Hypomenorrhea is a violation of menstrual function, in which the volume of bloody discharge does not exceed 50 ml. The disorder may have physiological causes or occur after operations, injuries, against the background of various diseases — malformations, inflammatory diseases of the genital area, endocrine pathology, brain tumors. Gynecological examination, ultrasound of pelvic organs, endoscopic and laboratory methods are used to determine the cause of poor menstruation. With physiological hypomenorrhea, treatment is not prescribed. In other cases, the origin of the symptom is taken into account when choosing therapy.
With meager monthly periods, small smearing secretions appear. Less often they have the appearance of dark brown bloody droplets. Ordinary daily and even ultra-thin pads cope well with the protection of underwear during such menstruation. Often, the duration of the menstrual period is reduced to 1-2 days (oligomenorrhea), and cycles are extended to 2-3 months (opsomenorrhea) and even longer (spaniomenorrhea). Usually such menstruation passes without pain and deterioration of well-being.
You should consult an obstetrician-gynecologist if an adult woman has poor discharge instead of the usual menstruation for 3 cycles or longer. The reason for concern should also be a combination of prolonged smearing periods (up to 2 weeks or more) with pain in the lower back and lower abdomen, which “shoot” into the sacrum, coccyx, rectum. Alarming is the reduction of secretions against the background of a constant or periodic increase in temperature, drowsiness, apathy, weight gain.
Causes of hypomenorrhea
Normally, the menstrual cycle is realized and regulated by a complex system that includes both the internal genitalia (uterus, ovaries) and the parts of the brain (pituitary gland, hypothalamus, cortex). With violations at any of these levels, it is possible to shorten the duration of menstruation, lengthen the intervals between them, and reduce the amount of menstrual blood. The reasons for such changes are natural (physiological) or pathological, associated with the development of diseases.
For most adolescents, scanty spotting during menstruation is a normal phenomenon during the formation of the menstrual cycle. Hypomenorrhea is caused by irregular production of estrogens and progesterone, the main hormones that regulate menstruation. As a rule, after the first menstrual period (menarche), which occurred at 11-15 years, the next menstrual bleeding begins at different intervals — from 25 to 56 days. Their duration and intensity vary from cycle to cycle, often the discharge remains scanty, smearing and lasts no longer than 2 days.
A regular monthly cycle with the usual volume of blood loss is established in 1-2 years. If scanty menstruation persists for 2-3 years, the intermenstrual period lasts longer than 5-6 weeks, the intervals between individual bleeding differ by more than 10 days or smearing brown discharge appears 2-4 times a year, a teenage girl needs to visit a gynecologist-endocrinologist. Such disorders may indicate both hormonal problems (adrenogenital syndrome) and some developmental abnormalities (infantilism, uterine hypoplasia).
A decrease in the amount of menstrual discharge in combination with a violation of the normal rhythm of menstruation, “hot flashes”, sweating, chills, fluctuations of emotions is an important sign of menopausal changes. In premenopause, age-related extinction of ovarian function occurs, the level of sex hormones decreases, which disrupts the cyclical maturation of the uterine mucosa. As a result, the intervals between menstrual bleeding are lengthened, and the volume of blood loss drops noticeably.
The period of scanty dark brown discharge preceding the complete cessation of menstruation (menopause) usually occurs after 40-45 years and lasts 1.5-2 years or a little longer. If signs of hypomenorrhea appear earlier, especially before the age of 35-40, and persist in several cycles, it is urgent to consult a gynecologist. In these cases, it is important to diagnose ovarian exhaustion syndrome, resistant ovarian disease, and other diseases that can provoke pathological early menopause in time.
In 80% of breast-feeding women, menstrual discharge appears 6-10 weeks after the end of the lactation period. The first 2-3 cycles are characterized by irregularity and scarcity of secretions. Normally, on the 4th-5th month, the cycle and the volume of monthly periods are fully restored. In 20% of nursing mothers, menstruation resumes when switching to mixed feeding with the introduction of complementary foods. Since prolactin is secreted at this time, which stimulates milk production and slows down the onset of menstruation, secretions are scarce and more rare.
Scant menstrual-like discharge when taking COCs or using the Mirena system is the absolute norm for most women. Such periods usually occur rhythmically, last 3-5 days, proceed almost painlessly, the amount of blood lost does not exceed 40-60 ml. In 30% of patients, intermenstrual brownish discharge is possible at the beginning of contraception or with improper selection of an oral contraceptive. Usually the situation is completely normalized in 2-3 months. A visit to a gynecologist is necessary for longer violations or complete disappearance of menstruation.
Abortions and uterine curettage
Injuries of the uterine wall with frequent artificial termination of pregnancy or diagnostic curettage of the mucous membrane can provoke the formation of adhesions in the uterine cavity (Ascherman syndrome). After another intrauterine manipulation, the patient notices that menstruation has become scarce and sharply painful, although their regularity remains. With the progression of the adhesive process, menstruation stops completely. In rare cases, the pathology develops after one complicated abortion or curettage (for example, removal of the placenta after childbirth).
Sometimes scanty brownish discharge results from inflammation of the internal genitals. In such cases, even before the appearance of hypomenorrhea, the patient is constantly or periodically disturbed by aching pains in the lower abdomen, vaginal discharge (white), itching in the vagina and vulva, fever. There is often a connection with a change of sexual partner, an abortion, a difficult birth. With hypomenorrhea, there are:
- Inflammatory diseases: chronic endometritis, adnexitis.
- Tuberculosis process: tuberculosis of the uterus, fallopian tubes, ovaries.
- Genital infections: gonorrhea, chlamydia, ureaplasmosis, etc.
A decrease in the volume of menstrual blood against the background of an elongation of the cycle is a typical sign of hormonal disorders with insufficient nutrition. Changes in menstruation are associated with the inhibition of ovulation due to an increase in the level of ghrelin – the “hunger hormone”. An important role is also played by a decrease in fat reserves involved in the production of estrogens, and hypovitaminosis. Meager monthly periods are preceded by an extreme diet or a long-term restriction of the diet in order to lose weight. With a large weight loss, menstruation can completely stop – almost half of patients with anorexia suffer from anovulation.
From 24 to 57% of professional athletes experience problems with menstrual function. The initial manifestations of disorders are usually a gradual decrease in discharge from one cycle to another and an elongation of the intervals between menstruation until their complete cessation (sports amenorrhea). The impetus for hypomenorrhea can be strenuous training and a sharp restriction of nutrition at sports camps, experiences at competitions. Gymnasts and ballerinas who monitor weight, bodybuilders who practice “drying” complain more often about poor menstruation.
Menstrual disorders in the form of spotting secretions and even cycle delays are observed after severe psychotrauma (sudden death of relatives, divorce, physical violence). In impressionable teenage girls and female students, menstrual function disorder can be provoked by entrance or final exams. Often, due to inhibitory reactions at the level of the brain, 1-3 monthly cycles fall out immediately after a stressful situation, then scanty discharge occurs within 1-2 months. As the severity of the experience decreases, menstruation is restored.
- Surgical interventions: ovarian resection for injuries and tumors, removal of myomatous nodes, postoperative atresia of the cervical canal.
- Violation of the secretory function of the ovaries: the consequences of radiation and chemotherapy of malignant tumors, polycystic ovaries.
- Brain diseases: tumors of the hypothalamic-pituitary region, traumatic brain injuries.
- Endocrine and metabolic disorders: hypothyroidism, persistent galactorrhea syndrome, obesity.
Since poor menstruation is more common in diseases of the reproductive sphere, a gynecologist is usually engaged in the search for the causes of the disorder. During a comprehensive examination, the condition of the uterus, fallopian tubes, ovaries, and the hormonal background of the patient is evaluated first of all. For a quick preliminary diagnosis , prescribe:
- Gynecological examination. With the help of vaginal mirrors, violations of the structure of the genitals, changes in the visible part of the cervix, pathological vaginal discharge are detected. The examination on the chair is supplemented with a bimanual examination to assess the uterus and appendages.
- Ultrasound examination. During ultrasound of the pelvic organs, the dimensions of the uterus and ovaries are determined, developmental anomalies, signs of inflammation, and tumor formations are detected. To clarify the diagnosis according to the indications, folliculometry and cervicometry are performed.
- Instrumental inspection. For a detailed study of the vaginal mucosa, cervical canal, uterus, colposcopy, cervicoscopy, hysteroscopy are prescribed. If there are doubtful areas, a biopsy is recommended. Diagnostic laparoscopy is performed when ovarian lesions are suspected.
- Laboratory methods. To exclude the inflammatory process and identify the pathogen, a smear on the flora, sowing with an antibioticogram, serological reactions (ELISA, PCR) are shown. Informative tests for the level of estradiol, progesterone, pituitary hormones (FSH, LH, prolactin) and thyroid gland.
If the role of gynecological pathology in the appearance of poor menstruation is not established, brain damage is necessarily excluded. For this purpose, a neurologist’s consultation is prescribed, an oculist’s examination of the fundus, an X-ray of the skull or a sighting of the Turkish saddle, an MRI of the pituitary gland, electroencephalography (EEG).
In the presence of poor menstruation caused by physiological reasons, treatment is not required. When hypomenorrhea is associated with lifestyle features (improper nutrition, intensive training, stress) to restore the cycle in most cases, it is enough to adjust the diet, reduce sports loads, increase rest. It is useful to take multivitamin complexes, and for emotional experiences — light sedative phytopreparations. For the rest of the patients, treatment, especially with the use of hormonal agents, is prescribed only after diagnosis.