Treatment of Irregular Periods

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Treatment of Irregular Periods

Main article: Irregular Periods Overview

Updated: 3-October-2024

Treatment of Irregular Periods

Assuming you have already tried to regulate your periods naturally, treatment of irregular periods varies according to which WHO Group you fall into and the exact cause.

Note these treatment options are specific to women with irregular periods who are not actively trying to conceive. Women trying to conceive with irregular periods should read ‘How to Get Pregnant with Irregular Periods‘.

Fortunately, almost all cases of irregular periods are manageable (permanently or temporarily).

WHO Group 1 (Hypothalamic-Pituitary Failure)

Functional Hypothalamic Amenorrhoea

Treatment options for functional hypothalamic amenorrhoea include:

  • Decrease stress / anxiety
  • Acetyl-L-Carnitine
  • Increase calorie intake and or decrease exercise
  • Cyclic estrogen-progestin therapy
  • Adjust weight
  • Leptin
  • Modify diet

Decreasing (or managing) stress and anxiety is important to restoring regular periods.1 Some supplements (i.e. Acetyl-L-Carnitine) are also proven to be helpful.2,3 Researchers believe every woman has a different level of resistance to stress.4 This explains how women in the same environment (work, social) will often experience different symptoms.

In other cases, simply increasing calorie intake by at least 20% is sufficient to restore regular periods.5

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Otherwise your doctor may recommend decreasing exercise levels to less than 4 hours per week or cyclic estrogen-progestin (Hormone Replacement Therapy) for athletes.6

References

  1. Berga S L, et al. (2003). Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy. https://www.fertstert.org/article/S0015-0282(03)01124-5/fulltext ↩︎
  2. Genazzani, A D, et al. (2011). Acetyl-L-carnitine (ALC) administration positively affects reproductive axis in hypogonadotropic women with functional hypothalamic amenorrhea. https://link.springer.com/article/10.1007/BF03347087 ↩︎
  3. Genazzani A D, et al. (1991). Acetyl-1-carnitine as possible drug in the treatment of hypothalamic amenorrhea. https://obgyn.onlinelibrary.wiley.com/doi/10.3109/00016349109007165 ↩︎
  4. Bethea C L, et al. (2008). Neurobiology of Stress-Induced Reproductive Dysfunction in Female Macaques. https://link.springer.com/article/10.1007/s12035-008-8042-z ↩︎
  5. De Souza M J, et al. (2021). Randomised controlled trial of the effects of increased energy intake on menstrual recovery in exercising women with menstrual disturbances: the ‘REFUEL’ study. https://academic.oup.com/humrep/article/36/8/2285/6308647 ↩︎
  6. De Souza M J, et al. (2010). High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. https://academic.oup.com/humrep/article/25/2/491/674505 ↩︎
  7. Van Oers A M, et al (2016). Effectiveness of lifestyle intervention in subgroups of obese infertile women: a subgroup analysis of a RCT. https://academic.oup.com/humrep/article/31/12/2704/2354543 ↩︎
  8. Rich-Edwards J W, et al. (2002). Physical Activity, Body Mass Index, and Ovulatory Disorder Infertility. https://journals.lww.com/epidem/fulltext/2002/03000/physical_activity,_body_mass_index,_and_ovulatory.13.aspx ↩︎
  9. Clark A M, et al. (1998). Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. https://academic.oup.com/humrep/article/13/6/1502/815807 ↩︎
  10. Clark A M, et al. (1995). Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. https://academic.oup.com/humrep/article-abstract/10/10/2705/725410 ↩︎
  11. Frisch R E, (1987). Body fat, menarche, fitness and fertility. https://academic.oup.com/humrep/article-abstract/2/6/521/639220 ↩︎
  12. Chou S H, et al. (2011). Leptin is an effective treatment for hypothalamic amenorrhea. https://www.pnas.org/doi/full/10.1073/pnas.1015674108 ↩︎
  13. Kim K, et al. (2021). Low Intake of Vegetable Protein is Associated With Altered Ovulatory Function Among Healthy Women of Reproductive Age. https://academic.oup.com/jcem/article/106/7/e2600/6178346 ↩︎
  14. Plessow F, et al. (2018). Estrogen administration improves the trajectory of eating disorder pathology in oligo-amenorrheic athletes: A randomized controlled trial. https://www.sciencedirect.com/science/article/abs/pii/S0306453018308102 ↩︎
  15. Baskaran C, et al. (2017). Estrogen Replacement Improves Verbal Memory and Executive Control in Oligomenorrheic/Amenorrheic Athletes in a Randomized Controlled Trial. https://www.psychiatrist.com/jcp/cognition-in-amenorrheic-athletes-receiving-estrogen/ ↩︎
  16. Misra M, et al. (2013). Impact of Physiologic Estrogen Replacement on Anxiety Symptoms, Body Shape Perception, and Eating Attitudes in Adolescent Girls With Anorexia Nervosa: Data From a Randomized Controlled Trial. https://www.psychiatrist.com/jcp/impact-physiologic-estrogen-replacement-anxiety-symptoms/ ↩︎
  17. Michels K A, et al. (2019). The influences of sleep duration, chronotype, and nightwork on the ovarian cycle. https://www.tandfonline.com/doi/full/10.1080/07420528.2019.1694938 ↩︎
  18. Smith M R and Eastman C I, (2012). Shift work: health, performance and safety problems, traditional countermeasures, and innovative management strategies to reduce circadian misalignment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630978/ ↩︎
  19. Lawson C C, et al. (2015). Work schedule and physically demanding work in relation to menstrual function: the Nurses’ Health Study 3. https://www.sjweh.fi/show_abstract.php?abstract_id=3482 ↩︎
  20. Bloom M S, et al. (2020). Adiposity is associated with anovulation independent of serum free testosterone: A prospective cohort study. https://onlinelibrary.wiley.com/doi/full/10.1111/ppe.12726 ↩︎
  21. Webster J, et al. (1994). A Comparison of Cabergoline and Bromocriptine in the Treatment of Hyperprolactinemic Amenorrhea. https://www.nejm.org/doi/full/10.1056/NEJM199410063311403 ↩︎
  22. Melmed S, et al. (2011). Diagnosis and Treatment of Hyperprolactinemia: An Endocrine Society Clinical Practice Guideline. https://academic.oup.com/jcem/article/96/2/273/2709487 ↩︎
  23. Petersenn S, et al. (2023). Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement. https://www.nature.com/articles/s41574-023-00886-5 ↩︎
  24. Buchfelder M, et al. (2019). Surgery for Prolactinomas to Date. https://karger.com/nen/article/109/1/77/227211/Surgery-for-Prolactinomas-to-Date ↩︎
  25. La Torre D and Falorni A, (2007). Pharmacological causes of hyperprolactinemia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376090/ ↩︎
  26. Kulshreshtha B, et al. (2017). Menstrual Cycle Abnormalities in Patients with Prolactinoma and Drug-induced Hyperprolactinemia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477442/ ↩︎
  27. Passos I and Britto R, (2020). Diagnosis and treatment of müllerian malformations. https://www.sciencedirect.com/science/article/pii/S1028455920300036 ↩︎
  28. American College of Obstetricians and Gynecologists, (2019). Management of Acute Obstructive Uterovaginal Anomalies: ACOG Committee Opinion, Number 779. https://journals.lww.com/greenjournal/fulltext/2019/06000/management_of_acute_obstructive_uterovaginal.45.aspx ↩︎

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