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Hypomenorrhea or hypomenorrhoea, also known as short or scanty periods, is extremely light menstrual blood flow. It is the opposite of hypermenorrhea which is more properly called menorrhagia.

Overview

In some women it may be normal to have less bleeding during menstrual periods. Less blood flow may be genetic and, if enquiries are made, it may be found that woman’s mother and/or sister also have decreased blood flow during their periods. Pregnancy can normally occur with this type of decreased flow during the period. The incidence of infertility is the same as in women with a normal blood flow. Constitutional scanty menstruation perhaps best explained by assuming the presence of an unusual arrangement, or relative insensitivity, of the endometrial vascular apparatus.

Reduced menstrual flow is a common side-effect of hormonal contraception methods, such as oral contraceptive pills, IUDs that release hormones (such as Mirena), or hormonal implants such as Depo-Provera. The relatively low estrogen contained in most hormonal contraceptives reduces the growth of the endometrium, so there is relatively little endometrium left to be shed during menstruation. Many women find this side-effect to be a benefit of hormonal contraceptive use.^[1]

Scanty menses or periods can occur normally at the extremes of the reproductive life that is, just after puberty and just before menopause. This is because ovulation is irregular at this time, and the endomaterial lining fails to develop normally. But normal problems at other times can also cause scanty blood flow. Anovulation due to a low thyroid hormone level, high prolactin level, high insulin level, high androgen level and problems with other hormone can also cause scanty periods.

Despite these common causes, hypomenorrhea is still technically an abnormality of the menstrual flow, and other underlying medical problems should be ruled out by a doctor.

Disorders causing scanty menstruation

One cause of hypomenorrhea is Asherman's syndrome (intrauterine adhesions), of which hypomenorrhea (or amenorrhea) may be the only apparent sign. The degree of menstrual deficiency is closely correlated to the extent of the adhesions.^[2]

Uterine: Scanty loss sometimes means that the bleeding surface is smaller than normal, and is occasionally seen when the endometrial cavity has been reduced in size during myomectomy or other plastic operation on the uterus. However, it rarely indicates uterine hypoplasia because the presence of this condition in a uterus which is responsive to hormones indicates ovarian under-activity, and this manifests itself by infrequent rather (oligomenorrhea) than scanty menstruation.

Nervous and emotional: Psychogenic factors such as stress due to exams, or excessive excitement about an upcoming event may cause hypomenorrhea. Such factors suppress the activity of the centers in the brain that stimulate the ovaries during the ovarian cycle (to secrete hormone like estrogen and progesterone), and may result in low production of these hormones.

Low body fat: Excessive exercise and crash dieting can cause scanty menstrual periods when the proportion of body fat drops beneath a certain level. It may cause a total absence of periods (also called amenorrhea).^[3]

Diagnosis

Blood Tests: Most of the common cause of decreased flow of blood during the menses can be detected by blood tests. Tests for the level of hormones such as follicle-stimulating hormone, luteinizing hormone, estrogen, prolactin, insulin are important. In polycystic ovarian syndrome, there will be high levels of insulin and androgens.
Ultra sonogram: An ultra sonogram can diagnose the thickness of the endometrium, size of the ovaries growth of follicles, ovulation and other abnormalities.
Other tests: Tests such as dilation and curettage and MRI scans are sometimes needed to determine the cause of scanty blood flow during the periods.

Treatment

Unless a significant causal abnormality is found no treatment other than reassurance is necessary. Otherwise, treatment is determined by the diagnosis of any significant causal abnormality.

External links

Medicinenet Article on Vaginal Bleeding

References

^ Carlson, Karen J., MD; Eisenstat, Stephanie A., MD; and Ziporyn, Terra, PhD (2004). The New Harvard Guide to Women's Health. Harvard University Press. p. 384. ISBN 0-674-01282-8.
^ Toaff R, Ballas S (1978). "Traumatic hypomenorrhea-amenorrhea (Asherman's syndrome)". Fertil. Steril. 30 (4): 379–87. PMID 568569.
^ "Amenorrhea: Causes". Mayo Clinic. Retrieved September 24, 2011.

UpToDate Contents

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1. 続発性無月経の病因、診断、および治療 etiology diagnosis and treatment of secondary amenorrhea
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4. 先天性子宮奇形の臨床症状および診断 clinical manifestations and diagnosis of congenital anomalies of the uterus
5. 不育症の定義および病因 definition and etiology of recurrent pregnancy loss

English Journal

Nature and Prevalence of Menstrual Disorders among Teenage Female Students at Zagazig University, Zagazig, Egypt.

Nooh AM1, Abdul-Hady A2, El-Attar N3.
Journal of pediatric and adolescent gynecology.J Pediatr Adolesc Gynecol.2016 Apr;29(2):137-42. doi: 10.1016/j.jpag.2015.08.008. Epub 2015 Sep 3.
STUDY OBJECTIVE: To determine the nature and prevalence of menstrual disorders among teenage girls.DESIGN: An observational descriptive cross-sectional study.SETTING: Zagazig University Students' Hospital, Zagazig, Egypt.PARTICIPANTS: A representative sample of female students who attended the unive
PMID 26343844

Adjunctive metformin for antipsychotic-induced hyperprolactinemia: A systematic review.

Bo QJ1, Wang ZM1, Li XB1, Ma X2, Wang CY3, de Leon J4.
Psychiatry research.Psychiatry Res.2016 Mar 30;237:257-63. doi: 10.1016/j.psychres.2016.01.031. Epub 2016 Jan 16.
This systematic review examines adjunctive metformin therapy for the treatment of antipsychotic-induced hyperprolactinemia. A computerized search of databases in Chinese and the international databases in English provided three trials with a total of 325 patients including one randomized clinical tr
PMID 26822064

Risk of Sjögren's syndrome in Taiwanese female adults with irregular menstrual cycles: a population-based case-control study.

Lu MC1,2, Hsieh MC2,3, Koo M4,5, Lai NS6,7.
Rheumatology international.Rheumatol Int.2016 Jan;36(1):155-60. doi: 10.1007/s00296-015-3324-z. Epub 2015 Jul 21.
Primary Sjögren's syndrome (pSS) is a progressive systemic autoimmune disorder with a strong female predominance. Hormonal influences are thought to play a role in the development of pSS. However, no studies have specifically evaluated the association between irregular menstrual cycles and pSS. The
PMID 26194149

Japanese Journal

Menstrual disturbances in various thyroid diseases

, , , , , , , , , , , , ,
Endocrine Journal 57(12), 1017-1022, 2010
… The prevalence of menstrual disturbances, including secondary amenorrhea, hypomenorrhea, oligomenorrhea, hypermenorrhea, polymenorrhea and irregular menstrual cycle were prospectively examined in 586 patients with hyperthyroidism due to Graves' disease, 111 with hypothyroidism, 558 with euthyroid chronic thyroiditis, 202 with painless thyroiditis and 595 with thyroid tumor. …
NAID 130004443597

角質水分計による血虚の客観的評価の試み

石田和之,佐藤弘
日本東洋醫學雜誌 60(1), 61-67, 2009-01-20
[目的]血虚では不眠・めまいなど全身症状や肌荒れなど皮膚関連の症状を呈し,心身に様々な影響を与える。血虚の診断は患者や医師の主観による部分が多く,必ずしも客観的とは言えないため,角質水分計を用いて血虚の客観的評価を試みた。[方法]当院を初診で,漢方未治療の女性患者80名(血虚なし38名・血虚あり42名)を対象に,角質水分計にて角質の水分量を測定し,血虚スコアと比較検討した。[結果]血虚なし群,あり …
NAID 110007098577

過多月経に対する新しい治療法Uterine Balloon Therapy(UBT)の有用性に関する検討

磯和男,井坂恵一,永田順子,小杉好紀,清水禄子,堀量博,高山雅臣
日本産科婦人科學會雜誌 52(4), 683-688, 2000-04-01
[目的]過多月経の患者に対し, Uterine Balloon Therapy(UBT)を施行し安全性と有効性について検討した.[方法]月経血スコアが150点以上の過多月経で年齢35〜55歳, 筋腫合併なし, 妊娠希望なし, 薬物療法継続不可の7症例を対象とした.操作法は静脈麻酔下にてヒーター内蔵バルーンを経頚管的に子宮内に挿入, 5%ブドウ糖液を注入しコンピューター制御でバルーン内を87°Cまで …
NAID 110002231180