Oligomenorrhoea/Oligomenorrhea also spelled oligomenorrhoea means the prolonged intervals between menstrual cycles. Menstruation is the normal cyclic bleeding from the female reproductive tract. Most women of reproductive age menstruate every 25 to 30 days if they are not pregnant, nursing a child, or experiencing other disorders such as tumors, anorexia nervosa, or Stein-Leventhal syndrome (polycystic ovary syndrome). However, in oligomenorrhea, menstruation occurs in intervals greater than 35 days, and affected women typically menstruate between 4 and 9 times per year. If a woman fails to menstruate at all, the condition is referred to as amenorrhea.
Oligomenorrhea is infrequent (or, in occasional usage, very light) menstruation. More strictly, it is menstrual periods occurring at intervals of greater than 35 days, with only four to nine periods in a year.[rx] Menstrual periods should have been regularly established before the development of infrequent flow.[rx] The duration of such events may vary.[rx]
Oligomenorrhea is defined as irregular and inconsistent menstrual blood flow in a woman. Some change in menstrual flow is normal at menarche, postpartum, or in the perimenopausal period. But if a woman reports the length of menstrual cycle greater than 35 days or four to nine menstrual cycles in a year, then it is termed as oligomenorrhea.
Menstrual flow should be normal before the development of oligomenorrhea.[rx]
Causes of Oligomenorrhea
Oligomenorrhea can be a result of prolactinomas (adenomas of the anterior pituitary). It may be caused by thyrotoxicosis, hormonal changes in perimenopause, Prader–Willi syndrome, and Graves disease.
- Endurance exercises such as running or swimming can affect the reproductive physiology of women athletes. Female runners,[rx][rx] swimmers[rx] and ballet dancers[rx] either menstruate infrequently in comparison to non-athletic women of comparable age or exhibit amenorrhea. A more recent study shows that athletes competing in sports that emphasize thinness or a specific weight exhibit a higher rate of menstrual dysfunction than either athlete competing in sports with less focus on these or control subjects.[rx]
- Breastfeeding has been linked to the irregularity of menstrual cycles due to hormones that delay ovulation.
- Women with polycystic ovary syndrome (PCOS) are also likely to have oligomenorrhea. PCOS is a condition in which excessive androgens (male sex hormones) are released by the ovaries. Women with PCOS show menstrual irregularities that range from oligomenorrhea and amenorrhea to very heavy, irregular periods. The condition affects about 6% of premenopausal women.
- Eating disorders can result in oligomenorrhea. Although menstrual disorders are most strongly associated with anorexia nervosa, bulimia nervosa may also result in oligomenorrhea or amenorrhea. There is some controversy regarding the mechanism for menstrual dysregulation, since amenorrhea may sometimes precede substantial weight loss in some anorexics.
- It is quite common for women at the beginning and end of their reproductive lives to miss or have irregular periods. This is normal and is usually the result of imperfect coordination between the hypothalamus, the pituitary gland, and the ovaries. For no apparent reason, a few women menstruate (with ovulation occurring) on a regular schedule as infrequently as once every two months. For them that schedule is normal and not a cause for concern.
- Women with polycystic ovary syndrome (PCOS) are also likely to suffer from oligomenorrhea. PCOS is a condition in which the ovaries become filled with small cysts. Women with PCOS show menstrual irregularities that range from oligomenorrhea and amenorrhea on the one hand to very heavy, irregular periods on the other. The condition affects about 6% of premenopausal women and is related to excess androgen production.
Oligomenorrhea is often a sign of underlying disease. Following may be the causes of oligomenorrhea.
- Polycystic ovarian disease[rx]
- Androgen secreting tumor of the ovary[rx]
- Androgen secreting tumor of the adrenal gland[rx]
- Cushing syndrome
- thyroid gland makes too much hormone. সহজ বাংলা: থাইরয়েড হরমোন বেশি।" data-rx-term="hyperthyroidism" data-rx-definition="Hyperthyroidism means the thyroid gland makes too much hormone. সহজ বাংলা: থাইরয়েড হরমোন বেশি।">Hyperthyroidism
- Prolactinomas
- Hypothalamic amenorrhea[rx]
- Pelvic inflammatory disease
- Asherman syndrome
- Uncontrolled insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes mellitus
- Type-1 insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes mellitus[rx]
- Congenital adrenal hyperplasia[rx]
- Non-classic congenital adrenal hyperplasia.
- A side effect of oral contraceptive pills[rx]
- Antipsychotics
- Antiepileptics
- Anatomic problems
- Primary ovarian insufficiency[rx]
- Exercising women with the polycystic ovarian disease[rx]
Other physical and emotional factors also cause a woman to miss periods. These include:
- emotional stress
- chronic illness
- poor nutrition
- eating disorders such as anorexia nervosa
- excessive exercise
- estrogen-secreting tumors
- illicit use of anabolic steriod drugs to enhance athletic performance
Professional ballet dancers, gymnasts, and ice skaters are especially at risk for oligomenorrhea because they combine strenuous physical activity with a diet intended to keep their weight down. Menstrual irregularities are now known to be one of the three disorders comprising the so-called “female athlete triad,” the other disorders being disordered eating and fracture risk. সহজ বাংলা: হাড় দুর্বল হয়ে ভাঙার ঝুঁকি বেশি।" data-rx-term="osteoporosis" data-rx-definition="Osteoporosis means weak, fragile bones with higher fracture risk. সহজ বাংলা: হাড় দুর্বল হয়ে ভাঙার ঝুঁকি বেশি।">osteoporosis. The triad was first formally named at the annual meeting of the American College of Sports Medicine in 1993, but doctors were aware of the combination of bone mineral loss, stress fractures, eating disorders, and participation in women’s sports for several decades before the triad was named. Women’s coaches have become increasingly aware of the problem since the early 1990s, and are encouraging female athletes to seek medical advice.
Symptoms of Oligomenorrhea
Symptoms of oligomenorrhea include:
- menstrual periods at intervals of more than 35 days
- irregular menstrual periods with unpredictable flow
- some women with oligomenorrhea may have difficulty conceiving.
- Oligomenorrhea that occurs in adolescents is often caused by immaturity or lack of synchronization between the hypothalamus, pituitary gland, and ovaries. The hypothalamus is part of the brain that controls body temperature, cellular metabolism, and basic functions such as eating, sleeping, and reproduction. It secretes hormones that regulate the pituitary gland.
- Headaches
- Depression, irritability and anxiety
- Fluid retention (evidence from swelling of feet and fingers)
- Acne and other skin conditions
- Fainting
- Vertigo
- Muscle spasms
- Allergies
- Heart palpitations
- Vision problems and eye infections
- Reduced sex drive
- Lack of appetite
- The pituitary gland is then stimulated to produce hormones that affect growth and reproduction. At the beginning and end of a woman’s reproductive life, some of these hormone messages may not be synchronized, causing menstrual irregularities.
- In PCOS, oligomenorrhea is probably caused by inappropriate levels of both female and male hormones. Male hormones are produced in small quantities by all women, but in women with PCOS, levels of male hormone (androgens) are slightly higher than in other women. More recently, however, some researchers are hypothesizing that the ovaries of women with PCOS are abnormal in other respects. In 2003, a group of researchers in London reported that there are fundamental differences between the development of egg follicles in normal ovaries and follicle development in the ovaries of women with PCOS.
In athletes, models, actresses, dancers, and women with anorexia nervosa, oligomenorrhea occurs because the ratio of body fat to weight drops too low.
Diagnosis of Oligomenorrhea
History and physical examination
Diagnosis of oligomenorrhea begins with the patient informing the doctor about infrequent periods. The doctor will ask for a detailed description of the problem and take a history of how long it has existed and any patterns the patient has observed.
- A woman can assist the doctor in diagnosing the cause of oligomenorrhea by keeping a record of the time, frequency, length, and quantity of bleeding. She should also tell the doctor about any recent illnesses, including longstanding conditions like insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes mellitus. The doctor may also inquire about the patient’s diet, exercise patterns, sexual activity, contraceptive use, current medications, or past surgical procedures.
- The doctor will then perform a physical examination to evaluate the patient’s weight in proportion to her height, to check for signs of normal sexual development, to make sure the heart rhythm and other vital signs are normal, and to palpate (feel) the thyroid gland for evidence of swelling.
Physical examination includes the following;
- External examination.
- Rectovaginal examination.
- Vaginal speculum examination.
- Abdomen examination.
- The external examination includes looking for any abnormal secondary sexual characteristics example, hair distribution, or clitoromegaly.
- The rectovaginal examination includes inserting a gloved finger lubricated with anesthetic gel to examine the walls of the vagina and to feel for any anatomic obstruction or abnormalities, pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।" data-rx-term="tenderness" data-rx-definition="Tenderness means pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।">tenderness in the abdomen, mass in adnexa or abdomen.
- Vaginal speculum examination includes looking into the vagina and cervix with the use of a speculum. Look for any abnormal discharge, signs of inflammation, and growths.
- Abdomen examination includes inspection of the abdomen for ascites. Palpate the abdomen for masses and pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।" data-rx-term="tenderness" data-rx-definition="Tenderness means pain when an area is touched or pressed. সহজ বাংলা: চাপ দিলে ব্যথা।">tenderness. Palpate the groin for inguinal lymphadenopathy.
Labs to evaluate the cause of oligomenorrhea includes the following:
Blood Tests
- FSH Levels; if increased, they show primary ovarian insufficiency.[rx]
- TSH levels; if decreased, then it shows thyroid gland makes too much hormone. সহজ বাংলা: থাইরয়েড হরমোন বেশি।" data-rx-term="hyperthyroidism" data-rx-definition="Hyperthyroidism means the thyroid gland makes too much hormone. সহজ বাংলা: থাইরয়েড হরমোন বেশি।">hyperthyroidism.[rx]
- Prolactin levels; if increased, then prolactinoma may be the cause.[rx]
- LH levels; the ratio of FSH\LH is useful in diagnosing polycystic ovarian disease.
- Free testosterone levels; increased in congenital adrenal hyperplasia and polycystic ovarian disease.[rx]
- 17 –OH levels; these are useful to diagnose congenital adrenal hyperplasia as a cause of oligomenorrhea.
- Overnight dexamethasone suppression test; is done to diagnose Cushing syndrome as a cause of oligomenorrhea, especially if the patient presents with signs of this condition.
- HbA1C[rx]
Laboratory tests
- After taking the woman’s history – the gynecologist or family practitioner does a pelvic examination and Pap test. To rule out specific causes of oligomenorrhea, the doctor may also do a pregnancy test and blood tests to check the level of thyroid hormone. Based on the initial test results, the doctor may want to do tests to determine the level of other hormones that play a role in reproduction.
- Blood Tests – Most of the common causes of decreased flow of blood during the menses can be detected by blood tests. Tests for the level of hormones such as follicle-stimulating hormone, luteinizing hormone, estrogen, prolactin, insulin are important. In polycystic ovarian syndrome, there will be high levels of insulin and androgens.
- Ultra sonogram – An ultrasonogram can diagnose the thickness of the endometrium, size of the ovaries growth of follicles, ovulation, and other abnormalities. Ultrasound of abdomen and pelvis; it may indicate polycystic ovaries, signs of pelvic infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation, and ascites.
- Other tests – Tests such as dilation and curettage and MRI scans are sometimes needed to determine the cause of scanty blood flow during the periods.
As of 2003, more sensitive monoclonal assays have been developed for measuring hormone levels in the blood serum of women with PCOS, thus allowing earlier and more accurate diagnosis.
Imaging studies
- In some cases the doctor may order an ultrasound study of the pelvic region to check for anatomical abnormalities, or x rays or a bone scan to check for bone fractures. In a few cases the doctor may order an MRI to rule out tumors affecting the hypothalamus or pituitary gland.
- CT scan is useful with suspicion of adnexal or adrenal masses.
- MRI pituitary helps to confirm prolactinoma if prolactin levels increase.
- Endocervical swabs are taken if there are signs of pelvic inflammatory disease.
Treatment of Oligomenorrhea
Treatment of oligomenorrhea mainly depends on the underlying cause;
- Lifestyle Changes – Oligomenorrhea, when caused by low basal metabolic index and stress levels, can be dealt with behavior modification, diet, psychotherapy, and stress reduction techniques. Anovulation, when caused by obesity, can be managed with weight reduction.
- Hormonal Therapy – Birth control pills are often used to restore the regularity of the menstrual cycle, especially in Polycystic ovarian disease. They are safe to use, especially when the patient does not desire pregnancy.
- Treating The Underlying Medical Conditions – If hyperthyroidism is the cause, then it is treated with antithyroid drugs, radioactive iodine or thyroidectomy. If the etiology is Cushing syndrome, then it is treated with medication that blocks excess cortisol overproduction example, ketoconazole, mitotane, and metyrapone. Prolactinomas, if small, can be treated with dopamine agonists example, bromocriptine, and cabergoline.
Most patients suffering from oligomenorrhea are treated with birth control pills. Other women, including those with PCOS, are treated with hormones. Prescribed hormones depend on which particular hormones are deficient or out of balance. When oligomenorrhea is associated with an eating disorder or the female athlete triad, the underlying condition must be treated. Consultation with a psychiatrist and nutritionist is usually necessary to manage an eating disorder. Female athletes may require physical therapy or rehabilitation as well.
Surgical Management
- Surgery may be necessary in the case of adnexal and adrenal tumors.
- Thyroidectomy may be necessary for hyperthyroidism.
- If prolactinoma is large enough to produce compressive symptoms, it may require surgical removal.
Alternative treatment
As with conventional medical treatments, alternative treatments are based on the cause of the condition. If a hormonal imbalance is revealed by laboratory testing, hormone replacements that are more “natural” for the body (including tri-estrogen and natural progesterone) are recommended. Glandular therapy can assist in bringing about a balance in the glands involved in the reproductive cycle, including the hypothalamus, pituitary, thyroid, ovarian, and adrenal glands. Since homeopathy and acupuncture work on deep, energetic levels to rebalance the body, these two modalities may be helpful in treating oligomenorrhea. Western and Chinese herbal medicines also can be very effective. Herbs used to treat oligomenorrhea include dong Quai (Angelica Sinensis), black cohosh (Cimicifuga racemosa), and chaste tree (Vitex agnus-castus). Herbal preparations used to bring on the menstrual period are known as emmenagogues. For some women, meditation, guided imagery, and visualization can play a key role in the treatment of oligomenorrhea by relieving emotional stress.
Diet and adequate nutrition, including adequate protein, essential fatty acids, whole grains, and fresh fruits and vegetables, are important for every woman, especially if deficiencies are present or if she regularly exercises very strenuously. Female athletes at the high school or college level should consult a nutritionist to make sure that they are eating a well-balanced diet that is adequate to maintain a healthy weight for their height. Girls participating in dance or in sports that emphasize weight control or a slender body type (gymnastics, track and field, swimming, and cheerleading) are at higher risk of developing eating disorders than those that are involved in such sports as softball, weight lifting, or basketball. In some cases the athlete may be given calcium or vitamin D supplements to lower the risk of osteoporosis.
Many women, including those with PCOS, are successfully treated with hormones for oligomenorrhea. They have more frequent periods and begin ovulating during their menstrual cycle, restoring their fertility.
For women who do not respond to hormones or who continue to have an underlying condition that causes oligomenorrhea, the outlook is less positive. Women who have oligomenorrhea may have difficulty conceiving children and may receive fertility drugs. The absence of adequate estrogen increases risk for bone loss (osteoporosis) and cardiovascular disease. Women who do not have regular periods also are more likely to develop uterine cancer. Oligomenorrhea can become amenorrhea at any time, increasing the chance of having these complications.
Medicinal plants used for treatment of oligomenorrhea and amenorrhea in traditional Persian medicine references.
| Traditional name | Suggested scientific name (synonym)∗ | Family | ∗∗Temperament | Part(s) used | Methods of application | |||
|---|---|---|---|---|---|---|---|---|
| Ghafes | Agrimonia eupatoria L. Eupatorium cannabinum | Rosaceae Asteraceae | Warm & dry | Aerial | Oral, vaginal (Hamool) | |||
| Komaphytus | Ajuga chamaepitys | Lamiaceae | Warm & dry | Aerial | Oral, vaginal (Hamool) | |||
| Koras | Allium ampeloprasum L. (Allium porrum L.) Allium ascalonicum L.. Allium roseum L. Allium scorodoprasum L. Allium ursinum L. Allium vineale L. | Amaryllidaceae Liliaceae Alliaceae | Warm & dry | Leaf, bulb | Oral | |||
| Basal | Allium cepa L. | Amaryllidaceae Liliaceae Alliaceae | Warm & dry | Bulb | Oral, bath | |||
| Sooom | Allium sativum L. | Amaryllidaceae Liliaceae | Warm & dry | Bulb | Bath | |||
| Abu khalsa | Alkanna tinctoria (Anchusa tinctoria L.) | Boraginaceae | Warm & dry | Root | Oral, vaginal (Hamool), bath | |||
| Karafs | Apium graveolens Petroselinum crispum (Mill.)Fuss (Apium petroselinum L.) | Apiaceae | Warm & dry | Fruit, stem, root | Oral, vaginal (Hamool) | |||
| Zaravand | Aristolochia fontanesii Boiss. & Reut. (Aristolochia longa L.) Aristolochia bottae Jaub. & Spach. (Aristolochia maurorum L.) | Aristolochiaceae | Warm & dry | Aerial, root | Oral, vaginal (Forzajah) | |||
| Ghaysoom | Artemisia abrotanum Artemisia montana (Nakai)Pamp. | Asteraceae | Warm & dry | Flower, leaf, root | Oral, vaginal (Hamool) | |||
| Afsantin | Artemisia absinthium Artemisia maritima L. Artemisia sieversiana Ehrh. ex Willd. | Asteraceae | Warm & dry | Aerial, leaf | Oral, vaginal (Forzajah) | |||
| Berenjasef | Artemisia vulgaris L. Achillea eriophora DC. | Asteraceae Compositae | Warm & dry | Root, aerial | Oral, bath, topical | |||
| Asaron | Asarum europaeum | Aristolochiaceae | Warm & dry | Root, leaf | Oral | |||
| Helyoun | Asparagus officinalis L. Asparagus adscendens Roxb. | Asparagaceae | Warm & dry | Aerial, rhizome, root | Vaginal (Hamool & Forzajah) | |||
| Komashir | Athamanta macedonica L. | Apiaceae | Warm & dry | Aerial | Oral, vaginal (Hamool) | |||
| Kornob | Brassica oleracea L. | Brassicaceae | Warm & dry | Leaf | Oral, vaginal (Hamool & Bakhoor) | |||
| Ghantoriyoun | Centaurium erythraea | Gentianaceae | Warm & dry | Aerial | Vaginal (Forzajah) | |||
| Qost | Cheilocostus speciosus (Costus speciosus) | Costaceae | Warm & dry | Rhizome | Oral, vaginal (Forzajah & Bakhoor) | |||
| Khandarili | Chondrilla juncea L. | Asteraceae | Dry | Leaf | Vaginal (Forzajah) | |||
| Hemmes | Cicer arietinum | Fabaceae | Warm & dry | Seed | Oral | |||
| Salikheh | Cinnamomum cassia (Cinnamomum aromaticum) Cinnamomum iners Cinnamomum bejolghota Sweet | Lauraceae | Warm & dry | Bark | Oral | |||
| Darcini | Cinnamomum verum (Cinnamomum zeylanicum) | Lauraceae | Warm & dry | Bark | Oral, vaginal (Hamool) | |||
| Ladan | Cistus ladanifer L. Cistus creticus L. Cistus incanus L. Tropaeolum majus L. | Cistaceae Tropaeolaceae | Warm & dry | Flower, leaf, seed, whole plant | vaginal (Forzajah & Bakhoor) | |||
| Hanzal | Citrullus colocynthis (Cucumis colocynthis L.) | Cucurbitaceae | Warm & dry | Fruit | Vaginal (Forzajah & Bakhoor) | |||
| Otroj | Citrus medica L. | Rutaceae | Compound | Fruit | Oral | |||
| Moghl | Commiphora mukul (Hook. ex Stocks) Engl. | Burseraceae | Warm & dry | Gum | Oral, vaginal (Bakhoor) | |||
| Morr | Commiphora myrrha (Nees) Engl. (Commiphora molmol) | Burseraceae | Warm & dry | Vaginal | Oral, vaginal (Hamool) | |||
| Phaghlaminus/Artanisa | Cyclamen purpurascens Mill. (Cyclamen europaeum) | Primulaceae | Warm & dry | Rhizome, root | Oral, vaginal (Hamool) | |||
| Ezkher | Cymbopogon citratus Cymbopogon jwarancusa (Jones) Schult. Cymbopogon nardus (L.) Rendle | Poaceae | Warm & dry | Flower | Oral, topical | |||
| Soed | Cyperus longus L. Cyperus rotundus L. | Cyperaceae | Warm & dry | Root | Oral | |||
| Dooghou | Daucus carota L. | Apiaceae | Warm & dry | Root | Oral, vaginal (Hamool) | |||
| Oshagh | Dorema ammoniacum | Apiaceae | Warm & dry | Resin | Oral, vaginal (Hamool) | |||
| Loof | Dracunculus vulgaris Schott (Arum dracunculus L.) Arum italicum Arum maculatum | Araceae | Warm & dry | Root | Oral, vaginal (Hamool), nasal | |||
| Ghesa-al hemar | Ecballium elaterium L. (Momordica elaterium) | Cucurbitaceae | Warm & dry | Fruit, seed | Oral, vaginal (Forzajah) | |||
| Kheiry | Erysimum × cheiri L. (Cheiranthus cheiri L.) | Brassicaceae | Warm & dry | flower | Oral, vaginal (Hamool), bath | |||
| Farfiyoun | Euphorbia helioscopia L. Euphorbia resinifera | Euphorbiaceae | Warm & dry | Flowering plant, root | Oral, vaginal (Hamool) | |||
| Razyanaj | Foeniculum vulgare Mill | Apiaceae | Warm & dry | Seed, root | Oral | |||
| Barzad | Ferula gummosa | Apiaceae | Warm & dry | Resin | vaginal (Hamool & Bakhoor) | |||
| Sakbinaj | Ferula persica Willd. | Apiaceae | Warm & dry | Resin | Oral, vaginal (Forzajah & Bakhoor) | |||
| Tin | Ficus carica L. | Moraceae | Warm & moist | Fruit | vaginal (Hamool) | |||
| Jentiana | Gentiana lutea | Gentianaceae | Warm & dry | Root | Oral | |||
| Kondosh | Gypsophila struthium Loefl Schoenocaulon officinale (Schltdl. & Cham.) A.Gray Veratrum album L. | Caryophyllaceae Melanthiaceae | Warm & dry | Root | Oral, vaginal (Hamool) | |||
| Ashagheh | Hedera helix L. | Araliaceae | Warm & dry | Leaf | Vaginal (Forzajah) | |||
| Kharbagh siyah | Helleborus niger | Ranunculaceae | Warm & dry | Rhizome, root | Vaginal (Forzajah) | |||
| Hofarighoon | Hypericum perforatum L Hypericum barbatum Jacq Hypericum coris L. | Hypericaceae | Warm & dry | Bud, flower, aerial | Oral, vaginal (Hamool) | |||
| Rasan | Inula helenium Calamintha incana Boiss. | Asteraceae Lamiaceae | Warm & dry | Rhizome | Oral, vaginal (Bakhoor) | |||
| Irsa | Iris Germanica (Iris × florentina L.) Iris ensata Thunb. | Iridaceae | Warm & dry | Rhizome, root | Oral, vaginal (Forzajah) | |||
| Abhal | Juniperus sabina L. | Cupressaceae | Warm & dry | berry cones, pseudo fruit | Oral, vaginal (Hamool & Bakhoor) | |||
| Horf | Lepidium sativum | Brassicaceae | Warm & dry | Aerial | Oral | |||
| Kashem/Anjedan roomi | Levisticum officinale (Ligusticum levisticum) Seseli tortuosum | Apiaceae | Warm & dry | Fruit, root, aerial | Oral | |||
| Soosan sefid | Lilium candidium | Liliaceae | Hot & mild | Bulb | Oral, vaginal (Hamool) | |||
| Maye-sayeleh | Liquidambar orientalis Mill. | Altingiaceae | Warm & dry | Sap | Oral, vaginal (Hamool & Forzajah & Bakhoor) | |||
| Farasiyoun | Marrubium vulgare | Lamiaceae | Warm & dry | Aerial, whole herb | Oral, bath, topicl | |||
| Baboonaj | Matricaria chamomilla L. (Matricaria recutita) Anthemis nobilis L. Tripleurospermum disciforme (C.A.Mey.)Sch.Bip. | Asteraceae | Warm & dry | flower | Oral, bath | |||
| Sisanbar | Mentha aquatica L. Mentha piperita L. | Lamiaceae | Warm & dry | Aerial | Oral, bath | |||
| Foodenj | Mentha pulegium L. Mentha longifola L. Mentha aquatica L. Mentha × piperita L. | Lamiaceae | Warm & dry | Aerial, leaf | Oral, vaginal (Hamool) | |||
| Shoniz | Nigella sativa L. | Ranunculaceae | Warm & dry | Seed | Oral | |||
| Jawshir | Opopanax chironium Prangos ferulacea (L.) Lindl. | Apiaceae | Warm & dry | Gum | Oral, vaginal (Hamool) | |||
| Fawania | Paeonia lactiflora Pall | Paeoniaceae | Warm | Seed, root | Oral | |||
| Harmal | Penagum harmala (Harmala peganum) | Nitrariaceae | Warm & dry | Seed | Oral, topical | |||
| Fatrasaliyoun | Petroselinum crispum (Carum Petroselinum, Petroselinum sativum) | Apiaceae | Warm & dry | Fruit, aerial | Oral | |||
| Loobia | Phaseolus vulgaris | Leguminosae | Warm & moist | Seed | Oral, bath | |||
| Anison | Pimpinella anisum | Umbelliferae | Warm & dry | Fruit | Oral, vaginal (Hamool & Bakhoor) | |||
| Senobar | Pinus sp. | Pinaceae | Warm & dry | Resin | Vaginal (Bakhoor) | |||
| Felfel | Piper nigrum L. | Piperaceae | Warm & dry | Fruit | Oral, vaginal (Hamool) | |||
| Gharasia | Prunus cerasus L. (Cerasus vulgaris) Prunus avium L. (Cerasus avium) | Rosaceae | Cold & dry | Fruit, peduncle | Oral | |||
| Loos al mor | Prunus dulcis (Amygdalus communis var. amara) | Rosaceae | Warm & dry | Leaf, flower, fruit | Vaginal (Hamool & Forzajah) | |||
| Fowweh | Rubia tinctorum | Rubiaceae | Warm & dry | Root | Vaginal (Hamool) | |||
| Hommaz | Rumex acetosa L. Rumex conglomeratus Murray (Rumex acutus Sm.) | Polygonaceae | Cold & dry | Leaf, aerial | Oral | |||
| Sodab | Ruta graveolens L. | Rutaceae | Warm & dry | Aerial | Vaginal (Hamool & Forzajah) | |||
| Satroniyoun | Saponaria officinalis | Caryophyllaceae | Warm & dry | Root | Oral, vaginal (Hamool) | |||
| Oshnan | Seidlitzia rosmarinus Salicornia sp. | Amaranthaceae | Warm & dry | Leaf, stem, ash | Oral | |||
| Semsem | Sesamum indicum L. (Sesamum orientale L.) | Pedaliaceae | Warm & moist | Seed | Oral | |||
| Ghora-tol-ayn | Sium latifolium L | Apiaceae | Warm & dry | Root | Oral | |||
| Astarak | Styrax officinale | Styracaceae | Warm & dry | Resin | Oral, vaginal (Forzajah & Bakhoor) | |||
| Ogh’hovan | Tanacetum parthenium Anthemis arvensis L. Anthemis cotula L. | Compositae | Warm & dry | Aerial | Oral, vaginal (Forzajah) | |||
| Khas barri | Taraxacum campylodes G.E.Haglund (Taraxacum officinale) | Asteraceae | Cold & moist | Aerial, leaf, rhizome, root, whole herb | Oral | |||
| Kamadarius | Teucrium chamaedrys | Lamiaceae | Warm & dry | Aerial | Oral | |||
| Jo’dah | Teucrium polium L. | Lamiaceae | Warm & dry | Whole herb | Oral | |||
| Hasha | Thymus vulgaris Thymus capitatus | Lamiaceae | Warm & dry | Aerial, leaf | Oral | |||
| Holbeh | Trigonella foenum-graecum | Fabaceae | Warm & dry | Seed | Oral, bath, topical | |||
| Handaghughi | Trifolium pretense Trigonella coerulea (Desr.) Ser. | Leguminosae | Warm & dry | Flower | Oral | |||
| Anjoreh | Urtica dioica | Urticaceae | Warm & dry | Flowering plant, root | Oral, vaginal (Hamool & Fetelah) | |||
| Valeriana dioscoridis Sm. | Caprifoliaceae | Warm & dry | Aerial, rhizome | Oral, bath | ||||
| Kharbagh sefid | Veratrum album L. | Melanthiaceae | Warm & dry | Root, rhizome | Vaginal (Forzajah) | |||
| Aslagh | Vitex agnus-castus L. | Lamiaceae | Warm & dry | Fruit, leaf | Oral, vaginal (Hamool & Bakhoor) | |||
| Mo | Vitis vinifera L. (Vitis sylvestris C.C.Gmel) | Vitaceae | Warm & dry | Leaf | Oral, bath | |||
| Meshketaramashie | Ziziphora clinopodioides Lam. Origanum dictamnus Mentha aquatic L. | Lamiaceae | Warm & dry | Leaf | Oral, vaginal (Bakhoor) | |||
Complications
- Infertility – Untreated oligomenorrhea can lead to infertility in polycystic ovarian disease and primary ovarian insufficiency due to anovulation, impaired endometrium required for implantation in Asherman syndrome, fibrosis that occur as a result of pelvic inflammatory disease and metabolic derangement that occur in uncontrolled diabetes that makes pregnancy difficult.
- Endometrial Hyperplasia – Oligomenorrhea that goes untreated for years can lead to endometrium proliferation and thus resulting in endometrial hyperplasia.
- Endometrial Cancer – Endometrial hyperplasia is a precursor for endometrial cancer. Oral contraceptive pills that contain estrogen and progesterone are protective against endometrial cancer.
- Osteoporosis – The main source of estrogen in the body is developing ovarian follicle that is lost due to anovulation in oligomenorrhea. This decrease in estrogen leads to osteoporosis.
- Cardiovascular Problems – Estrogen is cardioprotective. Lack of estrogen due to anovulation leads to increase risk of myocardial ischemia.
- Neuropsychiatric Complications – Anxiety, hallucination, delusion are psychiatric problems. Neurologic symptoms are involuntary movements in face and lips, anorexia, and asthenia.
Prevention
Oligomenorrhea is preventable only in women whose low body fat to weight ratio is keeping them from maintaining a regular menstrual cycle. Adequate nutrition and a less vigorous training schedules will normally prevent oligomenorrhea. When oligomenorrhea is caused by hormonal factors, it is not preventable, but it is often treatable.
References
