Conditions and Management

Menstruation can be a challenging time of the month for many women. Between the symptoms of premenstrual syndrome and the bleeding itself, some women may wish that their periods could come less often. However, having infrequent menstrual periods could signify a menstrual disorder that needs to be diagnosed and treated by a doctor.

What Is Oligomenorrhea?

When a woman of childbearing age experiences infrequent menstrual periods, she may have oligomenorrhea. Periods typically occur every 21 to 35 days, and some variation within this range is considered normal. Therefore, a woman who often falls outside the high end of this range may be diagnosed with oligomenorrhea.

Women who go longer than 35 days without a period and are not taking birth control medication should see their doctor, as should women who experience sudden changes to their cycle. Women with oligomenorrhea may also experience periods that are lighter than usual.

Oligomenorrhea can make it more difficult for a woman to become pregnant, so uncovering its cause is particularly important if you are trying to start a family.

How Is Oligomenorrhea Diagnosed?

Oligomenorrhea is a term used to describe infrequent menstruation, and it is typically diagnosed following a review of a woman’s menstrual history. Your doctor might ask questions about your health as well as the reproductive health of other women in your family, such as your mother, sisters, or aunts. Your doctor will discuss your symptoms with you and may ask about your sexual history and any pregnancies or births you have had, along with any medications you take, and surgeries you have undergone.

As a medical diagnosis, it refers to a normal menstrual cycle changing and lasting for more than 35 days or experiencing fewer than nine periods in the span of a year.

After being diagnosed with oligomenorrhea, it is important to determine its cause, some of which are considered relatively harmless. The hormones influencing the menstrual cycle can be affected temporarily by different factors, and periods could return to normal after a short time. However, in some cases, it could require medical treatment. Depending on the suspected cause, a physical exam, ultrasound imaging, or blood tests may be used to learn more about it.

The Causes of Oligomenorrhea

Below are some of the main causes of oligomenorrhea.

Pregnancy

One of the more common causes of a delayed menstrual cycle is pregnancy. If you suspect that this could be the cause of your period’s delay, you should take a pregnancy test to rule out this possibility.

Hormonal Birth Control

Oligomenorrhea is one of the known side effects of hormonal birth control pills. Around three to six months after you start taking birth control pills, you may begin to notice increasingly lighter periods. Some women report that their periods stop entirely. Thus, it is important to discuss this with your doctor if you have any concerns.

Age

In adolescent girls who are just beginning to get their period, it is not uncommon for their cycle to be irregular at first, and this may include periods that are spaced out longer than a typical mature woman would experience. In addition, oligomenorrhea may be seen in perimenopausal women because of fluctuations to hormone levels that occur during this phase of life.

Body Chemistry

Oligomenorrhea is common in women who have high levels of the protein prolactin in their blood as well as those who take certain types of medications known to decrease menstruation, such as antiepileptics and antipsychotics.

High Activity Levels

Young women who participate in heavy exercise and intense sports, such as marathon runners, may develop oligomenorrhea.

Eating Disorders

Women who have eating disorders, like bulimia or anorexia nervosa, may experience infrequent menstruation. Malnourishment is another common cause of oligomenorrhea.

Health Conditions

A light flow or a missed menstrual cycle could indicate that a woman has polycystic ovary syndrome, or PCOS. It may also occur in women who have thyroid problems or diabetes.

How Is Oligomenorrhea Treated?

It is important to keep in mind that just one missed cycle or light flow is not usually a problem. Moreover, oligomenorrhea is not considered serious on its own. It may be possible to adjust your menstrual period with help from hormonal birth control or progestin.

However, in cases where oligomenorrhea is caused by an underlying problem, treating that problem can restore menstrual regularity. For example, women whose oligomenorrhea is caused by an eating disorder may find that their periods return to normal once they have treated that disorder, while women whose problem is caused by excessive workouts might consider reducing their exercise regimen.

Get In Touch With Raleigh Gynecology & Wellness

If you have any concerns about your cycle or reproductive health, reach out to the compassionate team of experienced women’s health professionals at Raleigh Gynecology & Wellness. We offer specialized care for women of all ages for everything from menstrual disorders to fertility issues.

A pelvic exam by your gynecologist should be a part of every adult woman’s annual wellness regimen. During a pelvic exam, your doctor evaluates the health of your reproductive organs. Depending on your age, your doctor will provide recommendations on good hygiene, contraception and family planning options, and treat any abnormality that the pelvic exam reveals.

When Do Pelvic Exams Begin?

Once a young woman reaches puberty, she should have her first “well-woman” or “wellness” visit with her doctor or gynecologist. This first wellness visit normally occurs between the ages of 13 to 15. During that visit, you may simply have a regular physical exam where your height, weight, blood pressure, respiration, and other basic vital signs will be evaluated by your doctor. You may discuss your menstrual period, sexual activity, contraception and hygiene, and get some vaccines.

At some point after you become sexually active, your wellness visit will include a pelvic exam. By the time you reach the age of 21, an annual pelvic exam should be part of your healthcare routine.

What Happens During A Pelvic Exam?

The purpose of a pelvic exam is to examine the health condition of your external and internal reproductive organs. The doctor uses special tools designed to examine your internal reproductive organs, consisting of your vulva, vaginal canal, cervix, ovaries, fallopian tubes, and uterus.

If you think you may have any reproductive health issue or an STD or any kind of pelvic infection, it’s a good idea to inform your doctor when your appointment or examination begins. If a special test or exam is needed, the doctor may be able to perform it during your appointment, or you may need to schedule a follow-up visit to have it done.

When you arrive at your doctor’s office, you will be escorted to a private examining room. You will undress and put on a paper or cloth hospital-style gown that opens in the front. When your doctor and nurse return, they will position you so that you are safely lying down on the examining table.

After you lay down, you put your feet into the footrests, called “stirrups,” at the end of the table. Then, you slide yourself down to the edge of the table so that your knees spread out wide.

Once you are properly positioned, the examination begins.

1. The External Exam

This exam starts with a visual examination of your vulva and the opening of your vagina. The doctor is able to detect any cysts, abnormal discharge, genital warts, irritation, or other abnormalities.

2. The Speculum Exam

During this exam,your doctor gently slides a special tool called a speculum into your vagina. The speculum separates the walls of your vagina to hold it open during the examination. You may feel mild discomfort, but it shouldn’t hurt.

Your doctor then inserts a tiny spatula or brush into your vagina and swabs your cervix. This process takes some cells from your cervix that are sent to a lab for a Pap test. The purpose of the Pap test is to determine whether your cervix has any precancerous or cancerous cells.

If you are sexually active, your doctor may also take another small sample from your cervix to test for STDs or other pelvic infection.

3. The Bimanual Exam

After the speculum is removed, your doctor performs a manual examination of your pelvic region. It is the best way for your doctor to check the size and shape of your uterus. Using gloved and lubricated fingers on one hand, your doctor feels the inside of your vagina while using the other hand to gently press on your lower abdomen.

If you experience unusual tenderness or pain during this part of the exam, it may be a sign that you have an infection or an issue with enlarged ovaries, fallopian tubes, ovarian cysts, or even tumors.

4. The Rectovaginal Exam

The final part of the pelvic exam may include a rectal exam. Your doctor inserts a gloved finger into your rectum and, in some cases, another gloved finger into your vagina. This procedure enables the doctor to check the health of the muscles between your vagina and your anus. It also enables your doctor to feel for tumors on the ovaries,behind your uterus, on the walls of your vagina, or in your rectum.

How Often Should You Have A Pelvic Exam?

If you are a healthy, adult woman, you should have a pelvic exam every year. However, you may need to have one more frequently if there are any abnormalities in your pelvic area, such as any one or more of the following conditions:

• History of abnormal Pap test results.
• History of sexual health problems.
• Family history of certain kinds of cancer.
• STD or infection.
• Sex partner with an STD or infection.

Schedule Your Wellness Exam With Raleigh Gynecology & Wellness

Keeping up with your pelvic examinations is important to your overall health. It can even save your life by detecting pelvic infections, tumors or other problems before they become life-threatening. Contact the women’s health experts at Raleigh Gynecology and Wellness for more information and to schedule your appointment.

Your yearly gynecological checkup can be a nerve-wracking time, and it’s not unusual to be so flustered that you forget to ask the questions about menstrual disorders you were meaning to bring up during your appointment.

To avoid that sinking feeling that comes when you get to your car and realize you forgot to ask something important, jot down a list of questions ahead of your appointment and bring those with you to make sure you address all of your concerns.

Questions To Ask About Menstrual Disorders

Here is a look at some of the questions that you may want to ask your gynecologist about menstrual disorders.

Is This Normal?

By definition, menstrual disorders involve menstruation that falls outside of the normal range of duration and intensity. Therefore, if you suspect that something is amiss with your period, the first question you should ask is whether your experience is normal.

It is very helpful if you can bring a log of your periods to your appointment so that your doctor can spot any trends. Whether you’re not sure if the length of time you experience your period is normal or if you worry that you’re bleeding too much, finding out what is normal should be your first step.

I’m Not Pregnant, So Why Am I Not Getting My Period?

The most obvious reason that many women don’t get their period is pregnancy, but what happens if you are not pregnant and your period isn’t coming? You may have a menstrual disorder known as amenorrhea, which is the absence of menstruation. Some of the reasons that regular periods may suddenly stop include weight loss, excessive exercise, illness, and stress. Your doctor can help you uncover the cause of your amenorrhea.

Could My Birth Control Be Affecting My Period?

If your period is troubling you in any way, whether you have a diagnosed menstrual disorder or it’s simply impacting your lifestyle, you may want to ask if your birth control could be affecting your period in any way, or if medication may help control your period better.

In some cases, it may be possible to switch to a different birth control method. For example, an IUD might be causing unwanted bleeding. Some women find that taking certain hormonal birth control pills leads to lighter periods and less cramping; your doctor can advise you on the best course of action for your body.

Why Is My PMS So Bad?

Many women experience premenstrual syndrome, or PMS, and some monthly moodiness, nausea, breast tenderness, and cramping are not a cause for concern. However, a small group of women experience what is known as premenstrual dysphoric disorder, or PMDD, which is a heightened level of PMS that causes physical discomfort as well as emotional symptoms that may impact your life, affect your relationships, or your ability to work. If you feel that this describes you, be sure to mention it to your gynecologist and find out how it can be treated.

How Can I Determine My Fertile Days If I Have Menstrual Disorders?

One challenge for women with menstrual disorders is predicting their cycle. This is very inconvenient if you are trying to start a family. While women with normal cycles can typically determine their fertile window with relative ease, women who have a menstrual disorder that makes their period unpredictable cannot do this easily.

Your gynecologist can let you know about other signs to look for to signify your fertile days when you can’t rely on the calendar alone, and any other challenges to getting pregnant that may be posed by your disorder.

How Long Should My Period Last?

At the heart of many menstrual disorders is an unusual period length, whether it’s an abnormally long period or a surprisingly short one. If this only happens once, there may not be cause for concern, but if your once-normal periods begin to change dramatically in length, this is something you should discuss with your doctor to determine if you have a disorder.

Some women may bleed so heavily during their period that they need to put their normal lives on hold so they can address the heavy blood flow. If you must change your tampon or pad every hour instead of three or four times a day, you may be experiencing heavy menstrual bleeding.

Although this may be common at some stages in your life, such as when you first start to menstruate and when you head into menopause, it is best to discuss this with your doctor to decide if a menstrual disorder is the culprit.

Why Am I Bleeding Less During Periods?

Many women welcome less bleeding during periods, but if you’ve always been a heavy bleeder and you suddenly start bleeding significantly less each month, you should talk with your doctor. It may not signify anything serious, but your doctor can ask you about other symptoms to determine what might be occurring.

Reach Out To Raleigh Gynecology & Wellness For Questions On Menstrual Disorders

Periods are not fun, but your cycle doesn’t have to be a source of extreme stress every month. Make an appointment with the highly trained physicians at Raleigh Gynecology & Wellness to get answers to all your menstruation-related questions.

Amenorrhea is a name given to the absence of menstruation during a woman’s reproductive years. The term simply signifies that a woman has not been getting her period despite being between the ages of puberty and menopause.

Although amenorrhea isn’t a disease and does not signify a person is infertile, it can indicate that a health problem needs to be addressed. Amenorrhea is a symptom rather than an illness, and your doctor will try to find out why you are not menstruating.

Menstruation begins for women at puberty and then occurs once a month until approximately age 50, at which point it stops as menopause begins. Menstruation also stops during pregnancy and may even disappear while a woman is breastfeeding. However, if menstruation does not occur at a time when you expect it to, it is considered amenorrhea.

Types Of Amenorrhea

The main symptom of all types of amenorrhea is an absent period, but there are two main categories of amenorrhea that are used to explain causes and potential solutions.

Primary Amenorrhea

If a woman’s periods do not start during puberty, this is considered primary amenorrhea. The National Institutes of Health recommend that women seek medical help if they have not had their first period by age 16. It is important to note that primary amenorrhea is extremely rare, affecting fewer than 0.1% of American women. (1)

Most girls will get their first period sometime between 10 and 15, with the average age being 12. However, each girl’s body operates on its own schedule, and there is no “right” age for getting a first period.

Causes Of Primary Amenorrhea

One common reason a girl may not have her first period by age 16 is a family history of delayed menstruation. However, there could be a genetic condition that stops the ovaries from working properly, such as androgen insensitivity syndrome, Turner syndrome, or a malformation of the reproductive organs. A structural problem that is present from birth may also be at play; many times these can be corrected with surgery.

Diagnosis Of Primary Amenorrhea

If a girl does not get her first period by 16, a doctor may ask for her family history and conduct tests that measure her levels of certain hormones. A physical examination will also be performed to ensure that there are not any physical problems preventing menstruation from occurring.

Secondary Amenorrhea

Secondary amenorrhea is when a woman who had periods in the past suddenly finds that menstruation stops without explanation. If a woman who is not pregnant or breastfeeding finds that her once-regular periods stop occurring for three months or longer–six months or longer in the case of a woman who had irregular periods–there could be a problem. Missing a period once does not usually signify a health problem, although a pregnancy test is advised in this case.

Causes Of Secondary Amenorrhea

The main causes of secondary amenorrhea include health conditions, stress, weight loss, and medications.

Health Conditions

Long-term illnesses such as premature ovarian failure, thalamic pituitary problems, and polycystic ovary syndrome, or PCOS, could lead to secondary amenorrhea. In addition, an underactive thyroid or pituitary problems can cause hormonal imbalances that lead to menstrual issues.

Stress

Going through severe emotional upheaval or an extreme amount of stress may cause a woman’s periods to stop temporarily.

Weight Loss And Exercise

Serious weight loss, whether it stems from an eating disorder or a physical illness, can cause a woman’s period to stop. In addition, extremely stringent exercise regimens could lead to secondary amenorrhea. The condition is quite common among women who are professional ballet dancers and competitive long-distance runners, for example.

Low Body Mass Index

When a woman’s body mass index drops below 19, her risk of developing secondary amenorrhea increases significantly.

Medications

Certain medications may cause periods to stop. These include progesterone-only contraceptives, antipsychotics, antidepressants, blood pressure drugs, cancer chemotherapy, and allergy medications.

Diagnosis Of Secondary Amenorrhea

When a woman reports that she has stopped menstruating after having periods in the past, her doctor may ask her if pregnancy is possible in addition to inquiring about any recent weight loss or weight gain, her exercise routine, the regularity of her menstrual cycle in the past, and the age at which she began getting periods.

Depending on the potential cause, the doctor may order other tests, such as hormone tests, thyroid function tests, or pregnancy tests, as well as imaging tests as needed.

With secondary amenorrhea, addressing the underlying cause may be enough to restore normal menstruation. For example, a person who has been exercising excessively may wish to revise her regimen to help stabilize her monthly cycle, while those who have stopped getting periods due to stress may find relief from counseling.

Get In Touch With Raleigh Gynecology & Wellness

If you have concerns about your cycle, get in touch with the friendly team of health care professionals at Raleigh Gynecology & Wellness. We are experienced in addressing menstrual disorders, and our focus is on ensuring every patient feels comfortable and informed.

As an adult woman, routine Pap smear should be part of your healthcare routine. It is the best way for your doctor to detect signs of serious health conditions in your cervix, such as precancerous cells, or even cancer.

What Exactly Is A Pap Smear?

A Papanicolaou test, also called a “Pap” smear or Pap test, is a procedure that is performed in your gynecologist’s office, usually as part of a pelvic examination. A Pap smear tests your cervix for cervical cancer and precancerous cells. Your cervix is located at the lower, narrow end of your uterus at the top of your vagina.

To have a Pap test taken, you will be positioned lying down on the examining table to enable your doctor to access your cervix through your vaginal canal. The doctor gently slides a special tool called a speculum into your vagina to hold open the walls of the vaginal canal. Next, your doctor goes in with a tiny spatula or brush and wipes your cervix. This instrument takes some cervical cell samples that are sent to a lab to be tested.

Why Is A Pap Smear Necessary at All?

A Pap smear is the best way to screen for cervical cancer and other abnormal cells on your cervix. It is usually done in conjunction with your annual well woman exam.

When Should You Begin Having Pap Smears?

You should begin having Pap smears when you turn 21. Your doctor can give you a recommendation as to when you should begin Pap testing and how often you should have the test.

Why Is It A Good Idea To Have A Pap Smear Annually?

Annual Pap testing is the best way to detect cervical cancer early. Cervical cancer can be a deadly form of cancer. Early detection gives you a greater chance at a cure. Most women between 21 and 65 should have a Pap smear at least once every three years.

Even if no cancer cells are present, having routinePap smears can detect changes in your cervical cells that suggest cancer may develop in the future. Finding any abnormal cells early helps to prevent the development of cervical cancer.

In some cases testing for Human Papilloma Virus (HPV) is done in conjunction with the pap test. If you are one of many women who has specific risk factors, you should discuss with your doctor whether having Pap testing done more frequently is advisable.

Common risk factors include:

• Prior diagnosis of cervical cancer or precancerous cells.
• HIV infection.
• Weakened immune system due to organ transplant, chemotherapy, or chronic corticosteroid use.
• History of smoking.

Another reason to have Pap tests done regularly is to mitigate risks caused by false-negative tests. Pap tests are very reliable, but on rare occasions a patient can get false-negative results. A false-negative test means that the results show no abnormalities, but in fact there are changes in the cervical cells.

This can be caused by inadequate cell collection, insufficient amounts of abnormal cells to be identified in the test, or inflammation or blood obscured collection of abnormal cells. Because cervical cancer cells usually grow slowly, your next annual Pap test is likely to identify cell abnormalities early enough to treat it.

Are There Health Risks Associated With Having A Pap Smear Done?

A Pap smear presents very low health risks to the patient. Occasionally, you will feel discomfort, but no pain during the procedure. To minimize your discomfort, you should schedule your Pap test when you are not menstruating.

When Do You No Longer Need To Do Pap Testing?

You should continue getting Pap testing performed for as long as you are sexually active. You may no longer need to do so under the following conditions, but you should discuss your circumstances with your doctor:

1. You have had a total hysterectomy. A total hysterectomy means you have had your uterus and your cervix surgically removed for reasons not based on the presence of cancer or cancerous cells. If your hysterectomy was performed for a noncancerous condition, such as uterine fibroids, you may be able to discontinue routine Pap smears.
2. You are 65 or older. Some doctors suggest that routine Pap smears are not necessary for older women as long as their prior tests for cervical cancer have been negative.

Contact Raleigh Gynecology and Wellness to Schedule Your Pap Smear

If you need more information about Pap testing, consult with the experts at Raleigh Gynecology and Wellness. They are available to answer your questions about pap smears, pelvic examinations and any other issue pertaining to women’s reproductive health and wellness. Contact them to schedule an appointment.