Missed or Infrequent periods (Oligomenorrhea)

Oligomenorrhoea is a disorder commonly experienced by women in their childbearing age. In this condition, the menstrual cycle shows an irregular pattern and a delay in menstruation. The normal menstrual cycle occurs approximately at around 21-35 days; a slight variation is acceptable. However, if you are experiencing a delay of more than 35 days, which can range to as high as 90 days, oligomenorrhoea can be suspected. Oligomenorrhoea is a symptom of prevailing medical conditions, such as PCOS, hypothyroidism, and androgen-secreting tumours.

In India, the onset of the menstrual cycle occurs during the age of 11-14 years. Oligomenorrhoea is a common symptom in such girls and they have irregular menstrual cycles during the first few months of the onset of the menstruation. The following symptoms suggest that you have oligomenorrhoea:

• Scanty or light menstrual bleeding compared to normal flow.
• Unpredictable flow pattern wherein you might experience heavy blood flow in the next cycle if you had experienced scanty flow during the previous one.
• The occurrence of the menstrual cycle after 35 days.
• There can be just 6-8 periods in a year.
• Inability to conceive or infertility.
• Unpredictable nature of the cycle and ovulation (release of an egg) or an absence of ovulation can lead to difficulty in conceiving, as it may affect fertility.

Causes

The causes for a missed or infrequent period are as follows:

• Fluctuating Hormone Levels
  • Young adolescent girls who have just had the first menstrual cycle or a woman on the verge of menopause have fluctuating hormone levels that may lead to oligomenorrhoea.
  • Using birth control hormonal pills can be a cause for lighter periods leading to oligomenorrhoea.
  • The presence of oestrogen-secreting tumours may cause hormonal imbalance. This happens commonly in conditions, such as Cushing’s syndrome, which could lead to oligomenorrhoea.
• Polycystic Ovarian Syndrome
  The most common cause of oligomenorrhoea is PCOS, which is characterised by hyperandrogenism (a condition of excess male sex hormone production in females), dysfunction of the ovaries, and polycystic ovaries (presence of small cysts in ovaries). If you are diagnosed with PCOS, it leads to irregular periods and difficulty in conception. (Read more: Can I still get pregnant if I have PCOS)
• Heavy Exercise
  If you are an athlete doing heavy exercise, you may experience irregular menses. In athletes, the condition is called as female athlete triad, an interrelationship of menstrual disorder with low energy availability and decreased bone density.
• Diabetes and Thyroid Problems
  In a woman with diabetes, the risks of having menstrual disorders are higher. Thyroid hormones play an important role in normal reproductive physiology. If the thyroid hormones do not get released adequately, it can affect the hormonal levels and lead to oligomenorrhoea. Hypothyroidism is a common cause of oligomenorrhoea. (Read more: Thyroid problems causes)
• High Prolactin Levels
  The presence of higher prolactin levels in the blood raises the chances of a decreased or irregular menstrual bleeding. High prolactin levels are also there when a woman breastfeeds. (Read more: Benefits of breastfeeding for baby and mother)
• Other Factors
  If you have stress and anxiety, it is likely to affect the pituitary gland function, leading to changes in the menstrual cycle.

Risk factors

Based on the above-mentioned causes, you may be at risk of having oligomenorrhoea if you fulfil any of the following criteria:

• Menarcheal (age group of 14 to 16 years during the onset of a menstrual cycle) or menopausal age (45-50 years).
• Presence of multiple cysts in the ovary and having a family history of PCOS.
• Receiving hormonal treatment.
• Obesity or being overweight.
• Heavy exercise and improper diet.
• Diagnosed with any disorder where androgen-secreting tumours are found.
• Diabetes. 

In India, 68% of women report reduced working efficiency due to a menstrual disorder. The most common reason is unhealthy eating habits, which lead to weight gain. This, in turn, leads to hormonal imbalance and paves way for a disturbed menstrual cycle, which upon prolongation leads to oligomenorrhoea. Women in rural areas of the country are not an exception at all. They lack knowledge about the menstrual cycle and the problems associated with it. They are also surrounded by myths related to menstrual health.

(Read more: Period myths)

Awareness programmes in rural areas can educate young women about care to be taken to prevent menstrual disorders. Some easy tips given below can help in preventing oligomenorrhoea. These are:

• Avoid prolonged use of hormonal pills.
• Exercise or do yoga regularly to stay fit and avoid the risk of too much weight gain or weight loss.
• Creating and conducting health programs for inculcating awareness in adolescent girls regarding menstrual problems in rural India can help in preventing the condition and its quick diagnosis.
• Female athletes need to increase their calorie intake, as in this case, being bulimic (a person with an eating disorder) can lead to oligomenorrhoea.
• Manage stress by meditating, doing yoga, and following other relaxation methods. You may also take help from a professional psychologist or psychiatrist to cope with stress.
• Monitor your sugar and thyroid levels. (Read more: How to check blood sugar levels at home)
• A higher risk of PCOS suggests a higher risk of oligomenorrhoea. PCOS, in most cases, is hereditary and hence preventing it becomes difficult. (Read more: What to eat and what to avoid if you have PCOS)
  
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A logical approach towards diagnosing irregular periods involves testing for pregnancy before any further diagnosis is done. Once the possibility is ruled out, your doctor can ask you a series of relevant questions, and some examinations.

(Read more: Pregnancy tests) 

Possible Questions

A thorough medical history can be sought with the help of some of the following questions:

• Has there been any illness?
• What is your diet? Has there been any change in it recently?
• How regularly do you exercise?
• Have you been under any kind of stress?
• Have you been experiencing acne breakouts?
• Are you on any medications?
• Have you been diagnosed with diabetes or thyroid problems?

Physical Examination

A thorough physical examination will further help in diagnosis. You will be examined for:

• Hirsutism (excessive hair on chin, face, chest).
• Body weight and body mass index.
• Checking for erosion of dental enamel to rule out eating disorders.
• Vaginal dryness that suggests imbalanced oestrogen levels.

Laboratory Tests

Once the possibility of pregnancy is ruled out by your doctor, you will undergo some primary laboratory tests. These tests require a close follow-up after the initial testing. These include:

• TSH test
• Follicle-stimulating hormone test, oestrogen test, followed by testosterone test, especially if you have hirsutism.
• Glucose test
• Prolactin test

Imaging Studies

• Ultrasound of the uterus and ovaries.
• Magnetic resonance imaging to detect the presence of tumours of the hypothalamus and pituitary gland.
• X-ray of the bones.

Similar to other conditions, for oligomenorrhoea, an appropriate diagnosis is the main key to a successful treatment. Oligomenorrhoea is not a grave condition and can be easily treated with one or more of the below-mentioned methods.

Hormonal Therapy

In almost 90% cases, the cause is hormonal imbalance, and hence this can be treated by hormone supplements. Oral birth control pills are used to maintain normal hormone levels throughout the month for a timely commencement of the menstrual cycle. This treatment normalises the cycle in about two months. If the underlying cause is PCOS, the treatment regimen for treating PCOS will take care of the abnormal bleeding. (Read more: Hormone therapy)

Diet Monitoring

As in the case of the Female Athlete Triad, the main problem is an eating disorder. In such cases, the diet will be monitored by a dietician. Once the diet is maintained better and the calorie intake is normalised, the menses will become normal.

Alternative Treatment

Ayurveda has been practised in India since ancient times. Even today, people have a strong belief in the use of traditional medicines to treat various conditions. There are many formulations available in Ayurveda, which help maintain normal menstrual and reproductive health of women. Traditional Indian herbal preparations containing ‘Shatavari and ‘sowa’ are available in the market and prescribed by Ayurvedic practitioners. "Panchakarma" treatment can also be helpful in maintaining good menstrual health.

Homoeopathic treatment has proven to be useful in the treatment of PCOS, which helps in the management of the oligomenorrhoea associated with it. 

(Read more: Homeopathic treatment for PCOS)

Surgery

If the cause of oligomenorrhoea is the presence of a hormone-secreting tumour then its surgical removal is recommended.

Self-care

Watch what you eat! If you closely monitor your calorie intake and eating habits, these tiny steps will help you. Yoga and meditation can help restore the balance and peace of mind along with helping with maintaining body weight.

Lifestyle management

Studies carried out by WHO have suggested that the quality of life and health of people depend on lifestyle management. Some simple routine changes in lifestyle can be useful in managing the condition of irregular menses. These are:

• Eat a balanced diet.
• Avoid overeating.
• Avoid starving or low-calorie intake.
• Exercise regularly. (Read more: 10 common myths about exercise)
• Get routine check-ups done to control blood sugar levels.
• Manage stress by practising yoga and meditation.

Prognosis

Oligomenorrhoea is a curable condition if managed appropriately. Regular hormonal therapy can restore the normal frequency of the menstrual cycle. If left untreated, oligomenorrhoea may affect fertility and you may face difficulty in conception. Fertility treatment can increase the chances of pregnancy in such cases. Regular health check-ups and proper management of lifestyle help in the faster restoration of regular menstrual cycles. The complications arise when the response to the hormonal treatment is slow. In such cases, the condition can progress into amenorrhoea.

Complications

Infertility is the most common complication that may develop due to oligomenorrhoea. Complications, such as osteoporosis (a reduced bone density), may also develop, resulting in an increased tendency of bone fractures. Cardiovascular complications can arise especially in obese patients. Female athletes developing this condition can have further complications, such as osteoarthritis (swelling and pain in the joints), with increasing age. There can be neuropsychiatric or psychological complications in some cases that lead to a condition called uterine strangulation, wherein symptoms, such as dizziness, fainting, or seizures, may develop. There is a higher risk of developing uterine cancer in women diagnosed with oligomenorrhoea.