Hypomenorrhea is a menstrual disorder. In this case, the bleeding is very light and usually lasts less than two days.
What is hypomenorrhea?
Hypomenorrhea is menstruation that is absent, too weak, or too infrequent. Menstruation is a monthly recurring uterine bleeding. If an egg is not fertilized during the cycle, the lining of the uterus is broken down and shed with menstrual bleeding. Normally, a woman’s menstrual cycle lasts about 28 days, with a cycle defined as the time from the first day of menstruation to the last day before menstruation. A cycle length of 25 to 35 days is considered normal. Bleeding lasts an average of four days. During menstruation, a woman loses between 65ml and 200ml of fluid. This consists not only of blood, but also of other secretions and mucosal debris. In hypomenorrhea, bleeding usually lasts less than two days. Bleeding is very light, so blood loss is often less than 25ml. It is also referred to as spotting. The cycle duration is unaffected by the disorder.
Causes
Causes of hypomenorrhea may be organic or hormonal. A common cause is atrophy of the endometrium. Atrophy is a loss of tissue. This can be constitutional or caused by repeated scrapings of the uterus, so-called curettages. Long-term use of progestins (luteal hormones) can also have a negative effect on the endometrium. Progestins are a component of contraceptives such as the pill. If the uterine lining does not build up properly during the cycle, it consequently cannot be shed. This results in low bleeding. Especially overweight women and women suffering from anorexia can be affected by hypomenorrhea. The reason is ovarian weakness. The ovaries do not produce enough hormones as a result of malnutrition. As a result, the uterine lining cannot build up properly. This in turn leads to decreased breakdown of the mucosa in the second half of the cycle. Stress is also a factor that affects menstrual bleeding. Mental stress, professional or private stress and even strong climatic changes, such as on vacation, have an influence on the monthly cycle and can cause hypomenorrhea. Gynecological diseases such as ovarian cysts, endometriosis or cancer of the ovaries and uterus should also be considered as possible causes of hypomenorrhea. The same applies to metabolic and hormonal disorders such as diabetes mellitus or thyroid dysfunction.
Symptoms, complaints, and signs
Menstruation is very light in hypomenorrhea. Rarely it lasts longer than two days, in rare cases the bleeding lasts only a few hours. The amount of blood is rather small, usually there is only spotting. In contrast to hypermenorrhea, i.e. a very heavy menstrual period, hypomenorrhea usually does not cause any other symptoms. A general feeling of illness, weakness or pain are not observed in the majority of cases. Hypomenorrhea is actually rather harmless, and some women may even be grateful for the rather light bleeding. Hypomenorrhea only becomes problematic when those affected have a desire to have children. However, the problem is not the low menstrual bleeding, but the insufficiently developed endometrium, which is the basis of hypomenorrhea. A prerequisite for pregnancy is that ovulation takes place and that sufficient endometrium has built up for the fertilized egg to implant. Hypomenorrhea may be an indicator that one or even both of these requirements are not met.
Diagnosis and course of the disease
The foundation of the diagnosis is a detailed history with accurate documentation of the menstrual cycle and bleeding volumes. This is followed by a gynecologic palpation of the ovaries and uterus. A hysteroscopy is performed to measure the thickness of the endometrium. For further clarification of the cause, a blood test should also be performed. Hormones such as estrogen, progestin, progesterone and testosterone are determined in the blood. Hormone diagnostics via saliva is also possible.If more serious causes such as cancer are suspected, imaging procedures such as ultrasound or CT may be used. If a metabolic or thyroid disorder could be the cause of the hypomenorrhea, blood sugar and / or thyroid hormones must be tested. If there is a desire to have children, an even more detailed examination of the cycle will take place. It must be determined whether ovulation still occurs at all or whether the hypomenorrhea is only due to an insufficiently developed endometrium. To do this, the woman must measure her basal body temperature every morning immediately after waking up. The temperature curve within the cycle can then be used to determine whether ovulation is taking place.
Complications
Usually, hypomenorrhea does not cause any particular complications or discomfort. Due to hypomenorrhea, the bleeding during the woman’s period is very weak and also lasts only a very short period of time. The main symptom is spotting. However, there are no other symptoms, so the patient does not feel ill and does not suffer from pain. In most cases, hypomenorrhea is even a desirable effect, since the bleeding is reduced and there is no particular pain. However, hypomenorrhea can also be a sign that fertilization has not taken place and that the affected person is not pregnant. As a result, it is not uncommon for psychological discomfort to occur when the couple’s desire to have a child cannot be fulfilled. In this case, the partner also suffers from psychological disorders. Hypomenorrhea is usually not treated and disappears on its own. For this reason, there are no further complications. Often, even the change of life circumstances helps to influence the hypomenorrhea.
When should you go to the doctor?
If menstruation is repeatedly very weak, the gynecologist should be informed. Bleeding that lasts only a few hours to days indicates hypomenorrhea, which in any case must be clarified by a doctor. If this is accompanied by a general feeling of illness or weakness, the gynecologist must be consulted on the same day. Although the condition is relatively harmless, it may indicate infertility. Therefore, hypomenorrhea should be seen by a doctor in any case, even if the weak bleeding may even be perceived as pleasant. Women who suffer from atrophy of the endometrium are particularly susceptible to the development of hypomenorrhea. Long-term use of the pill can also cause menstrual cramps. Affected women should have a physical examination and talk to their doctor about changing their medication. Patients suffering from hypomenorrhea in connection with a gynecological disease such as ovarian cysts or tumors should talk to the responsible physician. In case of severe malaise, hospitalization is required.
Treatment and therapy
Often, hypomenorrhea normalizes on its own. Especially if the triggers are psychological, hypomenorrhea can disappear on its own when life circumstances change, for example by reducing stress. In principle, therapeutic treatment is only necessary if the causes of hypomenorrhea endanger the patient or if there is a desire to have children. The therapy is usually carried out by hormonal preparations. If hypomenorrhea is based on causes such as cancer or endometriosis, surgical procedures may be necessary to treat hypomenorrhea.
Prevention
Because stress can negatively affect the menstrual cycle, hypomenorrhea can also be prevented by reducing stress. Relaxation techniques such as autogenic training or gentle endurance sports can be helpful in this regard. Weight normalization also has a positive effect on hypomenorrhea. This applies to both underweight and overweight women. A balanced diet and avoidance of stimulants such as alcohol or nicotine can also prevent hypomenorrhea. Regular checkups with a gynecologist are useful as part of general prevention.
Follow-up care
Once the condition has normalized after hypomenorrhea, some aftercare advice is available for affected women.Among other things, stress avoidance can help improve living conditions and prevent the disease in the future. Therapy may also be useful, but is usually only considered for patients for whom the health risk is quite high or who have the desire to have a child. Depending on the trigger for the menstrual cramps, the doctor may prescribe long-term medication. These are used for aftercare and prevention at the same time. Relaxing techniques are also helpful, as are gentle exercise methods, such as yoga. Normalization of body weight also plays a role after successful treatment. This applies to overweight as well as underweight women. In connection with the renunciation of nicotine, alcohol and other stimulants, those affected strengthen their body awareness. With proven medicinal plants and household remedies it is possible to carry out the aftercare consistently. In general, patients can do without strong medications with side effects if they opt for the gentle method. In addition to these self-help measures, regular checkups with a gynecologist are important to ensure that there is no serious reason for the disorders.
Here’s what you can do yourself
Hypomenorrhea usually normalizes on its own. Various self-help measures and some household and natural remedies promote recovery. As with other menstrual cramps, heat is the main thing that helps with hypomenorrhea. A hot bath relaxes the muscles of the uterus and reduces cramps and pain. Exercise – whether biking, swimming or jogging – releases pain-relieving endorphins and inhibits the production of prostaglandins that trigger pain and inflammation. Support braces help with chest pain. A suitable natural remedy is vitamin B6. Taken as a dietary supplement, the substance helps against irritability and depression. Magnesium also promises quick help. Naturopathy recommends magnesium phosphate C12 or C6 in particular. Alternatively, the preparations Nux vomica and Pulsatilla can be used. Ginger and St. John’s wort are also proven remedies for menstrual cramps due to their soothing effect. Furthermore, a change in diet helps with hypomenorrhea. In particular, soy products should be on the menu, because these reduce pain and prevent new complaints. If the complaints do not subside despite all measures, it is best to talk to the gynecologist again.
