Menses in advance
Among the disorders related to menstruation, stands the polymenorrhea, a frequent condition that denotes the shortening of the intermenstrual period: it means that menstruation occurs prematurely, before passing the canons 24 days after their end. In other words, we talk about polymenorrhea in cases where menstruation occurs in advance.
When polymenorrhea is a unique event, or at least sporadic, it must not give rise to some concerns, since it can happen that the menstrual cycle presents some irregularities: stress, seasonal changes and fatigue can in fact affect the regularity of menstruation. In such circumstances, menstrual bleeding is delayed, is more abundant (menorrhagia) or is early, as in the case of polymenorrhea.
Causes of polymenorrhea
The polymenorrhea can be caused by a reduction in the proliferative stage (pre-ovulatory phase) or by a decrease in the secretory phase (post-ovulatory phase): the first case must not cause concern, while the second could be, in the most serious cases, infertility indicator (the woman is unable to complete the pregnancy). Furthermore, it was statistically recorded that women with heart disease are more likely to have polymenorrhea. The phenomenon can also be influenced by an alteration in the endometrium: when the mucosa of the internal uterine cavity (the endometrium) no longer responds correctly to a hormonal stimulus, polymenorrhea may appear. Also the endocrine modulations can contribute to the shortening of the period between one menstruation and the other, as well as the presence of uterine neoplasms (eg fibroids): in general, the presence of myomas is also associated with metrorrhagia and menorrhagia.
Incidence
The polymenorrhea occurs in 13% of girls during the first year of menarche (a period that coincides with the first menstruation): the body still has to balance its hormonal structure and needs some time to settle. In the second year after the first ovarian cycle, the polymenorrhea occurs in 7.5% of cases, to fall to 6% in the third year. In other words, when the polymenorrhea occurs at the beginning of the fertile age, it should not cause consequences within the organism: in general, the close menstrual cycles of the small women are characterized by a short follicular phase, but ovulation and the ovarian cycle are regular and adequate. Moreover, in young women, polymenorrhea is often associated with hypermenorrhea, ie an abundant and long-lasting cycle. In adult women, however, polymenorrhea is often related to an alteration in the production of progesterone, a phenomenon that coincides, in particular, with the luteal (or secretory) phase of the menstrual cycle; yet, changes in the thyroid and increased prolactin in the blood (hyperprolactinemia) are other factors that could favor polymenorrhea.
When it's worrying
As we have analyzed, when the polymenorrhea in the adult woman is an unusual and unusual phenomenon, it generally does not create problems; if the condition occurs frequently, alternating periods of regularity of the cycle, it is advisable to consult the doctor. In fact, the shortening of the intermenstrual phase could be a sign of hidden and asymptomatic pathologies: the anovulation (lack of ovulation) and the menstrual irregularity are the causes that mostly affect the manifestation of polymenorrhea.
It should be stressed that vaginal bleeding is not always a sign of menstruation: in some cases the bleeding could be interpreted as menstruation, when instead it involves much more. In the most serious cases, but unfortunately not rare, the necrosis of the superficial layers of the endometrium, which manifests itself with possible intermenstrual bleeding, could be misunderstood with polymenorrhea: in these cases the endometrial cells are no longer correctly oxygenated due to hyperestrogenism (bleeding is therefore attributable to the hyper-secretion of estrogen in the body).
Diagnosis and treatment
The woman should go to the doctor and undergo a gynecological check-up, with a relative tissue biopsy, for the diagnosis of the problem: if the close menstruation is an indication of polymenorrhea due to hormonal alteration, in general, the gynecologist recommends the administration of a progestin. The duration of therapy varies from patient to patient, but usually the treatment is continued for several months; if the woman needs an oral contraceptive, the contraceptive pill could also be useful to restore the balance of the menstrual cycle and resolve the typical symptoms of polymenorrhea.
Summary
To fix the concepts ...
Disorder | polymenorrhea |
Features | Menstrual problem that indicates the shortening of the intermenstrual period (more ovarian cycles occur before passing the canonical 24 days) |
Influential factors for polymenorrhea not worrying | Stress, seasonal change, tiredness, pharmacological treatments |
Poliipermenorrea | Polimenorrhea associated with an abundant and long-lasting blood flow |
Causes | Hormonal alterations, decreased secretion phase, proliferative stage reduction, tumors, cardiac pathologies, thyroid abnormalities, hyperprolactinaemia, anovulation, menstrual cycle irregularities |
Incidence in girls | It occurs in 13% of girls during the first year of menarche, in 7.5% of the second year from the first menstruation and in 6% from the third year. |
Associated conditions | Metrorrhagia, menorrhagia, hypermenorrhea |
therapies | Hormone intake; resolution of organic pathologies; the contraceptive pill also reduces the symptoms of polymenorrhea. |
