Libido, better known as sexual desire or drive, indicates an adult woman’s general health [1]. Libidos are instinctual urges, naturally present for all species to procreate and pass their genetic material to future generations. More importantly, libidos are also pertinent in maintaining a healthy relationship and sustaining a romantic bond with your sexual partner.
Low libido can be understood as the lack of sexual drive or interest.
Multiple pieces of literature [2] have raised the occurrence of lower libido in Asian women. These are often related to conservatism in Asian society. In the case of Singaporean women, however, it may be fair to deduce that they are more sexually empowered to treat lowered libido proactively.
A recent study [3] indicated that over half of middle-aged women in Singapore are sexually active; however, many are challenged with sexual dysfunction [4], such as loss of libido. A study [5] by KK Women's and Children's Hospital also revealed low sexual desire and rarely reaching orgasm are commonly reported forms of sexual dysfunction in women. In this article, we take a deep dive into the issue of low libido and how you may overcome it.
The science of libido
Libido differs from one individual to another, with many factors contributing to the phenomenon. Women exhibit different levels of libido at different ages, some attributed to natural biological changes and others due to factors unrelated to bodily changes. Symptoms of low libido may include:
Sudden disinterest in sexual activity
Lack of sexual thoughts or fantasies
Difficulty feeling aroused
Inability to orgasm
Biologically, changes in libido are often due to changes in hormones, such as the gonadal hormone [6], which plays a primary role in maintaining libido. Additionally, the hormones androgen [7], oestrogen [8], and testosterone [9] also play an important role in sexual function. Regulated hormone is important as it fuels a woman's psychosexual stimulation and increases sensitivity and blood flow (important in pleasure sensory).
At different ages, the levels of these hormones may fluctuate, providing some rationale for varying levels of libido in women. Below are general characteristics of libido levels at different stages.
Age group
Characteristics
20-30
High biological drive to reproduce but modest levels of sexual drive Women tend to be more selective about when and whom to reproduce with within these age groups (high sexual selection cognition) [10]
31-44
Decline of fertility begins Women’s sexual desire tends to become heightened Women tend to have more sex in these age groups
45 and above
A decrease in sexual drive is observed as oestrogen levels begin to drop Progressive decrease in libido as women undergo perimenopausal symptoms Libido in these age groups is mostly mind-induced versus biologically driven
Biopsychosocial elements of low libido: What causes low libido among women?
While libido patterns can be explained by age group and biological change, many can testify that these do not hold true. This is because libido is not just a biological occurrence but a culmination of biopsychosocial aspects.
It is natural and expected that most women have fluctuating changes in their sexual desires throughout their lifetime. Apart from naturally occurring biological changes in your body, some factors that may affect your libido include:
Biological factors:
Pregnancy: lower libido among postpartum mothers is a rising concern. While hormonal changes can rationalise these changes, low libidos can be due to fatigue and heightened stress levels affiliated with lifestyle changes.
Sexual dysfunction: issues such as vaginismus [11] (fear of vaginal penetration) and dyspareunia [12] (painful intercourse) tend also to lower libido and obstruct the ability to orgasm.
Underlying health conditions: low libidos can occasionally be secondary symptoms of chronic conditions, including hypertension, diabetes, rheumatoid arthritis, heart disease, stroke, cancer, and some gynaecological conditions.
Medications: certain medications, such as antidepressants and oral contraceptives, can also reduce sexual drive.
Fatigue and stress among postpartum mothers can be a factor of low libido.
Psychological factors:
Mental health: mental health issues such as depression and anxiety tend to significantly lower libido in women. This is also commonly seen among mothers dealing with postpartum depression [13].
Low self-esteem: physical insecurities such as body dysmorphia can lower libido. New mothers tend to also have reduced self-esteem from self-consciousness of their post-partum bodies.
Infidelity and trust: women tend to have reduced libido when trust is breached [14] in relationships. Even if one may want to emotionally overcome prior infidelity events, mental resistance tends to be persistent unconsciously.
Sexual oppression:shame and guilt attached to sex [15] due to negative connotations with sex lowers libido in women even if there are no significant biological changes. Oppression can come from sexual trauma, sexual disempowerment, and former sexual abuse.
Issues such as prior infidelity can lower libido among women.
Social factors:
Career and education: in their 20s, women tend to feel more insecure about their career and education prospects. These insecurities tend to be transmuted [16] as a lack of sexual desire. Simply put, prioritising personal development manifests as a lack of sexual enthusiasm in younger women.
Sexual conservatism: one may even observe a lack of libido among those who practice conservatism in their sexual lives. These are usually conscious choices by individuals. Sexual conservatism is also prevalent in more religious communities and societies. Often a choice, sexually conservative women are not phased by lowered libido.
Is there treatment for women with low libido?
Depending on the exact cause of your low libido, the approach to remedy your sexual drive varies. Low libido in women is usually a complex case. Your healthcare provider may offer multifaceted treatment and management upon understanding your condition. Below are some approaches you may take to solve libido issues:
1. Medical intervention for low libido: How is low libido diagnosed?
Women must conduct routine screening and gynaecological health check-ups to truly understand if there are biological changes in their bodies. For instance, regular screening may reveal thyroid disorders as a source of hormone dysregulation and lowered libido. Similarly, you may also obtain insight into other underlying health conditions or medications masking as a lowered libido issue.
Sexual dysfunction issues can also be addressed at your nearest sexual health clinic under the surveillance of a registered medical professional. Issues may include fear of penetration, painful sex, and inability to orgasm. With a health professional such as a gynaecologist, you can reduce trial-and-error roulette and get to the crux of the issue.
Where biological issues are present, your partner may also be able to empathise if they are provided with rational justification of what is behind your lowered sexual interest. This will also avoid straining romantic relationships.
2. Addressing mental barriers pertaining to lowered libido: Can therapy help libido?
Psychological factors can be just as detrimental to your libido and need not be a life sentence. Therapies such as Cognitive Behavioural Therapy (CBT) [17] and mindfulness-based therapy (MBT) [18] have been proven scientifically efficient [19] in addressing low libido. If you have not been diagnosed with mental health conditions, one can also perceive this as an opportunity to seek psychological intervention.
It is essential for mothers with postpartum depression to seek psychological help. Whilst lower libido may strain your relationship, there are also risks to your child's development. Interventions [20] may include pharmacological, psychotherapeutic, and nonpharmacologic options.
If infidelity issues have occurred, you and your partner may attempt couple counselling or marital counselling for assistance in repairing the relationship. A study [21] has shown that whilst couples with infidelity are significantly distressed and depressed initially, couple therapy intervention induced improvement for up to 6 months posttherapy with optimistic results.
Couple therapy can be a powerful tool in addressing low libido issues.
3. Holistically improving your libido: Can food and lifestyle increase sex drive?
There are some lifestyle changes you may attempt to address low libido at home. We suggest implementing these changes only if no significant medical or psychological issues impact your libido. Lifestyle changes includes:
Aphrodisiac diets: increase the consumption of food that increases female libido. Also known as aphrodisiacs [22], these are foods rich in vitamins, antioxidants, magnesium, zinc, iron, and other microminerals. Scientifically backed aphrodisiacs include maca, ginkgo biloba, saffron, fenugreek, and red ginseng.
Stress management: incorporating healthy stress management techniques [23] such as exercising, uptaking yoga and meditation, journaling, and spending more time in nature can improve your mood dramatically, promising an improved libido.
Prioritising sleep: poor sleep will undeniably drive lower sex [24] even if other aspects of your life are in order. There are various tips on improving sleep quality that you can attempt, especially if you are a parent of a newborn [25]. Try getting quality sleep before self-diagnosing with lowered libido.
Foods such as fenugreek and maca are scientifically proven to increase libido.
Can women take the blue pill to improve low libido?
There has been a rise in women attempting to self-medicate for lowered or loss of libido. This includes an increased demand for blue pills also known as sildenafil (Viagra) [26]. Sildenafil is approved by the FDA (US Food and Drug Administration) and permitted for use for erectile dysfunction in men. However, it is not approved for use by women in Singapore due to associated risks and complications, which include:
Headaches
Nasal congestion
Flushing
Visual disturbances
Indigestion
Palpitations
Blue pills known as Viagra are not medically approved to treat low libido in women.
Should I see my doctor if I struggle with libido loss?
It would be necessary for you to seek a doctor when libido loss becomes a persistent issue (over a month) and is causing you distress. Loss of libido may mean an increase in the possibility of a Hypoactive Sexual Desire Disorder [27] (HSDD) diagnosis. The key difference between low libido and HSDD is that the latter causes significant distress and lowered quality of life. Additionally, HSSD patients may even feel distressed at the thought of sex and can be averse to even self-pleasing.
If suspected of HSDD, you will be referred to a gynaecologist and sexual health clinic. Further investigations will be conducted to identify the classification of libido loss, which includes genito-pelvic pain/penetration disorder (GPP/PD), sexual interest or arousal disorder, or a female orgasmic disorder.
Conclusion
If you are struggling with a loss of libido, visit your nearest sexual health clinic for appropriate medical intervention. Attempting to self-medicate may worsen your condition or delay detection of serious health conditions. Remember, working to address your libido is healthy and should not be associated with guilt or shame.
We hope this article has empowered you to make the best choices for your sexual health. Our vision is that issues pertaining to lowered libido or libido loss garner greater momentum in Singapore and other Asian nations. Contrary to traditional beliefs, a great sexual life is as important to women as to men.
Loy, S.L. et al. (2021) Fecundability in reproductive aged women at risk of sexual dysfunction and associated risk factors: A prospective preconception cohort study - BMC pregnancy and childbirth, BMC Pregnancy and Childbirth . Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03892-5 (Accessed: 01 September 2023).
Wåhlin-Jacobsen , S. et al. (2015) Is there a correlation between androgens and sexual desire in women?, The journal of Sexual Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/25475395/ (Accessed: 01 September 2023).
Domenighetti , G. et al. (2009) Impact of job insecurity on sexual desire: An exploratory analysis, U.S. National Library of Medicine . Available at: https://pubmed.ncbi.nlm.nih.gov/19705309/ (Accessed: 01 September 2023).
Meyers, M., Margraf , J. and Velten, J. (2023) Subjective effects and perceived mechanisms of change of cognitive behavioral and mindfulness-based online interventions for low sexual desire in women, U.S. National Library of Medicine . Available at: https://pubmed.ncbi.nlm.nih.gov/37260167/ (Accessed: 01 September 2023).
Fitelson, E. et al. (2010) Treatment of postpartum depression: Clinical, psychological and pharmacological options, U.S. National Library of Medicine . Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039003/ (Accessed: 01 September 2023).
Atkins, D.C. et al. (2010) Outcomes of couples with infidelity in a community-based sample of couple therapy, U.S. National Library of Medicine . Available at: https://pubmed.ncbi.nlm.nih.gov/20438197/ (Accessed: 01 September 2023).
Kalmbach, D.A. et al. (2015) The impact of sleep on female sexual response and behavior: A pilot study, U.S. National Library of Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/25772315/ (Accessed: 01 September 2023).
Pelvic inflammatory disease (PID) is a severe inflammatory infection of the female reproductive organs, which includes the uterus, ovaries, and fallopian tubes. It is related to an untreated or unresolved sexually transmitted infection of the woman’s reproductive organs and is one of the causes of infertility. If pelvic inflammatory disease (PID) is left untreated, one can develop an abscess in the pelvic reproductive area and potentially develop a generalised infection, which can be life-threatening.
Pelvic inflammatory disease (PID) occurs when any part of the female reproductive organ is inflamed.
How common is pelvic inflammatory disease (PID) in Singapore?
In Singapore, pelvic inflammatory disease is commonly seen in women in the age group of 15-24 years old, with a general incidence of approximately 10 in every 1000 women [1].
What are the symptoms of pelvic inflammatory disease (PID)?
You may not be aware of pelvic inflammatory disease symptoms in milder cases, as one can present without any symptoms. Symptoms suggestive of PID include:
Fever
Nausea and vomiting
Lower pelvic or abdominal pain
Abnormal discharge from your vagina, including symptoms such as increased volume, abnormal colour, consistency, or odour
Painful intercourse
Bleeding in between your periods
Irregular periods
Painful or burning sensation upon urination
If you are experiencing any of the above symptoms or you are concerned about developing PID, you are advised to see your doctor for further evaluation of your condition and seek prompt and appropriate treatment.
Irregular periods are a common symptom of pelvic inflammatory disease.
What are the causes of pelvic inflammatory disease (PID)?
The cause of a person developing PID is commonly due to underlying sexually transmitted diseases (STDs) or reproductive organ infections that were left untreated.
Possible causes of pelvic inflammatory disease include [2-5]:
Untreated STDs
Having a history of PID or STDs
Having multiple sexual partners or sexual partner(s) who have other/multiple sexual partners
Speak to your doctor about ways to reduce the risk factors of developing PID, and consider STD screening if you are concerned about developing PID.
Vaginal douching can cause pelvic inflammatory disease.
What is the association between PID and STDs?
STDs are known causes that can lead to PID if the infections are left untreated, as the bacteria can ascend from the vagina to the cervix and further up to the uterus or fallopian tube of the female’s reproductive organs [6].
Recent surgical procedures such as abortion, IUD medical insertion, or surgical D&C (dilatation and curettage procedure)
Please see a doctor if you are concerned about PID or experiencing symptoms that suggest PID.
If I don’t treat the STD, which part of my reproductive system can be affected by PID?
As the STD bacteria that are left untreated can ascend the female reproductive system, areas that can eventually develop inflammation or scarring in PID include:
Uterus
Fallopian tube
Ovaries
The lining of the abdomen (peritoneum)
How do I reduce the risk of acquiring PID?
You can reduce the risk of acquiring PID by:
Practising safe sex and using barrier contraception the right way
Practising abstinence
Having monogamous relationships (though the risk is not completely eliminated)
Going for regular STD testing and seeking prompt treatment if necessary
Removing your IUD if your PID resulted from the insertion of the device
When should I consider seeing a doctor for PID?
You should seek medical advice if you are presenting with PID symptoms or if you notice the following:
Abnormal genital symptoms such as rash/ulcers/lumps and bumps or abnormal discharge
You or your sexual partner has been exposed to STDs
How is pelvic inflammatory disease diagnosed?
PID is diagnosed based on your clinical symptoms and findings from gynaecological tests and examination.
Depending on individual conditions, your doctor may offer vaginal and cervix swab tests for laboratory investigation of STD/bacterial infection. Your doctor may offer tests such as blood tests, urine tests, pregnancy tests, and an ultrasound of the pelvis region to screen further for PID.
In more severe cases, you may be advised to seek medical attention in the hospital and consider a laparoscopy procedure to investigate further for PID.
A pelvic ultrasound can identify pelvic inflammatory disease (PID).
Can pelvic inflammatory disease (PID) be treated?
PID can be treated. However, the complications of PID, such as damage or scarring of the reproductive organ, may not be reversible with treatment. Treatment works to clear off the underlying infection(s) and avoid further irreversible complications from PID [9]. Your sexual partner(s) must also be treated to prevent re-infection of the condition.
In severe cases of PID, you may be admitted to the hospital for intravenous antibiotics treatment and monitoring.
What will happen if my PID is not treated?
Long term complication from PID includes:
Scarring of the reproductive organ from prolonged inflammation, leading to fallopian tube blockages
Infertility (inability to conceive)
Chronic pelvic or abdominal pain
Ectopic pregnancy
When can I resume sexual intercourse if I have PID?
You can consider resuming your sexual life after completing your antibiotics and resolving your symptoms. Your partner is advised to get screened and tested before resuming a sexual lifestyle with you.
In conclusion
PID is a treatable condition if it is managed promptly and appropriately. Hence, do not allow the infection to brew longer and worsen; consider early STD screening and treatment!
AMY CURRY, T. W. (2019). Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. American Family Physician, 357-364.
Roberta B. Ness, S. L. (2005). Douching, Pelvic Inflammatory Disease, and Incident Gonococcal and Chlamydial Genital Infection in a Cohort of High-Risk Women. American Journal of Epidemiology, 186-195.
Ross, J. D. (2002). An update on pelvic inflammatory disease. BMJ Journals, 18-19.
D Scholes, J. R. (1992). Current cigarette smoking and risk of acute pelvic inflammatory disease. American Journal of Public Health, 1352–1355.
Lindsey K. Jennings, D. M. (2023). Pelvic Inflammatory Disease. Florida: StatPearls.
PAILLIER-GONZALEZ, J. E., & FLOREZ-ARANGO, N. S.-M. (2021). Case report. Pelvic inflammatory disease as a complication of acute appendicitis. Iatreia, https://doi.org/10.17533/udea.iatreia.84.
Jacques Ravel, I. M. (2021). Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. American Journal of Obstetrics and Gynecology, 251-257.
Centers for Disease Control and Prevention. (2021, July 22). Pelvic Inflammatory Disease (PID) Treatment and Care. Retrieved from Pelvic Inflammatory Disease: https://www.cdc.gov/std/pid/treatment.htm
Do you happen to know any female around you that is experiencing both physical and emotional lability symptoms that can be disruptive at certain times of the month? They may be suffering from PMDD, read on to find out more about this debilitating disorder.
What is Premenstrual Dysphoric Disorder (PMDD)?
Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS).
In PMDD, the symptoms occur in cycles, only during the second half of the menstrual cycle and may last until the first few days after your period begins. Contrary to PMS, PMDD is associated with a debilitating interference of normal routine life and personal relationship with others.
PMDD is a severe form of PMS that is debilitating and can interfere with normal daily activities.
What are the symptoms of PMDD?
Women with PMDD may experience the following symptoms:
Lethargy
Change of sleeping pattern or eating habits
Hot flashes
Digestive symptoms such as bloating, indigestion, nausea or vomiting, constipation
Breast tenderness
Fluid retention symptoms such as weight gain, swelling of the hands and feet
Neurological symptoms such as dizziness, headache, fainting spells, muscle cramps
Emotional or behavioural symptoms such as,
Irritability, agitation
Anger
Anxiety
Sadness or crying episodes
Depression
Nervousness
Concentration impairment, forgetfulness
Insomnia
Mood swings
When do symptoms of PMDD begin?
PMDD symptoms tend to begin 7-10 days before you start your period and may continue for the first few days after your period commences.
What causes PMDD?
The actual reason for a woman to develop PMDD remains unknown. However, there are several factors that have been linked to the development of PMDD, such as:
Genetics: family history of PMDD can make you more prone to developing it yourself.
Underlying endocrine abnormalities: fluctuation of oestrogen and progesterone, possible increase in aldosterone, antidiuretic hormone (ADH), can all lead to the development of PMDD.
Low serotonin levels: serotonin is responsible for regulating mood, sleep, digestion, nausea, and others. Low serotonin levels can contribute to the development of PMDD.
Low microminerals: low levels of microminerals such as magnesium and calcium can contribute to the development of PMDD.
High levels of serotonin, a neurotransmitter which also acts as a hormone can help boost your mood, while low levels of serotonin has been linked to the development of PMDD and other issues.
How common is PMDD?
Studies have shown that while PMS is fairly common, affecting 75% of women with a regular menstrual cycle, PMDD is uncommon and affects only 3-8% of women who are already affected by PMS.
Who is at risk of developing PMDD in Singapore?
You are more predisposed to PMDD if you have the following factors:
Family history: a family history of PMS or PMDD increases your risk of developing PMDD.
Mental health: a history or family history of psychiatric disorders such as depression, anxiety, or other mood disorders increases your risk of developing PMDD.
Smoking: smoking or a history of smoking can increase your risk of developing PMDD.
How does PMDD affect a woman’s life?
PMDD is extremely disruptive, affecting not only a woman’s day-to-day life but also affecting and disrupting her relationship with others. PMDD causes detrimental physical and emotional symptoms which go on to cause tensions and problems in all aspects of a woman’s life.
When should I see doctor if I suspect have PMDD?
PMDD can be treated so if you notice that you have cyclical symptoms suggestive of PMDD, and you are experiencing daily functional impairment with possible relationship breakdowns, make an appointment with us and we can help you through your symptoms.
Symptoms of PMDD can be treated by a medical professional.
How is PMDD diagnosed?
PMDD is diagnosed in the following ways:
Medical history: PMDD is associated with mental health symptoms hence, this can identify any triggers or cause for PMDD.
Physical examination: includes a pelvic examination to identify areas of tenderness with regards to your menstrual cycle.
Blood tests: help identify any organic conditions such as thyroid disease or underlying micromineral deficiency to aid in the diagnosis of PMDD.
What are the treatment options for PMDD in Singapore?
The management and treatment of PMDD are not easy as there is no single solution to the condition. Treatment usually requires a partnership discussion with your doctor, via motivation, patience, and trial and error.
Treatment for PMDD usually involves a combination of various options that include both medical and non-medical approaches.
Non-medical treatment options include:
Inculcate good sleep habits to help improve your mood.
Exercise can be beneficial in improving mental health as exercise releases endorphin and serotonin (also known as happy hormones). Furthermore, physical activities improve fluid retention symptoms.
Healthy dietary intake with more protein, high fibre, less complex carbohydrates, and low sugar is important. Your doctor may also recommend dietary supplements such as calcium, magnesium, vitamin B6, and vitamin E. Do check with your doctor on the doses of the supplement to avoid overdosing of microminerals.
Incorporate a healthy lifestyle to help reduce the intensity or severity of your PMDD symptoms.
Medical treatment options include:
Birth control pills: hormonal pills with synthetic oestrogen and progesterone can be useful in managing hormonal levels and hence allow for better control of PMDD symptoms. Your doctor will obtain your medical history and counsel you on the risk and side effects of hormonal medications prior to prescribing.
Mood tablets:Selective serotonin release inhibitors (SSRI) has been shown to be clinically effective in improving mood/behavioral symptoms. Some physical symptoms including breasts tenderness and change in appetite can be alleviated with the use of SSRI. SSRI can be taken continuously or only when symptoms of PMDD occur. Like most medications, SSRI comes with a list of side effects. Discuss with your doctor to educate yourself about the benefits and disadvantages of SSRI.
Nonsteroidal anti-inflammatory drugs (NSAIDS): useful in relieving physical symptoms such as migraines, aches, and menstrual cramps.
Your doctor wilL work together with you to come up with an individualised management plan for your symptoms and follow-up with you over the course of weeks to months to see your response to the treatment plan.
Birth control pills can help regulate the levels of oestrogen and progesterone in your body.
Is PMDD a psychiatric condition?
PMDD is a medical condition that can be associated with both physical symptoms and a range of mental health symptoms including depression, anxiety, irritability, or suicidal feelings. PMDD can coexist or be misdiagnosed with concurrent mood disorders.
You are advised to speak to your doctor if you notice persistent, chronic abnormal mood symptoms or if you have feedback from your loved ones on possible mood issues.
What is the difference between PMDD and PMS?
PMDD is an extension of and a more severe form of PMS. In addition to the usual physical symptoms of PMS, PMDD has a negative effect on a person’s social aspect with debilitating interference of daily routine and interpersonal relationship.
Is there a test for PMDD?
Unfortunately, there is no diagnostic test for PMDD. PMDD is diagnosed based on a detailed medical history and a clinical evaluation of your symptoms. Occasionally, your doctor may offer you blood tests to screen for other possible medical conditions (such as endocrine disorders) that may confound your symptoms.
Frequently asked questions
At what age does PMDD usually begin?
PMDD can occur anytime as long as a woman is reproductively healthy, however, the average age of PMDD onset is 26 years.
Is PMDD the same as bipolar?
Both PMDD and bipolar disorder are cyclic disorders, and they may often present together at the same time. However, they are not the same as each other.
When is PMDD at its peak?
Symptoms of PMDD usually begin approximately 6 days before your period begins and are at its peak 2 days before your period starts.
Can PMDD be cured?
PMDD is treatable through a non-medical treatment, medical treatment, or a combination of both. Speak to your doctor who can help personalise a treatment plan for you.
What are irregular periods?
An average menstrual cycle lasts approximately 28 days, although most women have menstrual cycles that vary and can range from slightly longer to slightly shorter than the stipulated average.
Menstrual cycles are temperamental at times. While some women may notice the gap between the end of their last periods and the start of their next period constantly changing, others may have missing or infrequent menses.
Amenorrhoea, also known as the absence of menses and can be further categorised into:
Primary amenorrhoea: periods that have not commenced by the age of 16.
Secondary amenorrhoea: periods that are absent for 3-6 months in a woman who previously had periods.
Oligomenorrhoea Oligomenorrhoea, also known as infrequent irregular menses and is defined by fewer than 6-8 periods per year.
Irregular or absent periods can be a sign of underlying medical conditions.
What are the symptoms of irregular periods?
Women with irregular periods may experience the following symptoms:
Menstrual bleeding that lasts longer than usual (more than 7 days)
Heavier than usual menstrual bleeding (changing pads/tampons every 1-2 hours)
Menstrual bleeding or spotting in between cycles
Spotting or bleeding after sexual intercourse
Spotting or bleeding after menopause
If you are experiencing any of the above symptoms, you are advised to consult your doctor to evaluate your symptoms further.
What causes irregular periods?
Irregular periods can be normal in some women. However, for others, there may be underlying medical conditions that require intervention/attention to re-establish a normal period cycle.
Below are some common medical causes of irregular or ceasing of periods:
Be honest and open when sharing your medical history with your doctor. This will help him/her come to the most accurate diagnosis with regards to your irregular periods.
Irregular periods can be regular again for some women if the underlying cause is treated.
When should I see a doctor for irregular periods? Should I be worried if I have irregular periods?
You are advised to seek medical attention if your period:
becomes irregular, and you are below 45 years old
is too frequent (less than 21 days)
is too long (more than 35 days)
lasts longer than 7 days
has always been irregular, and you are not able to conceive
How are irregular periods diagnosed?
Irregular periods and the underlying cause(s) can be diagnosed with clinical history and physical examination which involves a full body examination including abdominal and pelvic examinations.
Depending on your condition, you may be required to undergo the following:
Pregnancy test (urine and blood test)
Hormone tests (blood tests)
Imaging such as ultrasound or magnetic resonance imaging (MRI) of the gynaecological region
Pap smear
For sexually active patients, a pregnancy test will be offered. Depending on individual cases, further investigations such as blood tests, hormonal tests, ultrasound of the pelvis, MRI of the brain, and genetic testing may also be advised or conducted.
Pap smears can be used to identify underlying medical reasons for irregular periods.
What are the treatment options for irregular periods?
The goal of treatment is to treat the underlying condition and restore fertility in women who are in the reproductive phase of their life. How can we make irregular periods regular? This depends on the cause of the irregular periods.
Let’s take a look at some general treatment options for irregular periods:
Oral contraceptive pills: hormonal oral contraceptive pills in the form of oestrogen, and/or progesterone are commonly used to regulate and restore menses. This treatment also reduces the risks of osteoporosis in females in their later life.
Healthy diet and exercise: women who experience exercise-induced amenorrhoea are advised to increase their calorie intake and reduce the intensity or frequency of exercise. They are also advised to consume 1200 mg to 1500 mg of calcium and 400 IU of vitamin D daily. Healthy lifestyles with good de-stressing techniques are encouraged.
Take care of your mental health and emotional wellbeing: women with eating disorders often require further support from psychiatrists and dietician specialists to tackle the underlying cause.
Others: thyroid medication may be required for management of any underlying thyroid disease. 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. Surgical options may be offered to patients with structural problems of the reproductive tract.
Do speak to your doctor for further understanding on individual treatment and management of your irregular periods.
What is a healthy diet and lifestyle for irregular periods?
You are advised to consider moderate exercise; some women can restore a regular menstrual cycle with healthy moderate exercise. Exercises such as yoga, have also been clinically proven to alleviate premenstrual syndrome (PMS) symptoms as there is an increase in the production of endorphin and serotonin, commonly known as the ‘happy’ hormones.
In terms of diet, a healthy balanced diet, high in fibre, omega-3 fatty acids, calcium, and vitamin D is also important. Fatty meals high in saturated fats, salt, carbohydrates, and caffeine should be reduced or avoided.
You are encouraged to discuss your daily lifestyle when sharing your concerns regarding irregular periods with your doctor.
Healthy lifestyle choices can improve your life in more ways than one, from regulating your menstrual cycle to improving your overall wellbeing.
Can I get pregnant if I have irregular periods?
Some women with irregular periods may have difficulty in getting pregnant as they may not ovulate regularly. Hence, it is good practice to speak to your doctor if your menstrual cycle is abnormal.
Depending on individual medical circumstances, your doctor may advise hormonal medication or fertility treatment to facilitate the process of conceiving naturally.
Are irregular periods normal?
Some women may notice their period irregularity since young/puberty— this can be normal. Occasionally, period cycles may also become irregular due to stress, lifestyle changes, medical conditions, illnesses, vaccinations, etc.
You are encouraged to discuss your symptoms with your doctor so that he/she can come up with a concerted plan to screen for any underlying medical issues that may be the cause of your irregular periods and manage accordingly.
What is Polycystic Ovarian Syndrome?
In a healthy menstrual cycle, the reproductive hormones induce the ovaries to make the egg and release it every month. In PCOS, due to the imbalance of the hormones, the egg may not be developed, and even if it is developed, it may not be released during ovulation each month.
PCOS is a common condition that affects 10% of women of childbearing age. PCOS causes missed or irregular menstrual periods. Irregular periods in women can lead to:
High levels of androgen. Androgen is a male hormone that is responsible for the development of male traits, such as being more masculine, having more hair, acne, male-pattern baldness. In the reproductive organs, when the level of androgen is high in females, this can prevent the ovaries from releasing the egg during the menstrual cycle.
PCOS is associated with diabetes and insulin resistance. Insulin is a hormone that controls the carbohydrate and sugar in your body and turns them into energy. In insulin resistance circumstances, the body is not able to respond to insulin, leading to a high level of sugar in the body, which is termed diabetes mellitus.
Symptoms of PCOS include:
Irregular or absence of menstrual cycle
Acne
Hairy- distribution of hair over where men usually have- facial, chin, body
Hair loss and hair thinning
Weight gain
Skin pigmentation – typically over the skin creases over the neck, groin, armpit and under the breasts
Skin tags
What are other health conditions associated with PCOS?
Diabetes
High blood pressure
High cholesterol
Obstructive sleep apnoea
Depression and anxiety
Endometrial cancer
What do I expect during my consultation with my doctor?
Your doctor will take a relevant, thorough medical history, and a physical examination of your face, hair, chest back, abdomen, and pelvis. Other physical examinations include measuring your blood pressure, body mass index (BMI), and waist size. You will be offered hormonal blood tests and ultrasound of the pelvis to evaluate further your reproductive organs.
How is PCOS treated?
Although there is no cure, there are treatment options to manage PCOS. The goal of management is to manage your symptoms, restore and increase the chance of fertility in childbearing ladies, and manage risks of long term health issues such as diabetes and heart disease.
Leading a healthy lifestyle and eating a normal healthy balanced diet is crucial in PCOS ladies. A reduction of 5% of body weight has been shown to increase fertility chance and to restore spontaneous ovulation in some women.
In ladies who are not planning pregnancy, hormonal birth controls in the form of pills, patches, shot, vaginal rings, or intrauterine hormonal devices are used to regulate the menstrual cycle, reduce the risk of endometrial cancer, improves acne and reduce excessive hair in the face and body.
A medication known as metformin may be recommended in those with insulin resistance and diabetes. Interestingly metformin also lowers the androgen levels in ladies with PCOS, and aid in restoring ovulation.
Speak to your doctor for further advice, as every lady has different needs and concerns, and your treatment is likely individualized to yourself.
Can I still become pregnant if I have PCOS?
Yes. Although PCOS is a common cause of infertility in women, thankfully often, it is treatable. Your doctor can discuss ways to help you to ovulate and increase your chance of becoming pregnant.
