The menstrual cycle has earned recognition as the fifth vital sign for women due to its profound implications for overall health and well-being. Just as heart rate, blood pressure, respiratory rate, and body temperature offer crucial insights into a person's physiological state, the menstrual cycle provides a window into a woman's reproductive and general health. Beyond its role in reproduction, a healthy menstrual cycle indicates proper nutrition, stress management, and overall hormonal health. Irregularities and inconsistencies in the menstrual cycle, called oligomenorrhea, can be early indicators of underlying health issues. This article will discuss what oligomenorrhea is and labs to consider regularly ordering to help manage this women's health condition.

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What is Oligomenorrhea?

Oligomenorrhea is a medical term used to describe a menstrual cycle that is irregular in terms of timing and characterized by infrequent or unusually long intervals between periods. A normal menstrual cycle, composed of four phases (menstruation, follicular phase, ovulation, and luteal phase), typically lasts between 21-35 days, counting from the first day of one period to the first day of the next. 

Women with oligomenorrhea may experience menstrual cycles of more than 35 days, or they might have only a few menstrual periods throughout the year. Oligomenorrhea affects 13.5% of the general population and up to 60% of female athletes at some point in their lives. (14) 

What Causes Oligomenorrhea?  

Disruptions in the balance of hormones such as estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) can lead to irregular menstrual cycles. Conditions such as polycystic ovary syndrome (PCOS) and hypothalamic-pituitary-ovarian (HPO) axis dysfunction can contribute to hormonal imbalances. PCOS is a common hormonal disorder characterized by high levels of androgens (male hormones) in the body. It can lead to irregular periods, anovulation (lack of ovulation), and ovarian cysts. Also known as early menopause, premature ovarian insufficiency (POI) involves a decline in ovarian function before age 40, leading to irregular or absent periods. Other underlying health conditions, including prolactinoma, uncontrolled diabetes mellitus, and Cushing's syndrome, can disrupt the HPO axis (14). 

Thyroid disorders disrupt the hormonal balance regulating the menstrual cycle, potentially causing oligomenorrhea. Hypothyroidism reduces thyroid hormone production, affecting reproductive hormones like estrogen and progesterone, leading to irregular or absent ovulation and menstrual cycle irregularities. Conversely, hyperthyroidism, characterized by excessive thyroid hormone production, increases sex hormone-binding globulin (SHBG), diminishing estrogen availability, similarly impacting menstrual regularity. Even subtle thyroid hormone imbalances, such as alterations in the ratio of T3 to T4, affect the HPO axis, disrupting hormone release and potentially causing ovulation and menstrual irregularities. (8) 

Lifestyle factors, including excessive exercise, poor nutrition, high levels of chronic stress, and rapid changes in body weight, influence hormone levels and hold the potential to disrupt hormonal balance and menstrual regularity (17). 

Oligomenorrhea Symptoms

Missed and delayed periods are the most common sign of oligomenorrhea. Depending on what is causing your period to be irregular, you may also experience other accompanying symptoms related to hormonal imbalances, including:

• Changes in menstrual flow, such as lighter and shorter bleeding compared to a normal period or breakthrough bleeding between periods
• Acne
• Headaches
• Hot flashes
• Mood swings
• Abdominal pain
• Vaginal discharge
• Changes in vision
• Excessive hair growth on the face and body or hair loss
• Infertility

In some cases, oligomenorrhea may progress to amenorrhea, the absence of menstrual periods for three or more consecutive cycles. 

What Are The Benefits of Regular Lab Testing for Patients Who Experience Oligomenorrhea?

Regular lab testing for those experiencing oligomenorrhea provides essential benefits in diagnosis, monitoring, and health management. These advantages encompass identifying underlying causes like hormonal imbalances, thyroid dysfunction, or PCOS through tests measuring thyroid and reproductive hormones. Accurate diagnosis aids in tailoring effective treatments and interventions while monitoring hormonal levels and assessing treatment progress over time. Such tests offer insights into fertility, detect potential health complications such as thyroid disorders or metabolic issues, and guide lifestyle adjustments for hormonal balance and improved menstrual regularity. Patient education and preventive care are promoted through lab results, fostering a comprehensive approach to reproductive health and overall well-being.

Top Labs To Run Bi-Annually On Patients With Oligomenorrhea

Functional medicine offers access to various test panels that assess hormonal balance and underlying causes of irregular menstrual cycles. Test options to consider ordering bi-annually for patients with oligomenorrhea include:

Comprehensive Hormone Panel

A comprehensive hormone panel measures reproductive hormones, including estrogen, progesterone, testosterone, DHEA, FSH, and LH, to provide a broad view of the HPO axis and aid in diagnosing hormone-related medical conditions. Some functional medicine tests may also assess how hormones are metabolized in the body, including phase 1 and 2 detoxification pathways, providing insights into issues with hormonal clearance contributing to hormonal imbalances.

Thyroid Panel

Thyroid dysfunction is common among women with menstrual disorders, with one study calculating a prevalence rate of thyroid disorders in women with abnormal menstrual bleeding of 44%. By ordering a comprehensive thyroid panel, subtle variations in thyroid function can be detected so that they can be managed appropriately.

HPA Axis Assessment 

The hypothalamic-pituitary-adrenal (HPA) axis is a complex neuroendocrine system that plays a vital role in regulating the body's stress response and maintaining hormonal balance. It involves communication between the hypothalamus, pituitary gland, and adrenal glands to control the release of hormones like cortisol, which influence various physiological processes, including metabolism, immune function, and mood. Salivary cortisol testing helps provide insights into the body's stress response to understand the impact of chronic stress on hormonal balance and menstrual health.

Comprehensive Stool Analysis

Phase 3 detoxification refers to the elimination of waste products from the body that occurs via the intestines, kidneys, skin, and lungs. After estrogens are converted to inactive metabolites by the liver, they are predominantly eliminated from the body through feces. This is why promoting optimal gut health and regular bowel movements are critical for female reproductive health. A comprehensive stool analysis helps to identify issues with gut health and function that can perpetuate hormonal imbalances.

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Summary

In conclusion, regular and comprehensive lab testing is paramount in effectively managing and treating patients experiencing oligomenorrhea. By carefully selecting a combination of functional medicine tests, healthcare practitioners can uncover intricate hormonal imbalances, assess underlying health conditions, and gain a deeper understanding of each patient's unique physiology. By integrating these labs regularly into patient evaluations, we address the immediate concerns of oligomenorrhea and pave the way for a holistic and personalized healthcare journey that prioritizes long-term health and vitality.