As far as irregular cycles go, having too few periods might sound like a best-case scenario for many teen girls. Less bleeding, fewer days with cramps, and a smaller chance of a period starting at an inconvenient time–what’s not to love? But the truth is that women (including teen girls!) need periods. Not only do the fluctuating hormone levels of the menstrual cycle play important roles in various organ systems, but the cycle itself is an important vital sign that can reveal clues about overall health and health risks. One such clue is the connection between oligomenorrhea (infrequent periods) and metabolic syndrome.
Defining ‘infrequent’ or irregular periods
The medical term for infrequent periods is oligomenorrhea (in Greek, “oligo” means “few,” and “menorrhea” refers to menstrual flow/periods) [1]. This refers to having cycles longer than 35 days or having four to nine menstrual cycles per year. For context, if your cycle length was around 30 days, you would have twelve periods a year.
However, as we covered in detail in our two-part series on teens and irregular cycles, if you’ve only recently had your first period, this infrequent menstruation schedule might be perfectly normal. It takes some time for the body to coordinate activities between the brain, the ovaries, and the different hormones involved in a menstrual cycle before it settles into a regular, predictable pattern. If after two years the body has not settled into a more consistent menstrual cycle, with cycles between 21 and 35 days, then this would be defined as oligomenorrhea [2].
Why might teen oligomenorrhea predict obesity later in life?
Having periods infrequently is a sign that your hormones are out of balance. Because hormones impact one another, infrequent periods can be the result of a variety of hormone-related conditions. These include but are not limited to PCOS, excess cortisol levels (Cushing’s syndrome), thyroid disease, and diabetes [1].
While each of these conditions impacts the reproductive cycle, they also affect, and are affected by, blood sugar levels in the body. High blood glucose (sugar), as we will now discuss, is a hallmark of metabolic syndrome.
What is metabolic syndrome?
According to the American Heart Association (AHA), metabolic syndrome is defined as having at least three of the following risk factors, and it predisposes people to developing heart disease, diabetes, and stroke:
- High blood glucose (sugar)
- Low levels of HDL (“good”) cholesterol in the blood
- High levels of triglycerides in the blood
- Large waist circumference or “apple-shaped” body
- High blood pressure
The AHA recommends a healthy diet and exercise to prevent and treat metabolic syndrome, but there may be underlying factors that need to be addressed in order to effectively treat metabolic syndrome. An abnormal menstrual cycle is one such underlying factor.
Hormonal conditions associated with blood sugar problems
Polycystic ovary syndrome
PCOS is a condition connected to insulin resistance, which means cells are less responsive to insulin, the hormone that causes cells to absorb sugar out of the blood stream. This can lead to elevated insulin and blood glucose levels. Insulin resistance is commonly associated with weight gain and storing weight around the abdomen, also known as abdominal obesity. Recall from above that having large waist circumference, also known as apple-shaped body, and high blood sugar levels checks off two boxes on the metabolic syndrome checklist.
Cushing’s syndrome
Cushing’s syndrome, while quite rare, is a condition in which a person’s cortisol levels are too high. This can cause elevated blood pressure and high blood glucose levels.
Thyroid dysfunction
The thyroid has an important role in the body’s metabolism, and thyroid dysfunction is associated with developing metabolic syndrome [3]. This 2016 study found that fully 95% of women with a new hypothyroid (low thyroid) diagnosis had high cholesterol levels [4].
Diabetes
Diabetes is characterized by too high blood sugar and can lead to high blood pressure. All of the factors on the metabolic syndrome checklist are considered risk factors for diabetes.
How strong is the link between infrequent teen periods and metabolic syndrome?
Oligomenorrhea can be an important clue in identifying diseases that affect the body’s metabolism. But how strong is the link between irregular teen cycles and metabolic syndrome?
Too few periods at age 14 predicts obesity, metabolic syndrome at age 24
In a 2011 study following over 800 teens in Ohio, researchers found that oligomenorrhea at age 14 was associated with severe obesity at age 24 [2]. Women in this study were evaluated annually over a 15 year period and classified at age 14 as regularly cycling, oligomenorrheic, or as having PCOS. Other factors at age 14 that were positive predictors of having metabolic syndrome at age 24 included black race, already having metabolic syndrome at age 14, low levels of sex hormone binding globulin, having PCOS, and having elevated levels of insulin.
For teens whose oligomenorrhea was due to PCOS, 33% had metabolic syndrome at age 24 and 33% had severe obesity. Some women presented with both while others had one or the other, but both percentages came out to 33%. How did women who didn’t have infrequent periods as teens compare? They had only a 7.8% rate of metabolic syndrome at age 24 and an 8.4% rate of severe obesity [2].
Starting periods too soon or too late predicts heart disease, diabetes risk
Oligomenorrhea is also more common in women who start their periods unusually early or unusually late. A 2013 study found that women who had their first periods before age 10 or after age 16 had an increased risk of heart disease and type 2 diabetes later in life [5].
PCOS and metabolic syndrome
A 2014 study similarly reported that women with oligomenorrhea or hyperandrogenemia (excess amounts of androgen hormones) developed metabolic syndrome at rates of between 33% and 47% [6]. In contrast, only 19% of women aged 20–39 in the general population developed metabolic syndrome [6]. In this study, over 1900 women between the ages of 42 and 52 without metabolic syndrome were asked to answer questions on their reproductive history and agree to a follow up period of 12 years, during which nearly 500 new cases of metabolic syndrome were identified. Regarding compounding factors, the study noted that smoking and obesity were both strong predictors of metabolic syndrome regardless of menstrual cycle length. Furthermore, history of smoking and a diagnosis of obesity were “highly prevalent” in women with PCOS.
According to this 2021 summary of research, 43% of adult women and close to 33% of teen girls with PCOS also had metabolic syndrome [7]. And this small 2022 study found that of women with PCOS found that 47.1% also had metabolic syndrome [8].
Irregular cycles and… heart attack, stroke, diabetes?
These studies tell us that having oligomenorrhea as a teen is connected to a significantly higher risk of developing serious health problems and poor metabolic health. These health problems can occur as soon as early adulthood. Also, since metabolic syndrome by definition puts someone at a high risk for heart attack, stroke, and/or diabetes, these health problems could worsen or lead to premature death if left untreated.
Can hormonal birth control regulate irregular cycles?
It’s common for teens to start birth control in order to “regulate” their cycles. However, the idea that birth control can “regulate” a menstrual cycle comes from a misunderstanding of how the female body normally works. Birth control keeps hormone levels relatively constant most of the time. This is a very different state than how the female body naturally works, with hormones rising and falling in a healthy, predictable pattern.
Birth control can also be especially problematic for someone with existing concerns about their metabolism. Unlike restorative reproductive medicine (RRM), birth control can only mask the symptoms of a disease instead of treating the root cause. This can delay the process of identification and treatment of hormonal disorders, perhaps for many years.
How can fertility awareness help?
The good news is that oligomenorrhea can be identified early and treated. This is key because as a FACTS about Fertility commentary on the 2011 study noted, “age-14 oligomenorrhea was found to be just as strong a predictor of metabolic syndrome and obesity at age 24 as oligomenorrhea reported from ages 14 to 19,” but that this is a reversible condition that can improve life-long health outcomes [2].
Being able to quantify the extent of oligomenorrhea, track each cycle, make note of symptoms, and identify timing and signs of ovulation provides valuable information for treatment. A medical provider trained in restorative reproductive medicine (RRM) can then use this information to make a diagnosis and start creating a treatment plan for your unique situation. Common causes of oligomenorrhea like PCOS can be helped through diet, lifestyle changes, and sometimes even surgery.
The main takeaway
When you’re a teen, periods can take some time to figure out. However, if you can’t remember when your last period was, this could be a sign that your hormones–and metabolism–are out of balance. Tracking your cycle and getting help for an irregular cycle can make a huge positive impact on your future health, even as early as young adulthood!
This article was updated on November 29, 2024, to include additional references.
References:
[1] Riaz Y, Parekh U. Oligomenorrhea. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560575/ [2] Glueck, Charles J et al. “Sex hormone-binding globulin, oligomenorrhea, polycystic ovary syndrome, and childhood insulin at age 14 years predict metabolic syndrome and class III obesity at age 24 years.” The Journal of pediatrics vol. 159,2 (2011): 308-13.e2. doi:10.1016/j.jpeds.2011.01.018 [3] He, Jiaji et al. “The relationship between thyroid function and metabolic syndrome and its components: A cross-sectional study in a Chinese population.” Frontiers in Endocrinology, vol. 12 (2021). https://doi.org/10.3389/fendo.2021.661160 [4] Khatiwada S, Sah SK, Kc R, Baral N, Lamsal M. Thyroid dysfunction in metabolic syndrome patients and its relationship with components of metabolic syndrome. Clin Diabetes Endocrinol. 2016 Feb 1;2:3. doi: 10.1186/s40842-016-0021-0. PMID: 28702239; PMCID: PMC5471726. [5] Glueck, Charles J et al. “Early and late menarche are associated with oligomenorrhea and predict metabolic syndrome 26 years later.” Metabolism: clinical and experimental vol. 62,11 (2013): 1597-606. doi:10.1016/j.metabol.2013.07.005 [7] [6] Alex J. Polotsky, Amanda A. Allshouse, Sybil L. Crawford, Sioban D. Harlow, Naila Khalil, Rasa Kazlauskaite, Nanette Santoro, Richard S. Legro, Hyperandrogenic Oligomenorrhea and Metabolic Risks Across Menopausal Transition, The Journal of Clinical Endocrinology & Metabolism, Volume 99, Issue 6, 1 June 2014, Pages 2120–2127, https://doi.org/10.1210/jc.2013-4170 [7] Chen W, Pang Y. Metabolic Syndrome and PCOS: Pathogenesis and the Role of Metabolites. Metabolites. 2021 Dec 14;11(12):869. doi: 10.3390/metabo11120869. PMID: 34940628; PMCID: PMC8709086. [8] Giri A, Joshi A, Shrestha S, Chaudhary A. Metabolic Syndrome among Patients with Polycystic Ovarian Syndrome Presenting to a Tertiary Care Hospital: A Descriptive Cross-Sectional Study. JNMA J Nepal Med Assoc. 2022 Feb 15;60(246):137-141. doi: 10.31729/jnma.7221. PMID: 35210633; PMCID: PMC9200018.Additional Reading:
Teens and irregular periods: What’s normal—and what’s not (Part I)
Teens and irregular periods: What’s normal—and what’s not (Part II)
Endometriosis is usually diagnosed in adulthood: does it appear during the teen years?
