Absent or Irregular Menses
Some women have absent or infrequent menses. While some ladies are not bothered with missing their menstrual period, a miss of 3 periods (either consecutively or throughout a year) warrants a visit of your doctor’s clinic.
Absence of menses
The absence of menses is also known as amenorrhea. This can be subdivided into
- Primary amenorrhea – periods that have not commenced by the age of 16
- Secondary amenorrhea – periods that become absent for 3-6 months in a woman who previously had periods
Infrequent irregular menses
Infrequent irregular menses is also known as oligomenorrhea. This is defined by fewer than 6-8 periods per year.
What is the Cause
- Polycystic Ovarian Syndrome (PCOS)
- Low body mass (frequently associated with eating disorders such as anorexia nervosa, bulimia nervosa)
- Emotional stress
- Strenuous exercise
- Premature Ovarian Failure (menopause before the age of 40)
- Brain lesions such as pituitary or hypothalamus lesion
- Structural abnormalities of the womb, ovaries, cervix
- Hormonal conditions such as thyroid disease
- Genetic inheritance disorders
What do I expect when I visit my doctor?
Your doctor will take a thorough, relevant medical history, and a full-body examination, including your face, neck, breasts, abdominal, and pelvic examinations. In sexually active patients, a pregnancy test will be offered. Depends on individual cases, further investigations such as blood tests, hormonal testings, ultrasound of the pelvis, MRI of the brain, genetic testing may be advised.
The goal of treatment is to treat the underlying condition and restore fertility in a woman who are in their reproductive phase of life.
Oral Contraceptive Pills
Hormonal oral contraceptive pills in the form of estrogen and progesterone combinations are commonly used to regulate and restore menses. This treatment also reduces the risks of osteoporosis in females in their later life.
Diet and Exercise
In ladies who experience exercise-induced amenorrhea, they should be advised to increase their calorie intake and reduce the intensity or frequency of exercise. It is advisable for 1200mg to 1500mg of daily calcium intake, and 400IU of daily vitamin D. Healthy lifestyle with good de-stressing techniques are encouraged.
Those with eating disorders often require further support from psychiatrist and dietician specialist to tackle the underlying cause.
Hormonal Replacement Therapy (HT)
In premature ovarian failure cases, hormonal replacement therapy (HT) may be offered to prevent symptoms and long term complications associated with menopause such as vaginal dryness, hot flushes, and osteoporosis. Current guideline recommends hormonal replacement therapy for women with premature ovarian failure until the age of 50.
Surgical Options and Others
Surgical procedures may be offered to patients with structural problems of the reproductive tract.