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.

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

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

Meanwhile, obese and underweight women are advised to lose or gain weight (specifically body fat) in order to restart ovulation and menstruation.^7,8,9,10,11

In women with lower than normal leptin levels (hypoleptinemia) and functional hypothalamic amenorrhoea, leptin replacement therapy corrects the gonadal, thyroid, growth hormone, and adrenal axes, and restores regular menstruation.¹²

Lastly, Kim et al. reported that low intake of vegetable protein (legumes) was significantly linked to a higher risk of anovulation and lower levels of progesterone during the luteal phase (which leads to irregular periods).¹³

Increasing daily intake of vegetable protein may support regular periods, however further studies are needed to confirm this.

Physiological Hypothalamic Amenorrhoea

No treatment is required for physiological hypothalamic amenorrhoea. This normally resolves itself after the postpartum period or once breast feeding has ceased.

Psychiatric Disorders

Concurrent treatment of eating disorders, both mild (athletes) or severe (Anorexia, Bullimia) with estrogen replacement therapy is reported to improve their symptoms, which may help women slowly increase their calorie intake and restore regular periods.^14,15,16

Pharmacological

Discontinuing various drugs, prescribed, non-prescribed and recreational generally restores menstrual cycles although this is not always the case depending on the drug and length of use (i.e. cocaine).

Unexplained Hypothalamic Amenorrhoea

In unexplained cases of hypothalamic-pituitary failure, cyclic estrogen-progestin therapy may be recommended to ensure regular periods.

WHO Group 2 (Hypothalamic-Pituitary Dysfunction)

PCOS

Women with PCOS and irregular periods can sometimes be treated naturally but this is often combined with medication. In cases where medication (and lifestyle modification) fails, the doctor may recommend surgery (bariatric/metabolic).

Non-PCOS

Treatment options for women with irregular periods (and not PCOS) include:

• Improve sleep
• Decrease weight
• Supplements
• Cyclic progestin therapy

Research suggests women require a minimum of 7 hours sleep a night to adequately support their menstrual health.¹⁷ Alternatively, women who work night shift or shift work and experience irregular periods may benefit from strategies on how to reset the circadian clock.^18,19

Secondly, morbidly obese women with irregular periods can in theory decrease the risk of anovulation (and irregular periods) by slowly losing weight.²⁰

Studies also show that some vitamins are essential for regular periods. Women with irregular periods and lacking in vitamin D or C are advised to supplement their daily intake before seeking medication.

Lastly, cyclic progestin therapy may be necessary to ensure regular periods and prevent excessive thickening of the uterine lining and possibly cancer.

WHO Group 3 (Ovarian Failure)

Women with ovarian failure are normally treated with cyclic estrogen-progestin (Hormone Replacement Therapy) to reduce the risk of osteoporosis and cardiovascular disease. However, women with serious contraindications may be offered cyclic progestin therapy instead to ensure regular periods and prevent excessive thickening of the uterine lining (which can lead to cancer).

WHO Group 4 (Hyperprolactinaemia)

Women with non-drug-induced hyperprolactinemia and irregular periods are normally treated with dopamine agonists (cabergoline, bromocriptine). The majority of women respond to cabergoline which is sufficient to restore normal gondal function (and menstrual cycles).²¹ However, approximately 10% of women do not respond to cabergoline or experience severe side effects.²² In these cases, transsphenoidal surgery may be necessary to remove the adenoma and lower prolactin levels.^23,24

Women with drug-induced hyperprolactinemia can normally be resolved (restoring regular periods) after discontinuation or switching to prolactin sparing medication.^25,26

WHO Group 5 (Outflow Tract Defect)

Outflow tract defects are often treated by surgery which may resolve cases of primary amenorrhea but not oligomenorrhea (irregular periods).^27,28 In most cases, cyclic progestin therapy will still be required to ensure regular periods and prevent excessive thickening of the uterine lining.

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 ↩︎