Regular menstruation indicates the normal functioning of the female body. If a woman has no health problems, then the normal menstrual cycle is 28 days, sometimes fluctuations from 21 to 35 days are possible. However, the cycle fails quite often. If you encounter such a problem, it will be useful for you to learn about oligomenorrhea, what it is, what are the causes of the disease, symptoms, treatment regimens.
What is oligomenorrhea
The disease is most common in young girls. With complaints of rare menstruation, gynecologists diagnose oligomenorrhea to their patients. Oligomenorrhea is a disease in which menstrual disorders occur. The representatives of the fair sex between menstruation appear large intervals, which can last more than 40 days. It happens that a woman has less than eight menstruation a year, in some cases the discharge lasts only two days. Sometimes menstrual disorders occur due to diseases such as:
- Endometritis - inflammation of the mucous membrane of the uterus,
- Endometriosis is a gynecological disease failure, due to which the formation of benign nodes in the uterus. They can be located in the body or outside of it,
- Polycystic ovary syndrome - in this case, the ovaries increase in size and are filled with vials of fluid.
Oligomenorrhea is of two types: physiological - occurs in adolescent girls who are still having their menstrual cycle or when premenopause occurs in women. During this period, the extinction of reproductive function occurs and the menstruation gradually stops. The second type is a pathological syndrome, which is divided into two types:
- Primary oligomenorrhea - the appearance of the primary signs of the disease refers to the period of formation of the menstrual cycle. Usually you should not worry in this situation, as over time the menses will become regular. But if the girl has congenital diseases of the genital organs, surgical intervention will be required.
- Secondary oligomenorrhea - occurs after the menstrual cycle has recovered. It appears for a number of reasons:
- Congenital abnormalities of the genital organs,
- Ovarian disease,
- Stress states
- Hereditary factors
- Acute infectious diseases, such as encephalitis and meningitis,
- Endocrine diseases,
- Lack of body weight
- Pathology of the uterus,
- Genital infections.
Oligomenorrhea is often found in adolescents, since the body undergoes changes in girls, and the reproductive system is not yet fully formed. Professionals may find it difficult to determine the severity of a failure. Therefore, doctors diagnose:
- First, the doctor asks questions about whether periods have begun, about their regularity, about the patient's day regimen,
- An examination is conducted to determine if there are congenital diseases of the genital organs,
- The patient must be tested for blood and urine. An ultrasound of the pelvic organs is done.
Since the reproductive system is not yet fully formed, a specialist should be assigned a competent treatment. Usually teens recommend:
- Adjust the mode of the day,
- Specialists prescribe patients taking vitamins of groups B and E,
- Drink mineral water
- Doctors approach the hormone therapy very carefully, as there are drugs that have side effects on the fragile adolescent body. Usually appointed funds, having in the composition of estradiol and progesterone.
Oligomenorrhea has the following symptoms:
- The first sign that the fair sex should pay attention to is the interval between menstruations (it can be more than 40 days). If the duration of menstruation is less than three days and the amount of discharge is scarce, then this can be a serious reason for going to a doctor.
- Infertility decreased sexual desire
- Sometimes women experience intense hair growth on their face, back and chest. This phenomenon is called hirsutism, it can occur when a failure in the menstrual cycle,
- The appearance of acne. With the disease may appear severe rash on the face and body.
The doctor makes a diagnosis after she asks the patient about the regularity of the menstrual cycle and complaints, will conduct a general and gynecological examination of the functional, instrumental and laboratory. As an additional measure, basal temperature is measured and a graph is created. The patient is undergoing transvaginal pelvic ultrasound. It is also necessary to donate blood for sex hormones and study tubal patency. It is also recommended to consult a psychotherapist or a psychologist, because the mental state also plays a serious role in the reproductive system.
Treatment of oligomenorrhea, the search for an effective drug and complex therapy is carried out by a gynecologist-endocrinologist. Doctors usually prescribe to women the drug to stimulate ovulation "Clomiphen" or gonadotropic agents, oral contraceptives. Additionally, you should follow the recommendations of the attending physician on the diet. Physiotherapy, sedatives and antidepressants are useful for treatment.
Immunostimulation, acupuncture, homeopathic therapy speed up recovery. If measures are taken in a timely manner, over time, oligomenorrhea can be completely cured and the menstrual cycle will be restored. This will be indicated by a decrease in the intervals between the monthly periods, the normalization of the duration of discharge during the year. During this time, you should keep the menstrual calendar, and also visit the gynecologist once every three months.
Oligomenorrhea and pregnancy
Pregnancy with this disease is impossible. In the case when there is no ovulation, there are problems with rejection and restoration of the mucous membrane of the uterus, pregnancy should be planned after the elimination of all symptoms.
To do this, you need to restore the hormonal balance, as well as to take drugs prescribed by the attending physician, which help carry out the release of the egg. Before you try to conceive a child, you need to undergo an examination that will show whether you can plan a pregnancy or not.
To date, the disease is successfully treated. The main thing is not to delay the trip to the gynecologist and follow his recommendations. Competent treatment will help to restore women's health, and will give an opportunity to give birth to healthy children in the future.
Kristina, 30 years old
My husband and I have been trying to conceive a baby for a year already, but all without success. They were very afraid of infertility, but after passing the examination and passing the necessary tests, the doctor made a diagnosis: “oligomenorrhea”. It turned out that the problem lies in hormones. I was prescribed combined oral contraceptives plus I needed to follow a diet and change the mode of the day. Six months later, the hormonal balance leveled off, the monthly periods became regular and I managed to get pregnant and have a healthy baby without problems.
I was able to quickly restore the menstrual cycle. But I had primary oligomenorrhea at 12 years old. On the recommendation of the gynecologist by adjusting the diet, reduced physical exertion. Only by adhering to a healthy lifestyle, I managed to get rid of this disease. Now I live a full life and I feel great. The main thing is not to delay and in time to contact your doctor.
Recently complained to the gynecologist that the menstrual cycle had gone astray. The breaks between the monthly periods were 45 days, and they were very scarce. The specialist assigned me Utrozhestan, advised me to lead a healthy lifestyle, try to eat foods rich in vitamins, and include light physical activities in my daily routine. I hope I can soon recover my health, because in the near future I plan to have a baby. I am glad that I went to a specialist in a timely manner!
Causes of oligomenorrhea
Oligomenorrhea can be primary or secondary. It depends on the patient's age and the presence of a normal menstrual cycle before the onset of pathology. Primary oligomenorrhea occurs in adolescent girls. In the first years after menarche (the arrival of the first menstrual period), the menstrual cycle begins to form, and bleeding may be irregular and rare.
In addition, if oligomenorrhea is primary, it may be due to hypoplasia (infantilism) of the uterus. Hypothalamic dysfunction of puberty often contributes to oligomenorrhea. Finally, the hereditary factor can play its role.
Secondary oligomenorrhea is undoubtedly a deviation. Before her appearance, the girl had stable regular menstruation, but any disease provoked a malfunction. Most often the development of oligomenorrhea contributes to ovarian dysfunction. She, in turn, is due to the following reasons:
- hormonal disorder,
- physical exertion
- exhausting diets
- climate change
- taking certain drugs
- the onset of menopause,
- tumors in the pelvic organs.
If oligomenorrhea is secondary, the doctor will certainly ask if the patient has had any abortions. Such interventions often cause irregular menstruation.
Symptoms of oligomenorrhea
The main manifestation of oligomenorrhea is the intervals between menstruations. And if oligomenorrhea in adolescents can proceed unnoticed, then an adult woman can notice a lot of unpleasant symptoms accompanying her. First of all, it is hirsutism - excessive male hair growth. Vegetation appears on the face, chest, abdomen, inner thighs - that is, in places where the fair sex should not have it.
Hirsutism is usually caused by an excess in the blood of male sex hormones, which also causes:
- change of constitution: the female figure becomes similar to the male,
- decreased libido
- problems with conception.
In most cases, it is the last factor that causes women to begin treatment.
Oligomenorrhea - insidious female pathology
Oligomenorrhea is a type of menstrual disorder. Translation of the name of the disease from Greek means minor, short monthly bleeding. Most often, this female pathology is manifested by short and rare periods.
Depending on the causes of the violation, these types of oligomenorrhea are distinguished:
Primary oligomenorrhea may occur in the period of formation of menstruation.
The secondary form of pathology occurs against the background of various diseases some time after normal menstruation, when the cycle has already been established.
Secondary oligomenorrhea manifests itself in adult women against the background of any pathology, and the menstrual cycle was previously normal
There is another category of the disease - unspecified. This type includes oligomenorrhea caused by ovarian depletion, underdevelopment, immune disruptions and other disorders in the ovaries of unexplained nature.
Short-term rare periods can have a physiological nature - after menarche (first menstruation) in girls, the cycle has not yet been established in the premenopausal period (pre-menopausal stage), when a gradual decrease in menstrual function occurs.
Causes and factors of development
The main cause of pathology is the lack of synthesis of sex hormones that regulate the menstrual cycle.
The emergence of primary oligomenorrhea is associated with congenital malformations of the female reproductive system, caused by genetic abnormalities, such as uterus infantilism.
The secondary form of the pathology develops due to acute gynecological diseases or chronic infections, such as:
- polycystic ovaries,
- hypoplasia of the uterus.
The disease may occur due to tumors or surgery, namely:
- endometrial scraping.
The cause may be endocrine disorders:
- thyroid dysfunction,
- adrenal pathology,
- pancreatic diseases.
In addition, cause the development of menstrual failures can:
- adverse environmental factors,
- weight loss due to anorexia or, conversely, obesity,
- total depletion of the body
- severe stress
- abrupt climate change
- incorrect use of hormonal drugs, for example, oral contraceptives or glucocorticosteroids,
- pituitary tumors,
- injuries to the appendages and uterus.
One of the causes of oligomenorrhea can be polycystic ovarian cancer or a pituitary tumor that synthesizes hormones that regulate sexual function.
Rarely lead to oligomenorrhea pathology of the hematopoietic and cardiovascular systems.
The risk group includes professional athletes and women with psychological eating disorders - bulimia and anorexia.
Interesting fact. The functioning of the female reproductive system is directly related to body weight. Female sex hormones are deposited (accumulated) in the fatty tissue, so it should be enough. If the fat layer is developed very weakly, then the woman has serious violations, up to the complete absence of menstruation and infertility.
The disease does not cause the patient inconvenience with its main symptom; on the contrary, many women see only advantages in the short-term menstrual bleeding. In fact, scanty periods, lasting no more than 2 days, suggest that the inner layer, the endometrium, does not grow well in the uterus. And this is fraught with the fact that on a thin, weak uterine layer the fertilized egg is not able to gain a foothold and the pregnancy will not come. In addition, there is a high probability that the woman's estrogen production is reduced and the ovulatory function is impaired, that is, the maturation of the egg in the ovaries occurs very rarely or does not occur at all. Such a state, in fact, speaks of changes that are characteristic of premenopause.
In patients with oligomenorrhea, a violation of lipid metabolism quite often develops, which is accompanied by obesity and skin diseases (acne). Acne does not respond well to therapy.
Approximately 20% of women have hirsutism - increased hair growth in men, and the hair becomes hard and thick not only on the legs and arms, but also on the abdomen, chest, back and face. The body of the patient at the same time resembles a male silhouette - narrow hips and broad shoulders, well-developed muscles.
Oligomenorrhea is often accompanied by hirsutism - male type hair growth
Libido (sexual desire) with oligomenorrhea reduced.
The prescription of immunostimulatory drugs, vitamins (A, E, group B) is widely used.
Special gynecological massage improves blood circulation and eliminates stagnation in the pelvic organs, strengthens the muscular system, promotes the resorption of adhesions and inflammatory infiltrates. Bimanual massaging of the uterus is performed by a gynecologist using two-handed techniques, with one hand massaging the uterus from the vagina or rectum, and the other hand from the stomach.
Gynecological massage normalizes blood circulation in the pelvic organs, promotes the resorption of adhesions and inflammatory infiltrates
Diet for oligomenorrhea is prescribed individually by the doctor in each case. The general principles of nutrition during illness are the limitation of salt, animal fats, easily digestible carbohydrates in the diet, and the use of herbal teas.
Exercise therapy is aimed at improving the whole body and improving the blood circulation of the pelvic organs.
It is very important to adjust the daily routine, spend more time outdoors, avoid stress and overwork whenever possible.
The leading role in the treatment of the secondary form of the disease in adult women is played by hormonal therapy, which is prescribed to regulate the cycle and stimulate the process of ovulation.
If oligomenorrhea caused polycystic ovarian disease, then the patient is prescribed a course of progesterone - Vert, Duphaston, Utrogestan, Inzhest. The course of treatment with such agents lasts 10–12 days and is prescribed monthly or quarterly until normalization of menstrual bleeding.
Usually, the use of drugs with progesterone alternate with the use of other drugs-contraceptives. This combination leads to the most effective regulation of the cycle and helps to relieve the patient from associated symptoms, such as hirsutism and acne.
In order to restore ovulation, prescribed hormonal drugs - Clomiphene, Clomid, Pergonal.
In some cases, surgery is used to treat oligomenorrhea. In case of polycystic ovary, in order to normalize the ovulatory cycle, point diathermocoagulation is prescribed (cauterization of the ovarian tissue with high-frequency current). Such treatment is contraindicated in unborn women. Girls who are planning to have children in the future are assigned a more gentle method of radio wave coagulation.
Physiotherapy is contraindicated in the period of exacerbation of chronic inflammatory processes, with endometriosis, cancer, severe circulatory disorders, renal or hepatic failure.
With follicular dysfunction, electrophoresis with copper, ultrasound, phototherapy, and magnetic therapy are prescribed. These methods are aimed at improving the blood supply, strengthening and restoring the genital organs, relieving spasms, inflammation, stimulating the production of estrogen. With the same purpose, paraffin and ozokerite treatment can be prescribed.
With reduced ovarian function, hydrogen sulphide and nitrogen-thermal baths are shown, as well as spa treatment in Pyatigorsk, Anapa, Evpatoria, Saki, Goryachiy Klyuch.
Hydrogen sulfide baths are shown to restore reproductive function.
In some cases, acupuncture, which is appointed to restore the functional ability of the genitals, is very effective.
The use of herbs can be used only in consultation with the attending physician and used as an adjunct to the main therapy.
Traditional medicine recommends the use of fresh sorrel and mushrooms, raincoat, eleutherococcus, ginseng, as well as herbal teas, decoctions and infusions to oligomenorrhoea patients.
Physiology of the regulation of menstrual cycles
Menstrual cycles are repeated cyclical changes in the female body, especially in different parts of the reproductive system. The culmination of the external manifestation of it are menstruation, which recur with a certain interval during the entire reproductive period, except during pregnancy and lactation. Failure of these processes leads to the development of disorders, including oligomenorrhea. After the first menstruation (menarche), which appears, as a rule, in 10-12 years, the regularity of cycles can be established for 1-1.5 years.
The normal course and cyclical nature of these processes, accompanied by changes throughout the body, is ensured by a single neurohormonal system consisting of central (unifying) and peripheral effector (executive) structures, as well as intermediate links. In the mechanism of reproductive regulation, 5 levels are conventionally distinguished, which interact with each other in accordance with the principles of positive and negative direct and feedback relationships.
Higher or first level
Represented by the cerebral cortex and some other structures of the latter. They are involved in the perception and appropriate impact on other parts of the reproductive system, depending on the frequency, severity and duration of exposure to external (severe stress, instability of the psycho-emotional sphere, etc.) and internal stimuli. In the latter case, this occurs through specific receptors for estrogen, androgen and progesterone. In response to the action of stimuli in these structures of the brain, biologically active substances are synthesized, released and undergo biochemical transformations that affect the corresponding function of another brain formation, the hypothalamus.
The hypothalamus, as a neuroendocrine structure, is the second level of regulation. It possesses the properties of both neurons that reproduce electrical impulses, and cells that release the hormonal substances Liberin (stimulating) and statins (blocking). The activity of the hypothalamus depends both on the regulatory influence of the structures of the first level and on the content of sex hormones in the blood. The hypothalamic gonadotropic liberins are combined by the name gonadotropin releasing hormone (GnRH). Its secretion is programmed genetically and is of a cychoral (pulsating) nature. The maximum activity of the hypothalamus lasts a few minutes, the intervals of activity range from 1 to 3 hours, which is also influenced by the concentration of estradiol in the blood in the luteal or follicular phase of the menstrual cycle.
The anterior lobe of the pituitary gland is the third level of neuroendocrine regulation. Hormones are secreted by this part of the brain:
- FSH (follicle-stimulating), which stimulates the growth and maturation of follicles in the ovaries,
- LH (luteinizing), which together with the first contributes to the production of progesterone,
- prolactin, which controls the release of progesterone by the corpus luteum into the blood, as well as stimulating the growth of the mammary glands and regulating lactation,
- TSH (thyrotropic), STH (somatotropic) and ACTH (adrenocorticotropic).
Only with a balanced secretion of these hormones can adequate functioning of the reproductive system, the establishment of a regular menstrual cycle and the absence of such disorders as oligomenorrhea, amenorrhea, hypomenorrhea, etc.
It consists of peripheral endocrine organs, which include the ovaries, the thyroid gland and the adrenal glands. The ovaries, in which follicles grow and mature, sex hormones are synthesized, a yellow body forms, perform the main role. Hormones synthesized in the ovaries are not only determining the functional changes in the reproduction system itself, but they also have an active influence on the metabolic processes in tissues and organs that have receptors for sex hormones, aminopeptides, insulin and glucagon.
The vaginal mucosa, the uterus, especially its mucosa (endometrium), in which the cyclic processes are expressed to the maximum, the fallopian tubes and mammary glands, make up. Cyclic changes in the endometrium, consisting of cell proliferation, secretion and menstruation directly, depend on both the concentration of sex hormones in the blood and the state of the tissue receptor apparatus to sex hormones.
These levels form the hypothalamic-pituitary-ovarian axis. The principles of direct and reverse interaction through specific hormone receptors at all levels ensure cyclicality and adequate functioning of the reproductive system.
By “direct” communication is meant the stimulating effect of the hypothalamic region of the brain on the pituitary gland, followed by the synthesis of sex hormones in the ovaries, by the “reverse” effect of the level of concentration of sex hormones on the hypothalamus and pituitary.
One of the main generalizing indicators, which reflects the interaction of different levels of the hypothalamus-pituitary-ovary axis and the possibility of realizing the main function of the body's reproduction system, is the menstrual cycle. Its character makes it possible to clinically determine the level of the state of the reproductive system, due to the correct relationships in the hypothalamus-pituitary-ovaries system.
Thus, oligomenorrhea-type nmc, like other types of these disorders, can be triggered by factors causing disturbances in the interaction of the divisions of the neuroendocrine system at one or several levels.
Causes of oligomenorrhea
Oligomenorrhea can be physiological and pathological. Physiological oligomenorrhea is a disorder that accompanies physiological conditions. It occurs in adolescence, when the menstrual cycle begins to form, and during the period of premenopause, that is, the extinction of the functions of the reproductive system (what is and when the menopause period begins, read in our article). In the latter case, it precedes the menopausal amenorrhea.
Pathological syndrome varies as:
- Primary oligomenorrhea - occurs during the formation of the menstrual cycle. In this case, it is an external sign of the beginning of the development of the process, which in the fertile period determines the impairment of the neuroendocrine function of the reproductive system of the body. By the end of adolescence, the disorders in the hypothalamus-pituitary-ovaries system, which are initially functional in nature, acquire relative stability and retain their main features already at childbearing age.
- Secondary oligomenorrhea - develops after the established normal regular menstrual cycle.
Having an idea of the levels of physiological regulation of the menstrual cycle, it becomes clear that the cause of oligomenorrhea can be any organic or functional disturbance at one of the levels. These reasons may be:
- Anatomical changes in the brain due to trauma, pituitary and other tumors of different nature, the disease and Itsenko-Cushing syndrome.
- Chronic negative psychogenic stress or severe stress conditions.
- Excessive prolonged physical exertion and a sharp change in the climate or time zone.
- Acute infectious diseases complicated by neuroinfection, as well as meningitis or encephalitis.
- Endocrine diseases (hypothyroidism, diseases of the pancreas, adrenal tumors, some forms of menopausal and premenstrual syndromes).
- Familial susceptibility to reproductive function disorders (for more information on female infertility, read here).
- Congenital malformations of genital organs.
- Metabolic disorders in obesity, rapid loss of body weight, unbalanced diet, lack of body weight for a long time.
- Long-term use of oral contraceptives containing estrogens, opioid drugs, metoclopramide (an antiemetic), hallucinogens, and some drugs, long-term or inadequate treatment with hormonal (glucocorticosteroids) drugs.
- Ovarian diseases (cysts, polycystic ovary syndrome, tumors).
- The cause of oligomenorrhea can be frequent infectious diseases in childhood and in adulthood, including chronic inflammatory processes and post-inflammatory changes in the endometrium, as well as tumors, endometriosis, surgery on the uterus and ovaries, trauma (abortion).
- Diseases of the liver and cardiovascular system (rare).
The International Classification of Diseases (ICD-10) also introduced such a category as “unspecified oligomenorrhea”. It belongs to the class of diseases of the genitourinary system, the block "Non-inflammatory diseases of the female genital organs." This category includes oligomenorrhea, which may be due to exhaustion syndromes, dysgenesis, ovarian hyper retardation, or immune disorders that encompass the humoral and cellular immunity and may be manifested by autoimmune oophoritis or other disorders in the ovaries of an unclear cause.
Can I get pregnant with oligomenorrhea?
It largely depends on the reasons for the development of the syndrome. If this happens hormonal disorders, there is no ovulation, violations of rejection and restoration of the mucous membrane of the uterus, then of course, pregnancy becomes impossible. In cases of infantilism, the possibility of pregnancy depends on the degree of uterine hypoplasia, the degree of hormonal functioning of the ovaries, and the presence of concomitant pathological conditions.
In accordance with the data of the World Health Organization in 1985, among all the causes of infertility, 14.7% are accompanied by this type of pathology. Among all infertile women suffering from any violations of the menstrual cycle, the frequency of oligomenorrhea is 41.6%. Independent pregnancy occurs in approximately only 20% of women with this syndrome.
The diagnosis of primary oligomenorrhea is made to patients at a young age, if the end of puberty is not accompanied by the establishment of a normal rhythm of menstruation (a period of 21-35 days and a duration of 8, but not less than 2 days).
Primary oligomenorrhea is most often the result of intrauterine growth retardation, which accompanies hypoplasia and / or genital infantilism. If the size of the uterus does not correspond to the age norm, they talk about sexual infantilism. The severity of sexual infantilism is determined by the presence or absence of ovarian failure and the level of underdevelopment of the uterus:
- The first degree of infantilism is very rare and refers to anomalies of development, characterized by the presence of a rudimentary uterus. Menstruation is practically absent. Restoring the normal structure of the female genital organs with such a structure is impossible.
- The second degree of underdevelopment corresponds to the “childish” size of the uterus and is accompanied by oligomenorrhea. Adequate long-term treatment helps to restore the normal anatomical structure of the body.
- The third degree of infantilism is uterine hypoplasia. The uterus has a normal structure, but its size does not correlate with the age norm. The causes of hypoplasia can be severe infections or inflammatory diseases of the genital organs during puberty. Oligomenorrhea in hypoplasia is temporary and lasts until the uterus "grows up" under the influence of therapy. Uterine hypoplasia can disappear on its own due to internal hormonal resources.
Ultrasound in the presence of primary oligomenorrhea allows to determine the presence of abnormalities in the development of the genital organs, and laboratory tests will determine the nature of hormonal disorders.
Secondary oligomenorrhea never accompanies puberty, it is inherent in more adult women. This is facilitated by a variety of reasons - from the most "simple" such as overwork or cold to serious diseases. The appearance of a short-term violation of the menstrual cycle with its subsequent independent recovery is an absolutely normal situation.
If oligomenorrhea exists for a long time, accompanied by such alarming symptoms as infertility, hirsutism, obesity, decreased sexual desire or endocrine disorders, an in-depth examination is required.
Treatment of secondary oligomenorrhea involves the elimination of the underlying disease.
For the successful elimination of oligomenorrhea, it is necessary to establish its cause. Oligomenorrhea treatment is not carried out:
- When patients are young girls without signs of abnormal development of the genital organs and endocrine pathology, observation is allowed for two years,
- In the period of extinction of menstrual function (menopause),
- If oligomenorrhea is caused by short-term causes. For example, if the causes of oligomenorrhea are excessive physical exertion or overwork, the oligomenorrhea self-destructs.
The presence of endocrine pathology requires treatment together with an endocrinologist. The menstrual cycle can be brought to normal only after adequate treatment of the underlying disease.
After the therapy of the underlying disease has been successfully completed, the menstrual cycle is restored by hormonal correction. It is possible that the menstrual cycle is restored without medical intervention.