The Response of Modern Medicine
While oligomenorrhea in teenagers and women near menopause may require no treatment whatsoever, those cases due to extreme eating disorders receive a combination of medical treatment such as anti-depressants, plus psychotherapy. If, on the other hand, the symptoms are caused by a tumor, surgical removal is usually effective. However, most other women with the condition that involve low weight, vigorous athletics or similar factors are typically treated with estrogen, usually in the form of estradiol, to improve and/or restore their hormonal balance.
The problem with the modern medical treatment option of estrogen supplementation is that it does nothing to address the underlying cause of the oligomenorrhea. Furthermore, the use of estradiol has been implicated as a factor in female cancers and other female-related conditions, as reported by a major study of the Women’s Health Initiative study and elsewhere. For example, according to the American Cancer Society Textbook of Clinical Oncology, "Oral contraceptives and steroidal estrogens are chemicals and mixtures judged to be carcinogenic to humans by the International Agency for Research on Cancer, and estradiol is in a class of carcinogenic chemicals." What most people do not realize about estradiol is that it is at least partly responsible for many of the conditions that plague women, such as dysmenorrhea, PMS, endometriosis, uterine fibroids, fibrocystic breast disease, migraine headaches, and chronic pelvic pain, not to mention conditions such as breast, cervical, ovarian and uterine cancer. Fortunately, other treatment options for oligomenorrhea are available.
The Natural Medicine Approach to Oligomenorrhea
The natural medicine approach is to focus on the underlying problem of the oligomenorrhea. For cases of the condition not caused by a specific disease or a tumor, the underlying problem usually involves abnormally low body fat, which puts the individual’s body into a pre-pubescent state. Treatment starts with hormonal testing to establish the female patient’s precise hormonal profile, with the typical result of a prescription for a natural form of progesterone. In addition, a healthy diet including good proteins and fats, as well as natural supplements such as flax seed oil, Menstrual Support and Premenselator cream are also prescribed to restore a proper nutritional and hormonal balance and encourage the restoration of a menstrual cycle normal for that particular female patient.
Thursday, 15 May 2008
Wednesday, 7 May 2008
Getting Pregnant and Improving Fertility: Exercise
Exercise and fertility are very closely linked and exercise can be a determining factor in an individual’s chances of getting pregnant. In fact, getting either too little or too much exercise can hinder female fertility. This is because exercise affects the amount of body fat that a woman has; having a body fat level that is between 10 and 15 percent above or below normal levels (between 20 and 27 percent) can lead to infertility. Therefore, it is important to consider the effects of exercise on your fertility, as exercise can either improve your chances of getting pregnant or decrease them.
Exercise and Infertility
Exercise-induced infertility is a major cause of difficulty for women in the process of getting pregnant. This is because too little body fat can result in irregular ovulation, as body fat helps to regulate the body’s production of estrogen. Women who have too little body fat as a result of excessive exercise often experience oligomenorrhea (infrequent or light menstruation) and in some cases even amenorrhea (in which menstruation does not occur at all). Both of these conditions can have adverse effects on female fertility and thereby negatively influence a woman’s chances of getting pregnant.
Exercise and Weight Maintenance
Alternatively, obesity can also have a negative impact on a woman’s ability to get pregnant. In fact, 12% of infertility cases are due to being overweight or obese. This is because fat increases the amount of estrogen produced by the body. Since 30% of estrogen comes from fat cells, having higher levels of fat leads to an increased production of estrogen, which can affect ovulation, menstruation and fertility. Obesity also increases the risk of being resistant to insulin, which results in the body’s overproduction of insulin, a process that in turn prevents ovulation.
Exercise can be used to establish a healthy weight so as to improve a woman’s odds of getting pregnant. A moderate exercise program should be formulated with the supervision of a physician so as to minimize health complications associated with obesity. Exercises can include walking, swimming, cycling and yoga. An exercise regimen should be developed slowly, until the individual is working out for up to 30 minutes a day, three to four times a week.
Exercise and Stress
Developing a healthy exercise routine is an excellent way to increase fertility as well as to improve overall healthy. Exercise reduces high stress levels, which are linked to the development of cardiovascular diseases and depression, which can in turn negatively affect ovulation and menstruation. Exercise can also be used to help counteract the stress associated with fertility treatment procedures such as IVF.
Exercise, such as Pilates and yoga, releases endorphins which condition the body to respond in a more healthy manner to stress and also improves overall mental health, thereby improving a woman’s chances of getting pregnant.
Exercise and Infertility
Exercise-induced infertility is a major cause of difficulty for women in the process of getting pregnant. This is because too little body fat can result in irregular ovulation, as body fat helps to regulate the body’s production of estrogen. Women who have too little body fat as a result of excessive exercise often experience oligomenorrhea (infrequent or light menstruation) and in some cases even amenorrhea (in which menstruation does not occur at all). Both of these conditions can have adverse effects on female fertility and thereby negatively influence a woman’s chances of getting pregnant.
Exercise and Weight Maintenance
Alternatively, obesity can also have a negative impact on a woman’s ability to get pregnant. In fact, 12% of infertility cases are due to being overweight or obese. This is because fat increases the amount of estrogen produced by the body. Since 30% of estrogen comes from fat cells, having higher levels of fat leads to an increased production of estrogen, which can affect ovulation, menstruation and fertility. Obesity also increases the risk of being resistant to insulin, which results in the body’s overproduction of insulin, a process that in turn prevents ovulation.
Exercise can be used to establish a healthy weight so as to improve a woman’s odds of getting pregnant. A moderate exercise program should be formulated with the supervision of a physician so as to minimize health complications associated with obesity. Exercises can include walking, swimming, cycling and yoga. An exercise regimen should be developed slowly, until the individual is working out for up to 30 minutes a day, three to four times a week.
Exercise and Stress
Developing a healthy exercise routine is an excellent way to increase fertility as well as to improve overall healthy. Exercise reduces high stress levels, which are linked to the development of cardiovascular diseases and depression, which can in turn negatively affect ovulation and menstruation. Exercise can also be used to help counteract the stress associated with fertility treatment procedures such as IVF.
Exercise, such as Pilates and yoga, releases endorphins which condition the body to respond in a more healthy manner to stress and also improves overall mental health, thereby improving a woman’s chances of getting pregnant.
Tuesday, 6 May 2008
Oligomenorrhea
Oligomenorrhea
In most women, menstrual bleeding occurs every 28 days, plus or minus 4 days. Although some variation is normal, menstrual bleeding at intervals of greater than 36 days may indicate oligomenorrhea — abnormally infrequent menstrual bleeding characterized by three to six menstrual cycles per year. When menstrual bleeding does occur, it’s usually profuse, prolonged (up to 10 days), and laden with clots and tissue. Occasionally, scant bleeding or spotting occurs between these heavy menses.
Oligomenorrhea may develop suddenly or it may follow a period of gradually lengthening cycles. Although oligomenorrhea may alternate with normal menstrual bleeding, it can progress to secondary amenorrhea.
Because oligomenorrhea is commonly associated with anovulation, it’s common in infertile, early postmenarchal, and perimenopausal women. This sign usually reflects abnormalities of the hormones that govern normal endometrial function. It may result from ovarian, hypothalamic, pituitary, thyroid, and other metabolic disorders and from the effects of certain drugs. It may also result from emotional or physical stress, such as sudden weight change, a debilitating illness, or rigorous physical training.
Top History and physical examination
After asking the patient’s age, find out when menarche occurred. Has the patient ever experienced normal menstrual cycles? When did she begin having abnormal cycles? Ask her to describe the pattern of bleeding. How many days does the bleeding last, and how frequently does it occur? Are there clots and tissue fragments in her menstrual flow? Note when she last had menstrual bleeding.
Next, determine if she’s having symptoms of ovulatory bleeding. Does she experience mild, cramping abdominal pain 14 days before she bleeds? Is the bleeding accompanied by premenstrual symptoms, such as breast tenderness, irritability, bloating, weight gain, nausea, and diarrhea? Does she have cramping or pain with bleeding? Also, check for a history of infertility. Does the patient have children? Is she trying to conceive? Ask if she’s currently using hormonal contraceptives or if she has ever used them in the past. If she has, find out when she stopped taking them.
Then ask about previous gynecologic disorders such as ovarian cysts. If the patient is breast-feeding, has she experienced problems with milk production? If she hasn’t been breast-feeding recently, has she noticed milk leaking from her breasts? Ask about recent weight gain or loss. Is the patient less than 80% of her ideal weight? If so, does she claim that she’s overweight? Ask if she’s exercising more vigorously than usual.
Screen for metabolic disorders by asking about excessive thirst, frequent urination, or fatigue. Has the patient been jittery or had palpitations? Ask about headaches, dizziness, and impaired peripheral vision. Complete the history by finding out what drugs the patient is taking.
Begin the physical examination by taking the patient’s vital signs and weighing her. Inspect for increased facial hair growth, sparse body hair, male distribution of fat and muscle, acne, and clitoral enlargement. Note if the skin is abnormally dry or moist, and check hair texture. Also, be alert for signs of psychological or physical stress. Rule out pregnancy by a blood or urine pregnancy test.
Top Medical causes
TopAdrenal hyperplasia
In adrenal hyperplasia, oligomenorrhea may occur with signs of androgen excess, such as clitoral enlargement and male distribution of hair, fat, and muscle mass.
TopAnorexia nervosa
Anorexia nervosa may cause sporadic oligomenorrhea or amenorrhea. Its cardinal symptom, however, is a morbid fear of being fat associated with weight loss of more than 20% of ideal body weight. Typically, the patient displays dramatic skeletal muscle atrophy and loss of fatty tissue; dry or sparse scalp hair; lanugo on the face and body; and blotchy or sallow, dry skin. Other symptoms include constipation, a decreased libido, and sleep disturbances.
TopDiabetes mellitus
Oligomenorrhea may be an early sign in diabetes mellitus. In insulin-dependent diabetes, the patient may have never had normal menses. Associated findings include excessive hunger, polydipsia, polyuria, weakness, fatigue, dry mucous membranes, poor skin turgor, irritability and emotional lability, and weight loss.
TopHypothyroidism
Besides oligomenorrhea, hypothyroidism may result in fatigue; forgetfulness; cold intolerance; unexplained weight gain; constipation; bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails.
TopProlactin-secreting pituitary tumor
Oligomenorrhea or amenorrhea may be the first sign of a prolactin-secreting pituitary tumor. Accompanying findings include unilateral or bilateral galactorrhea, infertility, loss of libido, and sparse pubic hair. A headache and visual field disturbances — such as diminished peripheral vision, blurred vision, diplopia, and hemianopia — signal tumor expansion.
TopThyrotoxicosis
Thyrotoxicosis may produce oligomenorrhea along with reduced fertility. Cardinal findings include irritability, weight loss despite increased appetite, dyspnea, tachycardia, palpitations, diarrhea, tremors, diaphoresis, heat intolerance, an enlarged thyroid and, possibly, exophthalmos.
Top Other causes
TopDrugs
Drugs that increase androgen levels — such as corticosteroids, corticotropin, anabolic steroids, danocrine, and injectable and implanted hormonal contraceptives — may cause oligomenorrhea. Hormonal contraceptives may be associated with delayed resumption of normal menses when their use is discontinued; however, 95% of women resume normal menses within 3 months. Other drugs that may cause oligomenorrhea include phenothiazine derivatives and amphetamines, and antihypertensive drugs, which increase prolactin levels.
In most women, menstrual bleeding occurs every 28 days, plus or minus 4 days. Although some variation is normal, menstrual bleeding at intervals of greater than 36 days may indicate oligomenorrhea — abnormally infrequent menstrual bleeding characterized by three to six menstrual cycles per year. When menstrual bleeding does occur, it’s usually profuse, prolonged (up to 10 days), and laden with clots and tissue. Occasionally, scant bleeding or spotting occurs between these heavy menses.
Oligomenorrhea may develop suddenly or it may follow a period of gradually lengthening cycles. Although oligomenorrhea may alternate with normal menstrual bleeding, it can progress to secondary amenorrhea.
Because oligomenorrhea is commonly associated with anovulation, it’s common in infertile, early postmenarchal, and perimenopausal women. This sign usually reflects abnormalities of the hormones that govern normal endometrial function. It may result from ovarian, hypothalamic, pituitary, thyroid, and other metabolic disorders and from the effects of certain drugs. It may also result from emotional or physical stress, such as sudden weight change, a debilitating illness, or rigorous physical training.
Top History and physical examination
After asking the patient’s age, find out when menarche occurred. Has the patient ever experienced normal menstrual cycles? When did she begin having abnormal cycles? Ask her to describe the pattern of bleeding. How many days does the bleeding last, and how frequently does it occur? Are there clots and tissue fragments in her menstrual flow? Note when she last had menstrual bleeding.
Next, determine if she’s having symptoms of ovulatory bleeding. Does she experience mild, cramping abdominal pain 14 days before she bleeds? Is the bleeding accompanied by premenstrual symptoms, such as breast tenderness, irritability, bloating, weight gain, nausea, and diarrhea? Does she have cramping or pain with bleeding? Also, check for a history of infertility. Does the patient have children? Is she trying to conceive? Ask if she’s currently using hormonal contraceptives or if she has ever used them in the past. If she has, find out when she stopped taking them.
Then ask about previous gynecologic disorders such as ovarian cysts. If the patient is breast-feeding, has she experienced problems with milk production? If she hasn’t been breast-feeding recently, has she noticed milk leaking from her breasts? Ask about recent weight gain or loss. Is the patient less than 80% of her ideal weight? If so, does she claim that she’s overweight? Ask if she’s exercising more vigorously than usual.
Screen for metabolic disorders by asking about excessive thirst, frequent urination, or fatigue. Has the patient been jittery or had palpitations? Ask about headaches, dizziness, and impaired peripheral vision. Complete the history by finding out what drugs the patient is taking.
Begin the physical examination by taking the patient’s vital signs and weighing her. Inspect for increased facial hair growth, sparse body hair, male distribution of fat and muscle, acne, and clitoral enlargement. Note if the skin is abnormally dry or moist, and check hair texture. Also, be alert for signs of psychological or physical stress. Rule out pregnancy by a blood or urine pregnancy test.
Top Medical causes
TopAdrenal hyperplasia
In adrenal hyperplasia, oligomenorrhea may occur with signs of androgen excess, such as clitoral enlargement and male distribution of hair, fat, and muscle mass.
TopAnorexia nervosa
Anorexia nervosa may cause sporadic oligomenorrhea or amenorrhea. Its cardinal symptom, however, is a morbid fear of being fat associated with weight loss of more than 20% of ideal body weight. Typically, the patient displays dramatic skeletal muscle atrophy and loss of fatty tissue; dry or sparse scalp hair; lanugo on the face and body; and blotchy or sallow, dry skin. Other symptoms include constipation, a decreased libido, and sleep disturbances.
TopDiabetes mellitus
Oligomenorrhea may be an early sign in diabetes mellitus. In insulin-dependent diabetes, the patient may have never had normal menses. Associated findings include excessive hunger, polydipsia, polyuria, weakness, fatigue, dry mucous membranes, poor skin turgor, irritability and emotional lability, and weight loss.
TopHypothyroidism
Besides oligomenorrhea, hypothyroidism may result in fatigue; forgetfulness; cold intolerance; unexplained weight gain; constipation; bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails.
TopProlactin-secreting pituitary tumor
Oligomenorrhea or amenorrhea may be the first sign of a prolactin-secreting pituitary tumor. Accompanying findings include unilateral or bilateral galactorrhea, infertility, loss of libido, and sparse pubic hair. A headache and visual field disturbances — such as diminished peripheral vision, blurred vision, diplopia, and hemianopia — signal tumor expansion.
TopThyrotoxicosis
Thyrotoxicosis may produce oligomenorrhea along with reduced fertility. Cardinal findings include irritability, weight loss despite increased appetite, dyspnea, tachycardia, palpitations, diarrhea, tremors, diaphoresis, heat intolerance, an enlarged thyroid and, possibly, exophthalmos.
Top Other causes
TopDrugs
Drugs that increase androgen levels — such as corticosteroids, corticotropin, anabolic steroids, danocrine, and injectable and implanted hormonal contraceptives — may cause oligomenorrhea. Hormonal contraceptives may be associated with delayed resumption of normal menses when their use is discontinued; however, 95% of women resume normal menses within 3 months. Other drugs that may cause oligomenorrhea include phenothiazine derivatives and amphetamines, and antihypertensive drugs, which increase prolactin levels.
Oligomenorrhea
Definition
Medical dictionaries define oligomenorrhea as infrequent or very light menstruation. But physicians typically apply a narrower definition, restricting the diagnosis of oligomenorrhea to women whose periods were regularly established before they developed problems with infrequent flow. With oligomenorrhea, menstrual periods occur at intervals of greater than 35 days, with only four to nine periods in a year.
Description
True oligomenorrhea can not occur until menstrual periods have been established. In the United States, 97.5% of women have begun normal menstrual cycles by age 16. The complete absence of menstruation, whether menstrual periods never start or whether they stop after having been established, is called amenorrhea. Oligomenorrhea can become amenorrhea if menstruation stops for six months or more.
It is quite common for women at the beginning and end of their reproductive lives to miss or have irregular periods. This is normal and is usually the result of imperfect coordination between the hypothalamus, the pituitary gland, and the ovaries. For no apparent reason, a few women menstruate (with ovulation occurring) on a regular schedule as infrequently as once every two months. For them that schedule is normal and not a cause for concern.
Women with polycystic ovary syndrome (PCOS) are also likely to suffer from oligomenorrhea. PCOS is a condition in which the ovaries become filled with small cysts. Women with PCOS show menstrual irregularities that range from oligomenorrhea and amenorrhea on the one hand to very heavy, irregular periods on the other. The condition affects about 6% of premenopausal women and is related to excess androgen production.
Other physical and emotional factors also cause a woman to miss periods. These include:
* emotional stress
* chronic illness
* poor nutrition
* eating disorders such as anorexia nervosa
* excessive exercise
* estrogen-secreting tumors
* illicit use of anabolic steriod drugs to enhance athletic performance
Professional ballet dancers, gymnasts, and ice skaters are especially at risk for oligomenorrhea because they combine strenuous physical activity with a diet intended to keep their weight down. Menstrual irregularities are now known to be one of the three disorders comprising the so-called "female athlete triad," the other disorders being disordered eating and osteoporosis. The triad was first formally named at the annual meeting of the American College of Sports Medicine in 1993, but doctors were aware of the combination of bone mineral loss, stress fractures, eating disorders, and participation in women's sports for several decades before the triad was named. Women's coaches have become increasingly aware of the problem since the early 1990s, and are encouraging female athletes to seek medical advice.
Causes and symptoms
Symptoms of oligomenorrhea include:
* menstrual periods at intervals of more than 35 days
* irregular menstrual periods with unpredictable flow
* some women with oligomenorrhea may have difficulty conceiving.
Oligomenorrhea that occurs in adolescents is often caused by immaturity or lack of synchronization between the hypothalamus, pituitary gland, and ovaries. The hypothalamus is part of the brain that controls body temperature, cellular metabolism, and basic functions such as eating, sleeping, and reproduction. It secretes hormones that regulate the pituitary gland.
The pituitary gland is then stimulated to produce hormones that affect growth and reproduction. At the beginning and end of a woman's reproductive life, some of these hormone messages may not be synchronized, causing menstrual irregularities.
In PCOS, oligomenorrhea is probably caused by inappropriate levels of both female and male hormones. Male hormones are produced in small quantities by all women, but in women with PCOS, levels of male hormone (androgens) are slightly higher than in other women. More recently, however, some researchers are hypothesizing that the ovaries of women with PCOS are abnormal in other respects. In 2003, a group of researchers in London reported that there are fundamental differences between the development of egg follicles in normal ovaries and follicle development in the ovaries of women with PCOS.
In athletes, models, actresses, dancers, and women with anorexia nervosa, oligomenorrhea occurs because the ratio of body fat to weight drops too low.
Diagnosis
History and physical examination
Diagnosis of oligomenorrhea begins with the patient informing the doctor about infrequent periods. The doctor will ask for a detailed description of the problem and take a history of how long it has existed and any patterns the patient has observed. A woman can assist the doctor in diagnosing the cause of oligomenorrhea by keeping a record of the time, frequency, length, and quantity of bleeding. She should also tell the doctor about any recent illnesses, including longstanding conditions like diabetes mellitus. The doctor may also inquire about the patient's diet, exercise patterns, sexual activity, contraceptive use, current medications, or past surgical procedures.
The doctor will then perform a physical examination to evaluate the patient's weight in proportion to her height, to check for signs of normal sexual development, to make sure the heart rhythm and other vital signs are normal, and to palpate (feel) the thyroid gland for evidence of swelling.
In the case of female athletes, the doctor may need to establish a relationship of trust with the patient before asking about such matters as diet, practice and workout schedules, and the use of such drugs as steroids or ephedrine. The presence of stress fractures in young women should be investigated. In some cases, the doctor may give the patients the Eating Disorder Inventory (EDI) or a similar screening questionnaire to help determine whether the patient is at risk for developing anorexia or bulimia.
Laboratory tests
After taking the woman's history, the gynecologist or family practitioner does a pelvic examination and Pap test. To rule out specific causes of oligomenorrhea, the doctor may also do a pregnancy test and blood tests to check the level of thyroid hormone. Based on the initial test results, the doctor may want to do tests to determine the level of other hormones that play a role in reproduction.
As of 2003, more sensitive monoclonal assays have been developed for measuring hormone levels in the blood serum of women with PCOS, thus allowing earlier and more accurate diagnosis.
Imaging studies
In some cases the doctor may order an ultrasound study of the pelvic region to check for anatomical abnormalities, or x rays or a bone scan to check for bone fractures. In a few cases the doctor may order an MRI to rule out tumors affecting the hypothalamus or pituitary gland.
Treatment
Treatment of oligomenorrhea depends on the cause. In adolescents and women near menopause, oligomenorrhea usually needs no treatment. For some athletes, changes in training routines and eating habits may be enough to return the woman to a regular menstrual cycle.
Most patients suffering from oligomenorrhea are treated with birth control pills. Other women, including those with PCOS, are treated with hormones. Prescribed hormones depend on which particular hormones are deficient or out of balance. When oligomenorrhea is associated with an eating disorder or the female athlete triad, the underlying condition must be treated. Consultation with a psychiatrist and nutritionist is usually necessary to manage an eating disorder. Female athletes may require physical therapy or rehabilitation as well.
Alternative treatment
As with conventional medicial treatments, alternative treatments are based on the cause of the condition. If a hormonal imbalance is revealed by laboratory testing, hormone replacements that are more "natural" for the body (including tri-estrogen and natural progesterone) are recommended. Glandular therapy can assist in bringing about a balance in the glands involved in the reproductive cycle, including the hypothalmus, pituitary, thyroid, ovarian, and adrenal glands. Since homeopathy and acupuncture work on deep, energetic levels to rebalance the body, these two modalities may be helpful in treating oligomenorrhea. Western and Chinese herbal medicines also can be very effective. Herbs used to treat oligomenorrhea include dong quai (Angelica sinensis), black cohosh (Cimicifuga racemosa), and chaste tree (Vitex agnus-castus). Herbal preparations used to bring on the menstrual period are known as emmenagogues. For some women, meditation, guided imagery, and visualization can play a key role in the treatment of oligomenorrhea by relieving emotional stress.
Diet and adequate nutrition, including adequate protein, essential fatty acids, whole grains, and fresh fruits and vegetables, are important for every woman, especially if deficiencies are present or if she regularly exercises very strenuously. Female athletes at the high school or college level should consult a nutritionist to make sure that they are eating a well-balanced diet that is adequate to maintain a healthy weight for their height. Girls participating in dance or in sports that emphasize weight control or a slender body type (gymnastics, track and field, swimming, and cheerleading) are at higher risk of developing eating disorders than those that are involved in such sports as softball, weight lifting, or basketball. In some cases the athlete may be given calcium or vitamin D supplements to lower the risk of osteoporosis.
Many women, including those with PCOS, are successfully treated with hormones for oligomenorrhea. They have more frequent periods and begin ovulating during their menstrual cycle, restoring their fertility.
For women who do not respond to hormones or who continue to have an underlying condition that causes oligomenorrhea, the outlook is less positive. Women who have oligomenorrhea may have difficulty conceiving children and may receive fertility drugs. The absence of adequate estrogen increases risk for bone loss (osteoporosis) and cardiovascular disease. Women who do not have regular periods also are more likely to develop uterine cancer. Oligomenorrhea can become amenorrhea at any time, increasing the chance of having these complications.
Prevention
Oligomenorrhea is preventable only in women whose low body fat to weight ratio is keeping them from maintaining a regular menstrual cycle. Adequate nutrition and a less vigorous training schedules will normally prevent oligomenorrhea. When oligomenorrhea is caused by hormonal factors, it is not preventable, but it is often treatable.
Key Terms
Anorexia nervosa
A disorder of the mind and body in which people starve themselves in a desire to be thin, despite being of normal or below normal body weight for their size and age.
Cyst
An abnormal sac containing fluid or semi-solid material.
Emmenagogue
A medication or herbal preparation given to bring on a woman's menstrual period.
Female athlete triad
A combination of disorders frequently found in female athletes that includes disordered eating, osteoporosis, and oligo- or amenorrhea. The triad was first officially named in 1993.
Osteoporosis
The excessive loss of calcium from the bones, causing the bones to become fragile and break easily. Women who are not menstruating are especially vulnerable to this condition because estrogen, a hormone that protects bones against calcium loss, decreases drastically after menopause.
For Your Information
Resources
Books
* American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., revised. Washington, D.C.: American Psychiatric Association, 2000.
* Beers, Mark H., MD, and Robert Berkow, MD, editors. "Menstrual Abnormalities and Abnormal Uterine Bleeding." Section 18, Chapter 235 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
* Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part II, "CAM Therapies for Specific Conditions: Menstrual Symptoms, Menopause, and PMS." New York: Simon & Schuster, 2002.
Periodicals
* Barrow, Boone, MD. "Female Athlete Triad." eMedicine June 17, 2004.
* Chandran, Latha, MBBS, MPH. "Menstruation Disorders." eMedicine August 9, 2004.
* Hopkinson, R. A., and J. Lock. "Athletics, Perfectionism, and Disordered Eating." Eating and Weight Disorders 9 (June 2004): 99-106.
* Klentrou, P., and M. Plyley. "Onset of Puberty, Menstrual Frequency, and Body Fat in Elite Rhythmic Gymnasts Compared with Normal Controls." British Journal of Sports Medicine 37 (December 2003): 490-494.
* Milsom, S. R., M. C. Sowter, M. A. Carter, et al. "LH Levels in Women with Polycystic Ovarian Syndrome: Have Modern Assays Made Them Irrelevant?" BJOG 110 (August 2003): 760-764.
* Nelson, Lawrence M., MD, Vladimir Bakalov, MD, and Carmen Pastor, MD. "Amenorrhea." eMedicine August 9, 2004.
* Suliman, A. M., T. P. Smith, J. Gibney, and T. J. McKenna. "Frequent Misdiagnosis and Mismanagement of Hyperprolactinemic Patients Before the Introduction of Macroprolactin Screening: Application of a New Strict Laboratory Definition of Macroprolactinemia." Clinical Chemistry 49 (September 2003): 1504-1509.
* Webber, L. J., S. Stubbs, J. Stark, et al. "Formation and Early Development of Follicles in the Polycystic Ovary." Lancet 362 (September 27, 2003): 1017-1021.
Organizations
* American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016-3007. (202) 966-7300. Fax: (202) 966-2891.
* American College of Sports Medicine (ACSM). 401 West Michigan Street, Indianapolis, IN 46202-3233. (317) 637-9200. Fax: (317) 634-7817.
* Polycystic Ovarian Syndrome Association. P.O. Box 80517, Portland, OR 7280. (877) 775-7267.
Other
* Clinical Research Bulletin. vol. 1, no. 14.
Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group The Essay Author is Tish Davidson, A.M..
Medical dictionaries define oligomenorrhea as infrequent or very light menstruation. But physicians typically apply a narrower definition, restricting the diagnosis of oligomenorrhea to women whose periods were regularly established before they developed problems with infrequent flow. With oligomenorrhea, menstrual periods occur at intervals of greater than 35 days, with only four to nine periods in a year.
Description
True oligomenorrhea can not occur until menstrual periods have been established. In the United States, 97.5% of women have begun normal menstrual cycles by age 16. The complete absence of menstruation, whether menstrual periods never start or whether they stop after having been established, is called amenorrhea. Oligomenorrhea can become amenorrhea if menstruation stops for six months or more.
It is quite common for women at the beginning and end of their reproductive lives to miss or have irregular periods. This is normal and is usually the result of imperfect coordination between the hypothalamus, the pituitary gland, and the ovaries. For no apparent reason, a few women menstruate (with ovulation occurring) on a regular schedule as infrequently as once every two months. For them that schedule is normal and not a cause for concern.
Women with polycystic ovary syndrome (PCOS) are also likely to suffer from oligomenorrhea. PCOS is a condition in which the ovaries become filled with small cysts. Women with PCOS show menstrual irregularities that range from oligomenorrhea and amenorrhea on the one hand to very heavy, irregular periods on the other. The condition affects about 6% of premenopausal women and is related to excess androgen production.
Other physical and emotional factors also cause a woman to miss periods. These include:
* emotional stress
* chronic illness
* poor nutrition
* eating disorders such as anorexia nervosa
* excessive exercise
* estrogen-secreting tumors
* illicit use of anabolic steriod drugs to enhance athletic performance
Professional ballet dancers, gymnasts, and ice skaters are especially at risk for oligomenorrhea because they combine strenuous physical activity with a diet intended to keep their weight down. Menstrual irregularities are now known to be one of the three disorders comprising the so-called "female athlete triad," the other disorders being disordered eating and osteoporosis. The triad was first formally named at the annual meeting of the American College of Sports Medicine in 1993, but doctors were aware of the combination of bone mineral loss, stress fractures, eating disorders, and participation in women's sports for several decades before the triad was named. Women's coaches have become increasingly aware of the problem since the early 1990s, and are encouraging female athletes to seek medical advice.
Causes and symptoms
Symptoms of oligomenorrhea include:
* menstrual periods at intervals of more than 35 days
* irregular menstrual periods with unpredictable flow
* some women with oligomenorrhea may have difficulty conceiving.
Oligomenorrhea that occurs in adolescents is often caused by immaturity or lack of synchronization between the hypothalamus, pituitary gland, and ovaries. The hypothalamus is part of the brain that controls body temperature, cellular metabolism, and basic functions such as eating, sleeping, and reproduction. It secretes hormones that regulate the pituitary gland.
The pituitary gland is then stimulated to produce hormones that affect growth and reproduction. At the beginning and end of a woman's reproductive life, some of these hormone messages may not be synchronized, causing menstrual irregularities.
In PCOS, oligomenorrhea is probably caused by inappropriate levels of both female and male hormones. Male hormones are produced in small quantities by all women, but in women with PCOS, levels of male hormone (androgens) are slightly higher than in other women. More recently, however, some researchers are hypothesizing that the ovaries of women with PCOS are abnormal in other respects. In 2003, a group of researchers in London reported that there are fundamental differences between the development of egg follicles in normal ovaries and follicle development in the ovaries of women with PCOS.
In athletes, models, actresses, dancers, and women with anorexia nervosa, oligomenorrhea occurs because the ratio of body fat to weight drops too low.
Diagnosis
History and physical examination
Diagnosis of oligomenorrhea begins with the patient informing the doctor about infrequent periods. The doctor will ask for a detailed description of the problem and take a history of how long it has existed and any patterns the patient has observed. A woman can assist the doctor in diagnosing the cause of oligomenorrhea by keeping a record of the time, frequency, length, and quantity of bleeding. She should also tell the doctor about any recent illnesses, including longstanding conditions like diabetes mellitus. The doctor may also inquire about the patient's diet, exercise patterns, sexual activity, contraceptive use, current medications, or past surgical procedures.
The doctor will then perform a physical examination to evaluate the patient's weight in proportion to her height, to check for signs of normal sexual development, to make sure the heart rhythm and other vital signs are normal, and to palpate (feel) the thyroid gland for evidence of swelling.
In the case of female athletes, the doctor may need to establish a relationship of trust with the patient before asking about such matters as diet, practice and workout schedules, and the use of such drugs as steroids or ephedrine. The presence of stress fractures in young women should be investigated. In some cases, the doctor may give the patients the Eating Disorder Inventory (EDI) or a similar screening questionnaire to help determine whether the patient is at risk for developing anorexia or bulimia.
Laboratory tests
After taking the woman's history, the gynecologist or family practitioner does a pelvic examination and Pap test. To rule out specific causes of oligomenorrhea, the doctor may also do a pregnancy test and blood tests to check the level of thyroid hormone. Based on the initial test results, the doctor may want to do tests to determine the level of other hormones that play a role in reproduction.
As of 2003, more sensitive monoclonal assays have been developed for measuring hormone levels in the blood serum of women with PCOS, thus allowing earlier and more accurate diagnosis.
Imaging studies
In some cases the doctor may order an ultrasound study of the pelvic region to check for anatomical abnormalities, or x rays or a bone scan to check for bone fractures. In a few cases the doctor may order an MRI to rule out tumors affecting the hypothalamus or pituitary gland.
Treatment
Treatment of oligomenorrhea depends on the cause. In adolescents and women near menopause, oligomenorrhea usually needs no treatment. For some athletes, changes in training routines and eating habits may be enough to return the woman to a regular menstrual cycle.
Most patients suffering from oligomenorrhea are treated with birth control pills. Other women, including those with PCOS, are treated with hormones. Prescribed hormones depend on which particular hormones are deficient or out of balance. When oligomenorrhea is associated with an eating disorder or the female athlete triad, the underlying condition must be treated. Consultation with a psychiatrist and nutritionist is usually necessary to manage an eating disorder. Female athletes may require physical therapy or rehabilitation as well.
Alternative treatment
As with conventional medicial treatments, alternative treatments are based on the cause of the condition. If a hormonal imbalance is revealed by laboratory testing, hormone replacements that are more "natural" for the body (including tri-estrogen and natural progesterone) are recommended. Glandular therapy can assist in bringing about a balance in the glands involved in the reproductive cycle, including the hypothalmus, pituitary, thyroid, ovarian, and adrenal glands. Since homeopathy and acupuncture work on deep, energetic levels to rebalance the body, these two modalities may be helpful in treating oligomenorrhea. Western and Chinese herbal medicines also can be very effective. Herbs used to treat oligomenorrhea include dong quai (Angelica sinensis), black cohosh (Cimicifuga racemosa), and chaste tree (Vitex agnus-castus). Herbal preparations used to bring on the menstrual period are known as emmenagogues. For some women, meditation, guided imagery, and visualization can play a key role in the treatment of oligomenorrhea by relieving emotional stress.
Diet and adequate nutrition, including adequate protein, essential fatty acids, whole grains, and fresh fruits and vegetables, are important for every woman, especially if deficiencies are present or if she regularly exercises very strenuously. Female athletes at the high school or college level should consult a nutritionist to make sure that they are eating a well-balanced diet that is adequate to maintain a healthy weight for their height. Girls participating in dance or in sports that emphasize weight control or a slender body type (gymnastics, track and field, swimming, and cheerleading) are at higher risk of developing eating disorders than those that are involved in such sports as softball, weight lifting, or basketball. In some cases the athlete may be given calcium or vitamin D supplements to lower the risk of osteoporosis.
Many women, including those with PCOS, are successfully treated with hormones for oligomenorrhea. They have more frequent periods and begin ovulating during their menstrual cycle, restoring their fertility.
For women who do not respond to hormones or who continue to have an underlying condition that causes oligomenorrhea, the outlook is less positive. Women who have oligomenorrhea may have difficulty conceiving children and may receive fertility drugs. The absence of adequate estrogen increases risk for bone loss (osteoporosis) and cardiovascular disease. Women who do not have regular periods also are more likely to develop uterine cancer. Oligomenorrhea can become amenorrhea at any time, increasing the chance of having these complications.
Prevention
Oligomenorrhea is preventable only in women whose low body fat to weight ratio is keeping them from maintaining a regular menstrual cycle. Adequate nutrition and a less vigorous training schedules will normally prevent oligomenorrhea. When oligomenorrhea is caused by hormonal factors, it is not preventable, but it is often treatable.
Key Terms
Anorexia nervosa
A disorder of the mind and body in which people starve themselves in a desire to be thin, despite being of normal or below normal body weight for their size and age.
Cyst
An abnormal sac containing fluid or semi-solid material.
Emmenagogue
A medication or herbal preparation given to bring on a woman's menstrual period.
Female athlete triad
A combination of disorders frequently found in female athletes that includes disordered eating, osteoporosis, and oligo- or amenorrhea. The triad was first officially named in 1993.
Osteoporosis
The excessive loss of calcium from the bones, causing the bones to become fragile and break easily. Women who are not menstruating are especially vulnerable to this condition because estrogen, a hormone that protects bones against calcium loss, decreases drastically after menopause.
For Your Information
Resources
Books
* American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., revised. Washington, D.C.: American Psychiatric Association, 2000.
* Beers, Mark H., MD, and Robert Berkow, MD, editors. "Menstrual Abnormalities and Abnormal Uterine Bleeding." Section 18, Chapter 235 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
* Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part II, "CAM Therapies for Specific Conditions: Menstrual Symptoms, Menopause, and PMS." New York: Simon & Schuster, 2002.
Periodicals
* Barrow, Boone, MD. "Female Athlete Triad." eMedicine June 17, 2004.
* Chandran, Latha, MBBS, MPH. "Menstruation Disorders." eMedicine August 9, 2004.
* Hopkinson, R. A., and J. Lock. "Athletics, Perfectionism, and Disordered Eating." Eating and Weight Disorders 9 (June 2004): 99-106.
* Klentrou, P., and M. Plyley. "Onset of Puberty, Menstrual Frequency, and Body Fat in Elite Rhythmic Gymnasts Compared with Normal Controls." British Journal of Sports Medicine 37 (December 2003): 490-494.
* Milsom, S. R., M. C. Sowter, M. A. Carter, et al. "LH Levels in Women with Polycystic Ovarian Syndrome: Have Modern Assays Made Them Irrelevant?" BJOG 110 (August 2003): 760-764.
* Nelson, Lawrence M., MD, Vladimir Bakalov, MD, and Carmen Pastor, MD. "Amenorrhea." eMedicine August 9, 2004.
* Suliman, A. M., T. P. Smith, J. Gibney, and T. J. McKenna. "Frequent Misdiagnosis and Mismanagement of Hyperprolactinemic Patients Before the Introduction of Macroprolactin Screening: Application of a New Strict Laboratory Definition of Macroprolactinemia." Clinical Chemistry 49 (September 2003): 1504-1509.
* Webber, L. J., S. Stubbs, J. Stark, et al. "Formation and Early Development of Follicles in the Polycystic Ovary." Lancet 362 (September 27, 2003): 1017-1021.
Organizations
* American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016-3007. (202) 966-7300. Fax: (202) 966-2891.
* American College of Sports Medicine (ACSM). 401 West Michigan Street, Indianapolis, IN 46202-3233. (317) 637-9200. Fax: (317) 634-7817.
* Polycystic Ovarian Syndrome Association. P.O. Box 80517, Portland, OR 7280. (877) 775-7267.
Other
* Clinical Research Bulletin. vol. 1, no. 14.
Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group The Essay Author is Tish Davidson, A.M..
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