Oligomenorrhea is defined as abnormally infrequent menstrual bleeding, with menstrual intervals of greater than 36 days, typically resulting in 3–6 cycles per year. Menstrual bleeding, when it occurs, may be prolonged (up to 10 days), heavy, and laden with clots and tissue, or occasionally scant with spotting between menses.

Oligomenorrhea may develop suddenly or gradually and can alternate with normal cycles before potentially progressing to secondary amenorrhea. It is commonly associated with anovulation and is frequent in infertile, early postmenarchal, and perimenopausal women.

Causes are often hormonal, including ovarian, hypothalamic, pituitary, thyroid, and metabolic disorders, as well as the effects of certain drugs. Emotional or physical stress — sudden weight changes, debilitating illness, or rigorous physical training — can also trigger oligomenorrhea.

History and Physical Examination

History

• Age and menarche

• Past menstrual cycle pattern and onset of abnormal cycles

• Detailed bleeding history: duration, frequency, pad/tampon usage, clots/tissue

• Symptoms of ovulatory bleeding: cramping ~14 days before bleeding, premenstrual symptoms (breast tenderness, irritability, bloating, weight gain, nausea, diarrhea)

• History of infertility and desire for pregnancy

• Use of hormonal contraceptives and previous gynecologic disorders (e.g., ovarian cysts)

• Breastfeeding history and galactorrhea

• Recent weight changes and physical activity

• Screening for metabolic disorders: excessive thirst, polyuria, fatigue, palpitations, headaches, dizziness, impaired peripheral vision

• Medications

Physical Examination

• Vital signs and weight

• Signs of androgen excess: facial and body hair, male-pattern fat and muscle distribution, clitoral enlargement, acne

• Skin and hair changes: dryness, texture

• Signs of psychological or physical stress

• Pregnancy test to rule out pregnancy

Medical causes

Other causes

• Drugs: corticosteroids, corticotropin, anabolic steroids, danocrine, injectable/implant contraceptives, phenothiazines, amphetamines, certain antihypertensives

• Contraceptives may delay the return of normal menses after discontinuation; ~95% resume normal cycles within 3 months

Special considerations

Prepare the patient for diagnostic tests: hormone panels, thyroid studies, pelvic imaging

Patient counseling

• Teach basal body temperature monitoring

• Explain home ovulation testing if appropriate

• Provide guidance on contraceptive use if prescribed

Pediatric pointers

• Oligomenorrhea in teenagers may reflect immature hormonal function

• Prolonged oligomenorrhea or amenorrhea may indicate congenital adrenal hyperplasia or Turner’s syndrome

Geriatric pointers

Oligomenorrhea in perimenopausal women usually indicates impending menopause

References

1. Berkowitz CD. Berkowitz’s Pediatrics: A Primary Care Approach. 4th ed. USA: American Academy of Pediatrics; 2012.

2. Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis, MO: Mosby Elsevier; 2008. p. 444–447.

3. Lehne RA. Pharmacology for Nursing Care. 7th ed. St. Louis, MO: Saunders Elsevier; 2010.

4. Schuiling KD. Women’s Gynecologic Health. Burlington, MA: Jones & Bartlett Learning; 2013.

5. Sommers MS, Brunner LS. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.