Rare menstruation is a disorder of the menstrual cycle, in which its duration exceeds 35 days (opsomenorrhea). A variant of the disorder is spaniomenorrhea with the appearance of bloody discharge 2-4 times a year. The symptom may be accompanied by a decrease in the amount of bloody discharge, constant pain and discomfort in the lower abdomen. It is observed with physiological hormonal changes, overloads, diseases of the genitals. To determine the causes of rare menstruation, gynecological examination, ultrasound of the pelvic cavity, endoscopic methods, laboratory tests are used. Medications are prescribed only after verification of the diagnosis.
Causes of rare menstruation
In adolescent girls, in the first two years from the beginning of menstruation, the menstrual cycle may have a different duration, sometimes the interval between bleeding increases to 40-50 days. This is due to the formation of sexual function, insufficient synthesis of estrogens and progesterone by the ovaries. Normally, the cycle is established 1-2 years after the first menstruation. If a girl’s rare menstruation persists for more than 2 years, spotting is combined with sharp pains in the lower abdomen or other unpleasant symptoms, you should contact a pediatric gynecologist.
The menstrual cycle lengthens after 45 years, due to age-related changes in the ovaries and a decrease in the synthesis of sex hormones. Premenopausal patients note that rare menstruation is accompanied by a reduction in the duration of bleeding to 2-3 days. Spotting is sparse, dark brown in color. As menopause progresses, the intermenstrual intervals gradually increase. Specialist consultation is necessary if such menstrual disorders develop in women younger than 35-40 years.
Completion of hormonal contraception
In patients who have been taking oral contraceptives for a long time, the production of their own sex hormones decreases. Therefore, when canceling such drugs, the level of estrogen, the main substance regulating the onset of menstruation, sharply decreases. At the end of taking the pills, several cycles often fall out, a small amount of blood is released at the onset of menstruation, bleeding lasts 1-2 days. Such changes in a woman of reproductive age are an indication for a visit to a gynecologist.
A sharp change in climatic conditions causes stress, while the functional capabilities of nervous structures change and the regulation of menstrual bleeding is disrupted. Rare periods during 1-2 cycles are considered physiological after moving to a region with a radically different climate, rest in hot countries. Then, in most patients, the intervals between menstruation return to normal. If the symptom bothers longer, the duration of bleeding and the amount of discharge decreases, opsomenorrhea often indicates the development of diseases of the reproductive sphere.
Exhaustion of the body
Menstrual function disorders can occur in the absence of pathologies from the genital or nervous systems. Cycle failures are often provoked by chronic stress, in which the production of progesterone and estrogens is disrupted, there is a general asthenization of the body and functional (temporary) disorders of the neurohumoral regulation of the onset of menstruation. It is important to diagnose this condition in time, because without appropriate therapy, the reproductive function seriously suffers, up to infertility. The main reasons for the lengthening of the intermenstrual period:
- Insufficient nutrition. Rare and meager menstruation is most often found in young girls who adhere to strict diets. The lack of vitamins and lipids causes a decrease in hormone synthesis, while the patient does not ovulate. With a weight loss of more than 10% in a short period of time, menstruation can disappear for a long time.
- Excessive physical activity. The symptom occurs more often in professional athletes. The interval between menstruation gradually lengthens, the amount of discharge decreases, which eventually leads to sports amenorrhea. Cycle disorders are most characteristic of gymnasts and ballerinas who adhere to strict diets.
- Stress. The delay of menstruation happens after strong emotional shocks (death of loved ones, divorce, reduction at work). The period between bleeding either lengthens, or several menstrual cycles fall out. The usual rhythm of menstruation is restored after normalization of the psycho-emotional state.
Anomalies of the genitals
With congenital organic pathology, symptoms occur in adolescence during the first menstruation. The girls have scanty rare periods, and spotting spotting is characteristic. Bleeding is combined with severe pain in the lower abdomen and perineum. Over time, the symptoms worsen, up to amenorrhea. Most often, uterine abnormalities occur with opsomenorrhea — infantilism, hypoplasia, kinks, and also the underdevelopment of the fallopian tubes and vagina leads to menstrual dysfunction.
In PCOS, the lengthening of the menstrual cycle is associated with progressive ovarian dysfunction. Due to various reasons, the ovulation process is disrupted, cysts form in the genital glands, which inhibits the synthesis of estrogens. Intermenstrual intervals last from 40 days to 4-6 months, the duration of bleeding is reduced to 1-2 days (oligomenorrhea). Women note that against the background of menstrual function disorders, body weight is gaining for no reason, the growth of hair on the face and limbs increases. Without treatment, the condition is complicated by secondary amenorrhea.
Inflammatory gynecological diseases
Acute and chronic inflammation of the genitals can be manifested by rare menstruation, which is due to both hormonal dysfunction and pathological changes in the endometrium. The characteristic lengthening of the interval between periods occurs against the background of dull pulling pains in the lower abdomen, an increase in body temperature, itching and discomfort in the perineum. Periodically there are white or yellowish discharge from the vagina. With menstrual cycle disorders by the type of opsomenorrhea, there are:
- Sexual infections: chlamydia, gonorrhea, ureaplasmosis, etc.
- Chronic inflammation: endometritis, salpingoophoritis, adnexitis.
- Tuberculosis: damage to the ovaries, uterus, fallopian tubes.
- Neoplasms: uterine fibromyomas, adenocarcinomas, leiomyosarcomas.
- Pathology of the brain: tumors of the pituitary gland and hypothalamus, traumatic brain injuries, hypopituitarism, hyperprolactinemia.
- Endocrine disorders: hypothyroidism, hyperthyroidism, diabetes mellitus in the decompensation stage, virilizing adrenal tumors.
- Surgical interventions: artificial termination of pregnancy, operations on the uterus, ovarian resection.
- Radiation and cytostatic therapy of oncopathology.
Since rare menstruation is often caused by a lesion of the genital area, an obstetrician-gynecologist is engaged in primary diagnosis. Women are prescribed a comprehensive examination using laboratory and instrumental methods, which are aimed at finding out the root cause of menstrual dysfunction. The greatest diagnostic value are:
- Gynecological examination. All patients with complaints of irregular menstruation are shown a study of the vagina and cervix using mirrors. Additionally, bimanual palpation of the uterus and finger examination through the rectum are performed. It is mandatory to take swabs from the vagina to the microflora.
- Ultrasound examination. Ultrasound of the pelvic organs can be performed in any phase of the cycle. During sonography, the doctor evaluates the size and configuration of the uterus and appendages, identifies signs of abnormalities in the development of genital organs, inflammatory processes. The method is informative for the diagnosis of volumetric neoplasms.
- Hysterosalpingography. To exclude organic pathology, primarily volumetric neoplasms, an X-ray examination with contrast is prescribed. The method is highly informative, but has its own contraindications — it cannot be used in acute inflammatory processes.
- Endoscopic methods. To clarify the causes of rare menstruation, colposcopy and hysteroscopy are used – special methods of visualization of the mucous membrane of the vagina and uterus. In difficult cases, diagnostic laparoscopy is recommended.
- Laboratory tests. To study the secretory function of the ovaries, the concentration of estrogens and progesterone in the blood is measured on different days of the cycle. To exclude damage to the hypothalamic-pituitary system, the level of gonadotropins — FSH and LH, hypothalamic liberins – is determined.
In order to clarify the diagnosis, magnetic resonance imaging of the pelvic organs is prescribed. If genital pathology is excluded, neurological examination may be required: EEG, X-ray examination of the skull bones and the area of the Turkish saddle. If systemic hormonal disorders are suspected, an endocrinologist’s consultation is recommended.
In cases where rare menstruation is associated with physiological hormonal changes, treatment is not prescribed. Such patients are shown constant monitoring by a gynecologist. It is important to exclude all provoking factors — stress, physical fatigue. For teenage girls and young girls, it is especially important to adhere to a balanced calorie and vitamin diet. Specific drug therapy is prescribed only by a specialist upon completion of a comprehensive examination and detection of the disease that caused the lengthening of the intermenstrual interval.
Treatment of oligomenorrhea
Modern gynecology has a wide list of methods for treating oligomenorrhea. The tactics and sequence of therapeutic actions are selected depending on the diagnostic results. The treatment of oligomenorrhea is usually handled by a gynecologist-endocrinologist. Restorative therapy plays an important role in the treatment, including normalization of nutrition, vitamin intake, immunostimulation, physiotherapy, acupuncture. To activate blood circulation in the pelvis, a special gynecological massage and gymnastic exercises are prescribed.
Drug therapy of oligomenorrhea includes taking hormonal estrogen-containing drugs that stimulate the ovulation process and normalize the menstrual cycle (clomiphene, starting from day 2 to day 6 of the menstrual cycle). Since oligomenorrhea may develop hyperplasia and endometrial carcinoma, hormonal contraceptives are necessary in order to cause regular menstrual bleeding. In addition to the therapeutic effect, these drugs have a contraceptive effect. A number of conditions that cause oligomenorrhea require surgical intervention. In polycystic ovary syndrome, the use of spot diathermocoagulation of the ovaries (cauterization of ovarian tissue by high-frequency current through laparoscopic access), normalizing the ovulatory cycle, is effective.
An indicator of the cure of oligomenorrhea is the restoration of the duration of menstrual bleeding and a decrease in the intervals between them of less than 40 days, observed for one year. At this time, it is recommended to maintain a menstrual calendar and follow up with a gynecologist every three months. Further prevention of oligomenorrhea consists in the normalization of nutrition, physical activity, emotional reactions, the use of reliable, doctor-recommended methods of contraception.