Definition

Oligomenorrhea is a condition in which a woman has infrequent and irregular menstrual cycles. Medically, it is defined as menstrual cycles lasting more than 35 days, or about 4–9 periods per year.

Normally, a menstrual cycle occurs every 21–35 days, with an average of 28 days, and lasts for 4–7 days. The total days between periods are usually consistent; if there is a change, it typically shifts by only 1-2 days.

Approximately 12–15.3 percent of women of reproductive age have experienced oligomenorrhea at some point in their lives. Additionally, 10–20 percent of women with fertility issues have this condition. Oligomenorrhea is common in women with polycystic ovary syndrome (PCOS), a condition characterized by irregular menstruation and the presence of small cysts on the ovaries. About 75-85 percent of women with PCOS experience oligomenorrhea.

Oligomenorrhea causes unpredictable periods that become late or irregular. Missing a period once, not due to pregnancy, contraception, or menopause, usually isn't serious. However, if your menstrual cycle consistently exceeds 35 days, consult a doctor, as it may indicate a more serious condition.

You can read an article about menopause here: Menopause - Definition, Cause And Risk Factor.

Causes

Oligomenorrhea is not considered a disease but is usually a symptom of an underlying health issue. There are various causes of oligomenorrhea, and in many cases, it is due to hormonal imbalance. Different hormones are produced by glands in the brain and reproductive organs to regulate the menstrual cycle. If these hormone levels are imbalanced, the menstrual cycle can become irregular.

Below are some medical conditions that can cause oligomenorrhea:

• Polycystic Ovary Syndrome (PCOS)

PCOS can increase the production of androgens, a group of hormones involved in growth and reproduction and responsible for secondary male sexual characteristics. If a woman has too much androgen, fertility or ovulation (the release of an egg) can be disrupted.

• Tumors

Prolactinoma is a tumor that causes the pituitary gland in the brain to produce too much prolactin and too little sex hormones needed for the menstrual cycle, such as estrogen. Additionally, tumors on the ovaries or adrenal glands (glands above the kidneys) can cause an increase in androgen release.

• Primary Ovarian Insufficiency

In this condition, the ovaries stop releasing eggs prematurely before menopause occurs. This condition is also marked by the cessation of estrogen production.

• Eating Disorders

Conditions like bulimia, anorexia nervosa, and binge eating disorder can lead to nutrient deficiencies, which may cause delayed menstruation.

• Pelvic Inflammatory Disease

Untreated sexually transmitted infections can lead to pelvic inflammatory disease. The resulting infection and inflammation can disrupt the normal menstrual cycle.

• Extreme Physical Activity

Excessive fatigue can prevent the body from carrying out normal functions like menstruation.

Risk Factor

Several factors can increase the risk of irregular menstrual cycles, including:

• Extreme weight loss
• Excessive exercise
• Infections of the reproductive organs
• Severe stress
• Type 1 diabetes mellitus
• Certain medications, such as contraceptive pills, anticonvulsants, and antipsychotics, etc.

Symptoms

Oligomenorrhea can cause symptoms such as:

• No menstruation for more than 35 days
• Fewer than 9 menstrual cycles per year
• Irregular menstrual cycles
• Menstrual blood flow is lighter than usual

Missing a period or having an irregular cycle occasionally is not necessarily dangerous. However, if your menstrual cycle suddenly changes and does not return to normal, the underlying cause must be addressed. It is also important to differentiate oligomenorrhea from menstrual irregularities that occur during early puberty and approaching menopause.

During early menstruation, cycles can be irregular, with heavy blood flow. Over time, hormones stabilize, and cycles regulate naturally. Menstrual cycle changes may also occur as menopause approaches. Hormonal changes can cause periods to arrive earlier or later, with varying duration and blood flow until menstruation ceases altogether.

Diagnosis

Medical Interview

Doctors will conduct a medical interview and a series of examinations to diagnose oligomenorrhea and identify its underlying causes. Your doctor may ask about:

• Menstrual irregularities you are experiencing
• The duration of your menstrual cycle and the number of pads or tampons used per day
• The number of menstrual cycles per year
• The age of first period
• History of unprotected sexual intercourse
• Family history of menstrual cycle disorders
• Current medications
• Other complaints or symptoms

Physical Examination

The doctor may perform a physical examination to detect any abnormalities. Physical examinations may include:

• External Physical Examination: The doctor may observe some secondary sexual characteristics in women, such as the distribution of hair in various parts of the body or abnormalities in the external reproductive organs.
• Internal Examination: For sexually active women, an examination with a speculum may be performed to observe the inside of the vagina and cervix.
• Abdominal Examination: This can be done to check for signs of fluid buildup or abnormal lumps.

Diagnostic Tests

Since oligomenorrhea usually occurs due to hormonal imbalance, hormone testing may be conducted. A blood sample will be taken to check levels of hormones such as FSH, LH, TSH, or thyroid hormones to determine if they are normal.

Your doctor may also check HbA1C levels if there is suspicion of diabetes. In addition, some radiological examinations may be performed to view the structure of your reproductive organs, such as:

• Abdominal and pelvic ultrasound: To detect PCOS, signs of pelvic inflammation, and fluid accumulation.
• CT scan or MRI: To detect masses in the adrenal glands, pituitary gland, or ovaries.

Management

Treatment for oligomenorrhea depends on the underlying cause. Some treatments include:

• Hormonal therapy: Treatment with hormonal contraceptives or specific hormone injections can stabilize the menstrual cycle, especially in PCOS.
• Lifestyle changes: If oligomenorrhea is due to eating disorders or extreme physical activity, various therapies with a psychiatrist can be beneficial, such as psychotherapy, behavior modification, and stress management.
• Tumor treatment: This can help prevent the tumor from growing or spreading, thereby reducing symptoms, including oligomenorrhea.

Complications

If left untreated, oligomenorrhea can lead to complications such as:

• Infertility: Conditions like PCOS and primary ovarian insufficiency can cause infertility
• Osteoporosis: Estrogen plays a significant role in bone health. Estrogen levels can drop if oligomenorrhea occurs, increasing the risk of osteoporosis or bone weakening later in life
• Cardiovascular Disease: Besides protecting bones, estrogen also protects the heart. Estrogen deficiency can increase the risk of heart attacks
• Psychological Stress: This condition can cause stress and psychological problems

Prevention

You can maintain a regular menstrual cycle by keeping an ideal body weight, not overexercising, and managing stress well.

When to See a Doctor?

See a doctor immediately if your menstrual cycle becomes irregular, with cycles lasting more than 35 days, and you experience this for several cycles. A delayed or absent period is not normal, so it is important to determine the underlying cause.

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