Oligomenorrhea

What is oligomenorrhea?

Oligomenorrhea (pronounced uh-li-gu-meh-nr-ee-uh) is the medical term for having infrequent menstrual periods. A normal menstrual cycle occurs every 28 days and lasts from four to seven days. Your period can range from every 21 days to every 35 days and still be considered normal. Usually, you’ll have the same number of days in between periods, give or take a day or two.

With oligomenorrhea, periods are unpredictable. You may often go for more than 35 days without a period. Instead of having periods monthly, you may only have six to eight periods a year.

What is the difference between oligomenorrhea and amenorrhea?

Both oligomenorrhea and amenorrhea are types of abnormal menstruation. Amenorrhea refers to absent periods while oligomenorrhea refers to infrequent periods. With amenorrhea, you never get your period or you get your period and then stop menstruating for several months. With oligomenorrhea, you still menstruate, but you don’t always get your period on schedule. As a result, you menstruate less than is considered normal.

How common is oligomenorrhea?

Around 12% to 15.3% of people who menstruate experience oligomenorrhea at some point. Ten to 20% of people with fertility issues have it. Oligomenorrhea often happens alongside polycystic ovary syndrome (PCOS). Of those with PCOS, 75% to 85% experience infrequent periods.

What are the signs and symptoms of oligomenorrhea?

Missed and delayed periods are the most common sign of oligomenorrhea, but you may experience other symptoms depending on what’s causing your periods to be unpredictable. Symptoms include:

• Acne.
• Headaches.
• Hot flashes.
• Abdominal pain.
• Vaginal discharge.
• Impaired vision.
• Excess hair growth on your face and body.

What causes oligomenorrhea?

Conditions that cause hormone imbalances in your body are often to blame for infrequent periods. Your reproductive organs and glands in your brain produce a variety of hormones that regulate your menstrual cycle. When these hormones are in balance, your menstrual cycle is more predictable. Imbalanced hormones can interfere with regularity.

Infections and structural abnormalities in your reproductive organs can disrupt your menstrual cycle, too.

Causes of oligomenorrhea include:

• PCOS: PCOS causes your body to produce too many hormones called androgens (ex. testosterone) that can interrupt ovulation, the time in your cycle when your ovaries release an egg.
• Androgen-secreting tumors: Tumors that form on your ovary and adrenal glands can release androgens that disrupt your menstrual cycle. These tumors often lead to symptoms that are similar to PCOS.
• Cushing’s syndrome: With Cushing’s, your body produces too much of the hormone cortisol, which can lead to hormone imbalances that impact your cycle.
• Prolactinoma: Prolactinoma is a tumor that causes your pituitary gland to make too much of the hormone prolactin and too little of the sex hormones needed for normal menstruation, like estrogen.
• Primary ovarian syndrome: With primary ovarian syndrome, your ovaries stop producing eggs earlier than expected (before menopause). They also stop producing estrogen, a hormone needed for regular menstruation.
• Hyperthyroidism: Your thyroid gland triggers your pituitary gland to make too much prolactin and too little estrogen.
• Congenital adrenal hyperplasia: A condition you’re born with that prevents your adrenal glands from producing enough enzymes to make hormones needed for menstruation.
• Pelvic inflammatory disease (PID): Untreated sexually transmitted infections (STIs) can lead to PID. The infection and inflammation that result can disrupt your menstrual cycle.
• Asherman’s syndrome (endometrial adhesions): Scar tissue on your uterus or cervix (most commonly from a gynecological surgery, like dilation & curettage) interrupts your normal menstrual flow.
• Diabetes: Oligomenorrhea has been linked to Type 1 and Type 2 diabetes. It’s common in people who are underweight (common in Type 1 diabetes) and overweight (common in Type 2 diabetes).
• Eating disorders: Conditions like bulimia, anorexia and binge eating can lead to nutritional deficiencies that prevent or delay your period.
• Extreme physical activity: Overexerting yourself through exercise can strain your body so that it’s unable to carry out crucial routine processes, like menstruation.

Certain medications can lead to infrequent periods, including:

• Hormonal contraceptives, like birth control pills.
• Antipsychotics.
• Antiepileptics.

How is oligomenorrhea diagnosed?

Your provider will work with you to diagnose your oligomenorrhea and identify what’s causing it.

Medical history

Arrive at your appointment prepared to answer detailed questions about your period irregularity, including the number of days in between periods. Track this information for at least two months. Your provider may also ask about:

• What a normal period’s like for you: Your provider will want to know how many days pass between periods, how heavy your periods are, etc. Understanding what a typical period means for you helps your provider understand the severity of your issue.
• Your family’s medical history: Having a family member with a condition that causes oligomenorrhea (ex. PCOS) may increase the likelihood that you’ll have it, too.
• Your habits & lifestyle: Your provider may ask about your diet and exercise habits to see if your routine may be causing infrequent periods. They may also ask about whether you’re having unprotected sex, to rule out whether an STI may be causing your period irregularities.
• Medications you’re taking: Hormonal contraceptives, antipsychotics, antiepileptics and steroids have all been linked to oligomenorrhea.

Exams

Examinations include:

• Physical Exam: Your provider inspects your face, neck, breasts and abdomen to check for signs of conditions that are causing oligomenorrhea.
• Rectovaginal exam: Your provider inserts one gloved finger into your vagina and another into your rectum to feel for any masses inside your body.
• Vaginal speculum exam: An instrument called a speculum widens your vagina so that your provider can check your vagina and cervix for signs of bleeding, inflammation or scar tissue that may be causing issues. Your provider may order a cervical swab to test for an infection.
• Abdominal exam: Your provider feels for masses and tender spots in your abdomen.

Imaging

Imaging procedures include:

• CT scans: Detect masses that may be causing bleeding.
• Pelvic and abdominal ultrasounds: show signs of inflammation and PCOS.
• Magnetic resonance imaging (MRI): can confirm a prolactinoma diagnosis.

What tests will be done to diagnose oligomenorrhea?

Blood tests can help your provider check your hormone levels and blood sugar. Your provider may test your levels of:

• Thyroid-stimulating hormone (TSH): Decreased levels may indicate hypothyroidism.
• Follicle-stimulating hormone (FSH): Increased levels may indicate primary ovarian insufficiency.
• Luteinizing hormone (LH): Increased levels of LH in relation to FSH can help your provider diagnose PCOS.
• Prolactin: Increased prolactin levels may indicate prolactinoma.
• 17-OHP: Your levels of 17-OHP can help your provider diagnose congenital adrenal hyperplasia.
• Blood sugar: A HbA1ctest can help your provider diagnose diabetes.

How is oligomenorrhea treated?

Treatment for oligomenorrhea depends on the cause.

• Hormone therapy: Your provider may prescribe birth control pills or other hormone treatments if your oligomenorrhea is caused by a hormone imbalance.
• Surgery: Your provider may remove tumors that are producing excess androgens.
• Lifestyle changes: You may need to make adjustments to your diet and physical activity if nutritional deficiencies or strenuous activities are causing your issues.

How can I prevent oligomenorrhea?

Oligomenorrhea can’t be prevented, but your provider can recommend treatments once they’ve determined what’s causing your infrequent periods.

What can I expect if I have oligomenorrhea?

Oligomenorrhea isn’t a serious problem on its own. Still, it’s important to find out what’s causing it in case you have a condition that can lead to complications. For instance, untreated PID and PCOS can lead to infertility. Not shedding your uterine lining regularly because of oligomenorrhea may put you at risk of developing endometrial hyperplasia and endometrial cancer.

When should I see my healthcare provider?

If you’re regularly going more than 35 days without a period, or if you’re skipping periods, schedule an appointment with your provider. Missing or delayed periods aren’t normal, and it’s important to identify what’s causing your problem to prevent long-term complications.

Before your visit, track your periods using a calendar or an app so that you can easily answer your provider’s questions about what counts as a normal and abnormal period for you. Many apps allow you to track:

• The exact days when you stop and start your period.
• How heavy your bleeding is.
• Any symptoms you’re experiencing before, during and after your period.

What questions should I ask my doctor?

• Should I be concerned about my infrequent periods?
• Are my unpredictable periods negatively impacting my fertility?
• What treatment options are available to me if I want to get pregnant?
• Will I have to continue hormone treatments long-term if I want to manage oligomenorrhea?

Can oligomenorrhea cause infertility?

Oligomenorrhea may be a sign of a condition that’s often associated with infertility, like PCOS. The hormone imbalances that cause abnormal menstruation may also make it difficult for you to get pregnant.

Is PCOS the same as oligomenorrhea?

No. But PCOS and infrequent periods often happen together.

A note from Cleveland Clinic

Don’t be alarmed if your periods are infrequent. Your menstrual cycle may be out of sync for lots of reasons, and many of them are harmless. Still, it’s important to see a provider if you’re going long periods of time without menstruating. Pay attention to other symptoms, too, like how much you’re bleeding and if you’re noticing other changes, like abdominal pain or discharge. Share these details with your provider so that they can pinpoint what’s causing your period irregularities and get you the treatment you need.