SCANTY PERIODS / MENSTRUATION

Written by Dr.M.D.Mazumdar, MD

Scanty menstrual periods are periods in which the duration of blood flow is less than two days or the amount of blood flow is less than 80ml.

Most women though, use the term to mainly mean a decreased blood flow, even if the duration of the periods are more than 2 days. So here, the term 'scanty periods' has been used to describe both periods with a decreased blood flow, as well as periods with a duration of less than two days.

The medical term for less blood flow during periods is 'hypomenorrhoea'. And when periods occur at more than a gap of 35 days, it is called 'oligomenorrhea'. A gap of less than 35 days between two menstrual periods is considered normal.

Causes of Scanty Blood Flow During the Period

Constitutional Causes
In some women it may be normal to have less bleeding during the menstrual periods. Less blood flow may be genetic and, if enquiries are made, it may be found that the woman's mother and/or sisters also have decreased blood flow during their periods. Pregnancy can normally occur with with this type of decreased flow during the periods. The incidence of infertility is the same as in women with a normal blood flow.
Hormonal Causes
- Extremes of Reproductive Lives:
  Scanty menses or periods can occur normally at the extremes of reproductive life - that is, just after puberty and just before menopause. This is because ovulation is irregular at this time, and the endometrial lining fails to develop normally.
- Anovulation:
  But hormonal 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 hormones can also cause scanty periods.
- Oral Contraceptive Pills (OCP):
  Scanty menses can also occur after long term use of oral contraceptives as a result of progressive endometrial atrophy.
  Complete loss of periods after oral birth control pills is known as postpill amenorrhea.
- Sheehan's Syndrome:
  In a condition called Sheehan's Syndrome, there is pituitary insufficiency leading to scanty or complete loss of periods (amenorrhea).

Uterine Cause
Blood flow during a period depends on the normal growth of the endometrium (internal uterine lining). If there is a scar in the uterus, the surface area of the endometrium may be smaller than normal. Scarring can occur after operations on the uterus like a myomectomy (removal of fibroids), after radiation treatment or in conditions like Asherman's syndrome. This may cause less blood flow during the periods.

Emotional Causes
Sometimes psychological factors can come into play. Emotions and stress can act on the centers in the brain that stimulate the ovaries during the ovarian cycle. If these centers in the brain are suppressed due to stress, they fail to stimulate the ovaries leading to less or no production of estrogens and hence scanty menses or periods.

Other Causes
Other causes that can cause scanty or decreased blood flow during the periods are excessive exercise, crash dieting, change in the environment (such as by changing a job), stress due to exams, excessive excitement due to an upcoming event can all cause scanty or less blood flow duering the periods.

Tests for the Diagnosis of Scanty Periods

Blood Tests: Most of the common causes of decreased flow of blood during the menses can be detected by blood tests. Tests for the level of hormones like FSH, LH, estrogen, progesterone, thyroid hormones, prolactin, insulin and androgen are important. In polycystic ovarian disease (PCOD), there will be high levels of insulin and androgens.
Ultrasonogram: An ultrasonogram can diagnose the thickness of the endometrium, size of the ovaries, growth of follicles, ovulation and other abnormalities.
Related Articles
- Midcycle Bleeding
Other Tests: Tests like D&C and MRI scans are sometimes needed to find out the cause of scanty blood flow during the periods.

Treatment of Scanty Periods

Treatment is as per the cause of the scanty periods. A full and thorough history of previous menstrual cycles should be taken to diagnose constitutional causes. Hormonal problems can usually be treated by prescribing hormones. If all reports are normal, assurance and a description of the process is all that is necessary.

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