetes: when blood sugar levels are consistently high, it can affect menstrual cycles.
– Type-1 diabetes: a chronic condition where the pancreas produces little or no insulin, can also affect menstrual cycles.
– Congenital adrenal hyperplasia: a group of inherited genetic disorders that affect your adrenal glands.
– Non-classic congenital adrenal hyperplasia: a mild form of congenital adrenal hyperplasia.
Besides these medical conditions, certain medications like oral contraceptives, antipsychotics and antiepileptics can also sometimes lead to oligomenorrhea as a side effect. In addition, structural problems with the reproductive system, such as primary ovarian insufficiency (when the ovaries stop functioning normally) or regular intensive exercise while also suffering from polycystic ovarian disease, can cause it as well.
Risk Factors and Frequency for Oligomenorrhea
Oligomenorrhea, a condition where menstrual cycles are irregular, is seen in 13.5% of the overall population. A particular condition called Polycystic Ovarian Disease leads to oligomenorrhea in 4 to 10% of women who are in their reproductive years, from puberty to menopause. It’s also noted that 11 to 44% of dancers and 6 to 60% of athletes have reported experiencing oligomenorrhea at some stage in their lives.
Signs and Symptoms of Oligomenorrhea
Oligomenorrhea is a medical term for infrequent or very light menstruation. To diagnose this condition, doctors gather detailed information about the patient’s menstrual cycles. Important details include cycle duration, menstrual flow length, the number of pads used daily, time between two cycles, and whether past cycles have been regular. This information helps doctors to understand how heavy the bleeding is, the number of cycles in a year, and their regularity.
Doctors also need to know if the patient experiences irregular bleeding between menstrual cycles, hot flashes, and night sweats. Understanding the baseline pattern of bleeding before oligomenorrhea onset is crucial to assess the severity of the condition. Other inquiries include the patient’s age at first menstruation (`menarche`), unprotected sexual intercourse, abdominal pain, discharge, weight loss, and any recent changes, including voice tone, hair growth, acne, blurred vision, headaches, decreased libido, and nipple discharge. Changes in bowel habits and skin are also taken into account.
Other relevant information can be birth history, which could indicate infertility or past uterus cleanings (`dilatation and curettage`). Additionally, doctors will check the patient’s medication history for birth control pills, antipsychotics, antiepileptics, and steroids use. A family history could reveal if there’s an inherited condition like Turner syndrome or polycystic ovarian disease.
During a physical examination, doctors perform several checks:
- External examination: assessing abnormal secondary sexual characteristics such as hair distribution or enlarged clitoris.
- Rectovaginal examination: using a lubricated gloved finger to check the walls of the vagina for any obstructions or abnormalities, abdominal tenderness, or masses in the adnexa or abdomen.
- Vaginal speculum examination: looking into the vagina and cervix with a speculum to spot any abnormal discharge, signs of inflammation, and growths.
- Abdomen examination: inspecting the abdomen for fluid accumulation (ascites) and feeling the abdomen for masses and tenderness. The groin is also checked for swollen lymph nodes (`inguinal lymphadenopathy`).
Testing for Oligomenorrhea
If you have irregular periods, which doctors call oligomenorrhea, certain tests can be done to figure out why.
Blood Tests:
These measure various levels of hormones in your blood.
– FSH levels: If you have more than usual, it could mean your ovaries aren’t working well.
– TSH levels: If you have less than usual, you might have hyperthyroidism, a condition where your thyroid gland is overly-active.
– Prolactin levels: If you have more than usual, it might be due to a prolactinoma, which is a benign (non-cancerous) tumor of the pituitary gland.
– LH levels: The ratio of FSH to LH can help diagnose polycystic ovarian disease.
– Free testosterone levels: If these are higher, it could be due to congenital adrenal hyperplasia (a genetic disorder affecting your adrenal glands) or polycystic ovarian disease.
– 17 –OH levels: These are useful to diagnose congenital adrenal hyperplasia as a cause of irregular periods.
Dexamethasone suppression test:
This is a special test done overnight that can help diagnose a condition called Cushing syndrome, especially if you’re showing signs of this condition.
Additionally, a test called HbA1C can measure your average blood sugar over the past 3 months.
Investigations:
There are also tests that create images of the inside of your body.
– Ultrasound of abdomen and pelvis: This can help reveal if you have polycystic ovaries, signs of pelvic inflammation, or fluid build-up called ascites.
– CT scan: This test is helpful if there’s a suspicion of masses or lumps in or near your ovaries or adrenal glands.
– MRI of the pituitary gland: This can help confirm a prolactinoma if prolactin levels are high.
– Endocervical swabs: These are taken if there are signs of pelvic inflammatory disease, which is an infection of the female reproductive organs.
Treatment Options for Oligomenorrhea
The treatment for oligomenorrhea, or irregular periods, largely depends on what’s causing it.
Lifestyle Changes
If irregular periods are caused by a low metabolic rate and high stress levels, making certain lifestyle changes can help. These may involve modifying your behavior, changing your diet, undergoing psychotherapy, and learning stress management techniques. When irregular periods are due to being overweight, managing your weight can help bring your periods back to normal.
Hormonal Therapy
Birth control pills can often help regulate your menstrual cycle, especially if you have a condition called Polycystic Ovarian Disease. They’re a safe treatment option, particularly if you’re not looking to get pregnant at the moment.
Treating Underlying Medical Conditions
If your irregular periods are due to a problem with your thyroid function, known as hyperthyroidism, then the treatment would involve medications that reduce thyroid hormone levels, radioactive iodine treatment, or surgery to remove part or all of your thyroid. If Cushing syndrome (a hormonal disorder) is the cause, then medication to reduce the production of cortisol, the “stress hormone,” is typically used. If the cause of irregular periods is a small tumor that increases the levels of a hormone known as prolactin (known as a prolactinoma), it can be treated with medication that increases dopamine, another hormone in your body.
Surgical Management
In certain instances, surgery might be necessary. Tumors on your adrenal glands or ovaries may need to be surgically removed. If you have hyperthyroidism, you might need a procedure known as a thyroidectomy to remove your thyroid. A large prolactinoma may require surgical removal if it’s causing symptoms due to pressure on nearby structures.
What else can Oligomenorrhea be?
The onset of menstruation, known as “Menarche”, typically occurs around the age of 12.5 in the United States. During this time, girls may experience light or irregular periods, which become more regular as time goes on. This could potentially be mistaken for a condition called “Oligomenorrhea”, which is when periods are regular at first but become lighter over time.
The time leading up to menopause is called “Perimenopause”, during which women may also experience irregular periods that can be mistaken for oligomenorrhea. But usually, perimenopause comes with symptoms like hot flashes, vaginal dryness, night sweats, weight gain, mood changes, and vaginal pain during sex. These signs and symptoms are not associated with oligomenorrhea caused by other medical conditions.
“Irregular Bleeding” can also be mistaken for oligomenorrhea. This refers to bleeding that happens between regular menstrual cycles. It could potentially indicate health conditions like a polyp in the lining of the uterus for women still having their periods or cancer of the uterus lining for women who have gone through menopause.
In cases of missed or delayed periods, it’s vital to rule out “Pregnancy”. A pregnancy test can verify this by checking for a hormone known as human chorionic gonadotropin (HCG) in urine or blood.
What to expect with Oligomenorrhea
Oligomenorrhea, a condition where the menstrual cycle is infrequent or irregular, is not a severe issue in itself. However, figuring out the root cause is important to prevent infertility. Additionally, if not addressed, it could increase your chances of developing endometrial hyperplasia and endometrial cancer. Endometrial hyperplasia refers to the abnormal thickening of the lining of the uterus, and endometrial cancer is a type of cancer that starts in the uterus.
Possible Complications When Diagnosed with Oligomenorrhea
Infertility could result from untreated oligomenorrhea if a woman has polycystic ovarian disease or primary ovarian insufficiency because there’s no egg released from the ovaries. Other causes include damage to the uterine lining essential for implantation, such as in Asherman syndrome, scarring from pelvic inflammatory disease, and metabolic disturbances caused by uncontrolled diabetes which can make pregnancy challenging.
Over time, oligomenorrhea which isn’t treated can cause the lining of the womb, the endometrium, to excessively grow, leading to a condition known as endometrial hyperplasia. This condition could eventually progress to endometrial cancer. However, oral contraceptive pills containing estrogen and progesterone may provide protection against this cancer.
In anovulation, where there is no egg release, the primary source of estrogen is lost. This deficiency can lead to osteoporosis, or weakened bones. Paramedics label estrogen as a heart-protecting hormone, so if its levels fall, the risk of heart muscle damage or mycordial ischemia may increase. Lastly, lack of estrogen may also contribute to neuropsychiatric problems like anxiety, hallucinations, delusions, twitching of the face and lips, loss of appetite, and general weakness.
Summary of Issues related to Oligomenorrhea:
- Infertility
- Endometrial hyperplasia (excessive growth of the womb lining)
- Endometrial cancer
- Osteoporosis (weakening of bones)
- Increase risk of heart muscle damage
- Neuropsychiatric problems such as anxiety, hallucinations, delusions, involuntary facial movements, loss of appetite, and general weakness
Preventing Oligomenorrhea
It’s important for patients to keep track of their monthly periods and take note of any changes in the cycle or in the amount of bleeding. Any sudden shifts in your menstrual cycle should be noted. You should also educate yourself about what a normal menstrual cycle looks like, including when you should get in touch with a doctor. One example is if you don’t have a period for more than 35 days – this is a time when you should contact a gynecologist. By keeping aware of these things, you can make sure you get medical advice when you need it.
As for birth control pills, which are often used to help manage irregular periods, it’s essential to follow your doctor’s instructions about taking them. You should aim to take your medication every day at the same time to make the pills as effective as possible and to prevent unwanted bleeding that can happen if you don’t take your medication regularly. While taking these drugs, you should not expect to get pregnant. If you wish to become pregnant, you’ll need to talk to your doctor about other treatment options.
