gynecology

Poor menstrual cycle - Scarce Menstruation by G. Bertelli

Generality

The low menstrual cycle is a condition characterized by the reduction of menstruation, in terms of quantity and duration .

The poor menstrual cycle recognizes various causes: in some cases, the condition is occasional and has no clinical significance; at other times, a flow with these characteristics occurs frequently. This latter event makes it necessary to investigate the reasons for this phenomenon.

The diagnosis of the low menstrual cycle usually involves measuring the hormonal levels in the blood and performing a pelvic ultrasound. Possible causes include some endocrine dysfunctions, diseases of the uterus and ovaries, massive intake of drugs and systemic diseases that can weaken the body and cause an imbalance.

If necessary, the treatment of the low menstrual cycle is aimed at the triggers.

What's this

The low menstrual cycle (or hypomenorrhea ) consists in the presence of menstruations reduced in quantity and duration .

  • Normally, blood loss is 28-80 ml. When menstruation is scarce, however, the flow is less than 20 ml .

The poor menstrual cycle can occur with:

  • Regular rhythm (on average every 28 days);
  • Lengthening of the intermenstrual period ( oligomenorrhea ), therefore with spaced flows and a rhythm exceeding 36 days.

The low menstrual cycle represents the phenomenon contrary to hypermenorrhea (abundant menstrual flow, with blood loss above 80 ml).

The hypomenorrhea is defined when this phenomenon is repeated in succession, for several months.

Note: difference between menstrual cycle and menstruation

In common parlance, the term " menstrual cycle " is often used to indicate menstruation, that is, the blood loss that occurs every month and lasts on average from 3 to 7 days . In reality, the menstrual cycle coincides with the interval of time that elapses between a menstruation and the next one.

  • By MESTRUAL CYCLE we mean the delicate chain of physiological events, whose purpose consists in the maturation of the egg cell (female gamete) and the preparation of an "environment" suitable for its eventual plant. These processes predispose, therefore, to the beginning of a possible pregnancy, in the case in which the fertilization of the oocyte by a sperm of male origin occurs. The menstrual cycle occurs at regular intervals, on average every 28 days, that is from the 1st day of a period to the day before the start of the next flow. However, some individual variability should be considered normal.
  • MESTRUAZIONI consist of the exfoliation of the mucosa that covers the inner wall of the uterus (endometrium), accompanied by a variable loss of blood through the vagina. This phenomenon is renewed cyclically every month and lasts, on average, from 3 to 7 days. Menstruation therefore occurs with a regular frequency and with fairly constant duration and quantity characteristics.

Causes and Risk Factors

The factors that can predispose to a poor menstrual cycle are many .

This condition can occur, first of all, due to the alteration of the anatomical structure of the UTERO (rare occurrence) or the hypoplasia of the same organ (for example, secondary to the poor general development of the body and the genital apparatus, with infantile organs ). The small size of the uterus may be the basis of a reduced flow, since the bleeding surface is smaller than normal; a poor menstrual cycle is therefore a possible consequence of a partial hysterectomy or other operations on the uterus.

When the cause of the reduced menstrual flows resides in the uterus, lesions of ENDOMETRY may be involved, as can happen, for example, following surgery, inflammatory processes or scarring (synechiae). Sometimes, the low menstrual cycle results from the decreased sensitivity of the endometrium to ovarian stimuli.

The dysfunction can also be caused by hormonal balance disorders and various diseases of the genital apparatus, in particular all those that alter the endocrine activity of OVAIO .

Above all, ovarian dysfunctions include:

  • Insufficient production of estrogen hormones;
  • Regression phenomena affecting the ovary, secondary to inflammatory processes;
  • Ovarian infantilism.

The physiological activity of the ovaries may also be affected by pituitary or thyroid endocrine changes .

In other cases, the poor menstrual cycle can be the expression of general illnesses of the body, of a debilitating nature (eg anemia, infections, neoplastic processes, etc.), or the consequence of high levels of psycho-physical stress (eg. miscarriage, excessive physical activity, malnutrition, mourning, etc.).

What does having menstruation mean?

The first day of menstruation marks the beginning of a new menstrual cycle, which in most women lasts between 25 and 36 days. Regardless of the period of time between two flows, menstruation occurs 14 days after ovulation.

Menstruation allows the uterus to eliminate the inner lining built during the previous cycle (if conception has not occurred). By renewing the mucosal layer of the endometrium, the uterus maintains, from a biological point of view, the "soil" that will host the possibly fertilized egg. These changes occur from puberty to menopause and are directly related to fertility. In other words, menstruation indicates the presence of an ovulation cycle, hence the ability to procreate.

Poor menstrual cycle: most common causes

The factors that determine a poor menstrual cycle are numerous and these include sudden weight changes, stress, climate changes and taking specific medications.

In mature women, poor menstruation can herald the onset of menopause . Despite being a physiological event, the reduction of flows in the perimenopausal period must not be underestimated: it is always advisable to consult a doctor and, possibly, a check-up to ascertain that this condition does not depend on other pathologies.

In adult women, some diseases of the female reproductive system, such as:

  • Synechiae (adhesions that interpose between the walls of the uterine cavities);
  • Asherman syndrome (a disease characterized by obstruction of the uterine cavity by scar tissue);
  • Ovarian inflammation;
  • Polycystic ovary syndrome;
  • Early ovarian senescence;
  • Endometrial lesions;
  • Inflammations of the uterus;
  • Polyps and uterine myomas;
  • Ovarian cysts;
  • Ovarian tumors.

It should also be considered that the phases of the menstrual cycle are associated with the periodic and regular secretion of the ovarian, hypothalamic and pituitary hormones, directly related to fertility. Consequently, different structures of the body (central nervous system, hypothalamus, pituitary and ovary) contribute to maintaining the regularity of menstruation, ovulation and other related events.

Therefore, the poor menstrual cycle can recognize what causes:

  • Primary or secondary alterations of the hypothalamic-pituitary-ovarian axis:
    • Neoplasms;
    • Trauma;
    • Excessive duration of oral contraceptive therapy (Sherman's syndrome).
    • Congenital or acquired hypoplasia;
  • Disorders of the thyroid, both in the sense of a poor functioning and, on the contrary, of an excessive activity (hypothyroidism or hyperthyroidism, autoimmune thyroid diseases etc.).

Symptoms and Complications

The low menstrual cycle manifests itself with a reduction in menstruation, also with regard to duration. The reduced menstrual flow is not in itself associated with other particular physical manifestations.

A possible consequence of the poor menstrual cycle is the difficulty in conception .

Diagnosis

Menstrual cycle Occasional poor

A poorly abundant menstrual cycle can occasionally occur and should not alarm; often, at the base of the problem, there may be stress, fatigue, anxiety and considerable concerns.

If occasional or accompanied by regular menstruation by rhythm, hypomenorrhea does not have a serious pathological significance, but should not be overlooked.

Menstrual Cycle Poor Recurrent

If the low menstrual cycle is a phenomenon that recurs several times, it is advisable to consult your primary care physician or the reference gynecologist for the appropriate diagnostic tests. In relation to clinical suspicion, the execution of hormonal dosages, pelvic ultrasound and any other tests may be indicated.

Among the various causes that determine the repetition of the scarce menstrual cycle there can be alterations of the hormonal secretion by the ovary or other endocrine glands, which must be correctly identified and treated.

Poor menstrual cycle: what tests are needed?

To evaluate the causes responsible for the poor menstrual cycle, it is necessary to note with precision on the menstrual calendar the beginning of each cycle (ie the day on which the flow appears). Your doctor may require some blood tests that include measuring the levels of hormones involved in the menstrual cycle.

Performing an ultrasound and a pelvic exam will check the conditions of the uterus and ovaries and the possible presence of cysts (polycystic ovary), as well as allowing the measurement of the thickness of the endometrium or identifying other ovulation abnormalities. Other tests, such as MRI, are sometimes necessary to identify physical causes of the poor menstrual cycle.

Treatment

The treatment of the poor menstrual cycle must be directed towards the cause that determined it.

In the absence of specific pathologies, poor menstruation can be a transient condition. In any case, for the therapy or the most suitable indications, it is always recommended to contact a specialized doctor.

Useful tricks

In general, if the scarce menstruation represents a sporadic or occasional condition, the woman must not worry too much about it.

Sometimes, it is possible to manage the condition simply by adopting an adequate diet, the practice of moderate exercise, stress control and other lifestyle changes .

Hypomenorrhea should cause serious concerns, however, when it appears as a recurrent phenomenon, except, of course, for women who approach menopause.

Drugs and surgery

The regularization of menstruation is possible only if it becomes the effect of the normalization of the functional relationships between the pituitary, the ovary and the uterus.

In the most serious cases, that is when the scarce menstrual cycle is a reason for disorders or sterility, the doctor can direct the patient towards a pharmacological treatment aimed at solving the problem. In particular, a hormonal therapy may be prescribed, based on the administration of estrogens and progesterone, to be performed for several menstrual cycles.

On some occasions, the solution of the poor menstrual cycle is represented by a surgical intervention .