Scanty Periods/ Spotting


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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.

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:

Problems with hormones other than the reproductive hormones 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 cause scanty periods.

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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

A condition called Sheehan's Syndrome can occur after childbirth associated with heavy blood loss. The acute blood loss can lead to pituitary insufficiency. Failure of the pituitary gland to secrete adequate hormones can cause 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 inside the uterus, the surface area of the endometrium may be smaller than normal. Presence of scars inside the uterine cavity is known as Asherman's Syndrome. Scarring can occur after operations on the uterus like a myomectomy (removal of fibroids), D&Cs, or after radiation treatment . 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 to ovulate, 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 during 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 ovary syndrome (PCOS), 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.

  • 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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