What is considered a scanty period?
Normal menstruation lasts from 2 to 8 days with a total blood loss of approximately 5–80 ml per cycle. In practice, a woman is guided not by milliliters, but by her usual volume: if previously several pads a day were required, but now daily is enough, we are talking about hypomenorrhea. The rhythm of the cycle is assessed separately: scanty but regular periods and scanty periods due to delays - these are different situations with a different set of reasons. A one-time episode after an illness, flight or stress does not cause anxiety.
- Discharge is spotting, brownish or very light in color
- Menstruation lasts 1–2 days instead of the usual 4–5
- The volume has decreased markedly compared to previous years
- Sometimes accompanied by delays and irregular periods
When is this the norm?
The first one and a half to two years after the start of menstruation, the cycle is just being adjusted; ovulation does not occur every month, so the volume of discharge fluctuates. After 40–45 years, the supply of follicles is depleted, and periods gradually become shorter and sparser - this is the natural approach of menopause. Scanty or completely absent menstruation is typical against the background of combined contraceptives, hormonal IUDs and subcutaneous implants: the endometrium under their influence is thinner, and there is almost nothing to be rejected. Breastfeeding mothers also often notice spotting in the first cycles after the return of menstruation.
- The first years after menarche
- Premenopause after 40–45 years
- Combined contraceptives and hormonal intrauterine device
- Breastfeeding period
- Single episode after stress, flight or illness
Possible reasons
Most often, scarcity is due to the fact that the endometrium does not have time to grow due to low estrogen levels. This happens with a lack of body weight and strict diets, with intense training, prolonged stress, as well as with diseases of the pituitary gland and thyroid gland. The second large group of reasons is damage to the endometrium itself: intrauterine adhesions after curettage and inflammation, chronic endometritis. Less commonly, polycystic ovary syndrome, premature ovarian failure, and taking certain medications play a role. In women of reproductive age, any sudden leanness is first checked for pregnancy, including ectopic pregnancy.
- Weight loss, strict diets, eating disorders
- Chronic stress and lack of sleep, high sports loads
- Thyroid diseases, increased prolactin
- Polycystic ovary syndrome
- Intrauterine adhesions and chronic endometritis
- Decreased ovarian reserve, approaching menopause
- Pregnancy, including ectopic
What examinations are needed
The examination begins with an examination by a gynecologist and clarification of the menstrual calendar: the duration, rhythm and moment when the volume changes are important. Ultrasound of the uterus and ovaries shows the thickness of the endometrium, the condition of the follicles and signs of adhesions. Hormones are given on certain days of the cycle, so the doctor prescribes the regimen: usually FSH, LH, prolactin, TSH, and according to indications - estradiol, testosterone and anti-Mullerian hormone. If intrauterine adhesions or chronic inflammation are suspected, hysteroscopy with endometrial biopsy is performed.
- Pregnancy test or blood hCG
- Examination by a gynecologist and assessment of the menstrual calendar
- Ultrasound of the uterus and ovaries, preferably transvaginal
- FSH, LH, prolactin, TSH, according to indications - estradiol and AMH
- Hysteroscopy with endometrial biopsy for suspected adhesions
What to do and how to treat it
It is not the symptom that is treated, but the cause, so there is no universal scheme. If the problem is underweight and overload, restoring nutrition, sleep and reasonable physical activity often returns the cycle without medication. In case of diseases of the thyroid gland and increased prolactin, the cycle is normalized after correction of the main disorder. For intrauterine adhesions, hysteroscopic dissection is performed followed by endometrial support. Hormonal medications are selected only by a doctor, taking into account your pregnancy plans. If menstruation is scanty due to contraception and everything else is in order, treatment is not required.
- Normalize weight, nutrition and sleep patterns
- Reduce excessive training loads
- Treat thyroid disease and hyperprolactinemia
- Hysteroscopic treatment of intrauterine adhesions
- Hormonal therapy strictly as prescribed by the doctor
- Maintain a menstrual calendar and show it at the appointment
