Scanty menstruation (hypomenorrhea) is a violation of menstrual function, in which the amount of bleeding does not exceed 50 ml. The disorder can 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. To determine the cause of scanty menstruation, a gynecological examination, ultrasound of the pelvic organs, endoscopic and laboratory methods are used. With physiological hypomenorrhea, treatment is not prescribed. In other cases, the choice of therapy takes into account the origin of the symptom.
With meager periods, small spotting appears. Less commonly, they look like dark brown bloody drops. With the protection of linen during such menstruation, ordinary daily and even ultra-thin pads do a good job. Often, the duration of the menstrual period is reduced to 1-2 days (oligomenorrhea), and the cycles are lengthened to 2-3 months (opsomenorrhea) and even longer (spaniomenorrhea). Usually, such menstruation passes without pain and deterioration of well-being.
It is worth contacting an obstetrician-gynecologist for a consultation if an adult woman has scanty discharge instead of the usual menstruation for 3 cycles or longer. A cause for concern should also be a combination of prolonged spotting periods (up to 2 weeks or more) with pain in the lower back and lower abdomen, which "shoot" in the sacrum, coccyx, rectum. Alarming is the decrease in secretions against the background of a constant or periodic increase in temperature, drowsiness, apathy, weight gain.
Normally, the menstrual cycle is implemented and regulated by a complex system, including both the internal genital organs (uterus, ovaries) and 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 teenagers, scanty bleeding during menstruation is normal during the formation of the menstrual cycle. Hypomenorrhea is caused by irregular production of estrogen and progesterone, the main hormones that regulate menstruation. As a rule, after the first menstruation (menarche), which occurred at the age of 11-15, the following menstrual bleeding begins at different intervals - from 25 to 56 days. Their duration and intensity vary from cycle to cycle, often the discharge remains meager, spotting 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 meager periods persist for 2-3 years, the intermenstrual period lasts longer than 5-6 weeks, the intervals between individual bleeding differ by more than 1 day, or spotting 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 anomalies (infantilism, uterine hypoplasia).
A decrease in the amount of menstrual flow, combined with a violation of the normal rhythm of menstruation, hot flashes, sweating, chills, fluctuations in emotions is an important sign of menopausal changes. In premenopause, age-related fading of ovarian function occurs, the level of sex hormones decreases, which disrupts the cyclic maturation of the mucous layer of the uterus. As a result, the intervals between menstrual bleeding are lengthened, and the volume of blood loss drops markedly.
The period of meager 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 35-4 years, and persist in several cycles, it is urgent to contact a gynecologist. In these cases, it is important to diagnose ovarian failure syndrome, resistant ovarian disease, and other diseases that can provoke a pathological early menopause in time.
In 80% of breastfeeding women, menstrual flow appears 6-1 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 cyclicity and volume of menstruation are completely 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, the discharge is scarce and more rare.
Scanty menstrual flow 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 40-6 ml. In 30% of patients at the beginning of contraception or with the wrong selection of an oral contraceptive, intermenstrual brownish discharge is possible. Usually the situation is completely normalized in 2-3 months. A visit to the gynecologist is necessary for longer violations or the complete disappearance of menstruation.
Injuries of the uterine wall with frequent artificial termination of pregnancy or diagnostic curettage of the mucosa can provoke the formation of adhesions in the uterine cavity (Asherman's syndrome). After another intrauterine manipulation, the patient notices that menstruation has become meager and sharply painful, although their regularity remains. With the progression of the adhesive process, menstruation completely stops. In rare cases, the pathology develops after one complicated abortion or curettage (for example, removal of the placenta after childbirth).
Sometimes scanty brownish discharge is the result of inflammation of the internal genital organs. 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 (leucorrhoea), itching in the vagina and vulva, fever. Often there is a connection with a change of sexual partner, an abortion, a difficult birth. Hypomenorrhea is accompanied by:
A decrease in the volume of menstrual blood against the background of a lengthening of the cycle is a typical sign of hormonal disorders with malnutrition. Changes in menstruation are associated with inhibition of ovulation by increasing 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. A scanty period is 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 lengthening of the intervals between menstruation up to 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” often complain about scanty menstruation.
Violations of menstruation in the form of spotting and even delays in the cycle are observed after severe psychological trauma (sudden death of relatives, divorce, physical abuse). In impressionable teenage girls and students, menstrual dysfunction can be provoked by entrance or final exams. Often, due to inhibitory reactions at the level of the brain, immediately after a stressful situation, 1-3 monthly cycles fall out, then scanty discharge occurs within 1-2 months. As the severity of the experiences decreases, menstruation is restored.
Since scanty periods are more common in diseases of the reproductive sphere, a gynecologist is usually engaged in the search for the causes of the disorder. In the course of a comprehensive examination, the condition of the uterus, fallopian tubes, ovaries, and the patient's hormonal background are primarily assessed. For a quick preliminary diagnosis, prescribe:
If the role of gynecological pathology in the appearance of scanty menstruation is not established, brain damage is necessarily excluded. For this purpose, a consultation with a neurologist, an examination of the fundus by an oculist, an x-ray of the skull or an aiming image of the Turkish saddle, an MRI of the pituitary gland, and electroencephalography (EEG) are prescribed.
Gynecological examination
In the presence of meager periods caused by physiological causes, treatment is not required. When hypomenorrhea is associated with lifestyle features (malnutrition, intense training, stress), in most cases it is enough to adjust the diet, reduce sports loads, and increase rest to restore the cycle. 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 the diagnosis is established.