The most common complaint which I get to see in OPD these days is, sir I'm not getting my periods properly. I hardly ever bleed during my periods. I'm just having spotting.
Today in this post, we will be talking about why don't the periods come? Why does the flow of the period becomes less and why do the periods become scanty?
The flow of period actually varies from one person to another person. The flow of the period could be anything between 2 to 7 days. On average, woman uses about 10 to 12 pads or tampons during her whole menstrual cycle. So if the total amount of bleeding which means the number of pads or the tampons used per cycle decreases or the number of days of the bleeding reduces, we now need to investigate.
Did you know that every month the body prepares itself for pregnancy and when the pregnancy does not happen the entire preparation goes waste and it is shed in form of the monthly periods? Now let's understand this a little more in detail.
In our brain there is a gland called hypothalamus that produces a hormone called GnRH gonadotrophin releasing hormone which then acts on another gland in the brain called pituitary which produces two hormones called FSH and LH. These two hormones then act on the ovary which in turn produces two hormones called estrogen and progesterone. These hormones then act on the endometrium which is the inner lining of the uterus.
The estrogen typically makes the endometrium thicker and prepares it for pregnancy. When the pregnancy does not happen the level of estrogen and progesterone come down, the endometrium dies and it sheds off in form of periods. We explain this entire process in detail in our post on irregular periods too. So please endeavour to read it also.
The periods happen because of interplay of hormones in the body. There is nothing dirty about it, there is nothing dirty which accumulates over the entire month and it must be thrown out. Most of the patients ask me sir if i do not bleed properly will something dirty accumulate inside me? No that's not the case but the absence of good periods could be indicative of some serious health problem.
Now we understand that if the periods are scanty this means that the endometrium is not becoming thick and is not bleeding properly. So this means that either there are not enough hormones to stimulate the endometrium or there is something wrong with the endometrium itself because of which it is not bleeding. So hence the causes of scanty periods could be two.
1. Hormonal Problems
2. Endometrial Problems
Hormonal Problems that Causes Scanty Period
Physiological causes
Let's talk about the hormonal reasons first, there could be some physiological reasons. Physiological means that these are normal. These are not indicative of some disease.
1. The first could be genetic which means that if your mother sister or grandmother had scanty periods then you are also likely to have scanty periods.
2. Then there are certain stages in life when the periods could be scanty. The first is menarche when a girl starts having her periods. Also at the time when you are heading towards menopause which is known as perimenopause.
Perimenopause is the time the ovarian reserve is less, the good follicles in the ovary are less, the estrogen is less and hence the periods become scanty.
3. When you are breastfeeding the baby that's also the time the ovulation is irregular and hence the periods become scanty.
Pathological causes
Now let's talk about the pathological reasons of not getting periods. Pathological means that there is something wrong. There is some kind of pathology behind it.
1. Can you imagine the first one in this category is stress, any kind of serious heavy physical or mental stress is one reason of scanty periods. This disturbs the hormones at the level of hypothalamus and pituitary and leading to scanty periods.
2. Obesity: When your BMI is more is also one reason of scanty periods.
3. Sudden crash dieting, sudden weight loss also leads to scanty periods. Remember fat in the body actually is a place where the estrogen is stored. So sudden depletion of fat stores in the body lead to sudden loss of estrogen in the body leading to scanty periods.
4. Over exercising or not exercising, both the things are wrong. An average woman is supposed to exercise minimum 150 minutes per week or maybe 30 minutes every day. So over exercising or under exercising both can lead to scanty periods.
You all must have heard that so many athletes who are into high performance sports they tend to either miss their periods, skip their periods or their periods become very scanty.
5. Then the most common cause of scanty periods these days is polycystic ovarian disease PCOD.
6. Another cause of scanty periods is thyroid disorder.
7. There is another hormone which is known as prolactin. The elevated or increased levels of prolactin hormone in the body are also associated with the scanty periods.
8. There is also another disturbing trend which we are seeing these days is premature menopause. Now the normal age of menopause is anything after 38 years. If a woman gets menopause before 38 years then we call it as premature menopause.
This means that your ovarian reserve has come down. This means number of good eggs in the ovary has come down. So hence less number of eggs, less estrogen and obviously the scanty periods. It's actually very disturbing these days we see women as young as 33-34 coming to us with falling ovarian reserve and almost heading towards menopause.
9. Then there are certain drugs also which are known to cause scanty periods. For example if you've been taking contraceptive pills, the pills which you take for 21 days the birth control pills they are known to make the period flow less. If you've been using a hormonal contraceptive device known as Mirena, it also causes scanty periods. Certain psychiatric medicines are also known to reduce the flow of the periods.
10. Hormonal injectable contraception like Depoprovera. This is a very common injection which is given once in every 3 months for contraception. This is also known to reduce the flow of the periods.
Endometrial Causes of Scanty Period
Now let's talk about the endometrial reasons of scanty periods. Which means that there is something wrong with the endometrium itself, it is not able to bleed properly.
1. The first is known as the Asherman's syndrome, this is a serious condition. It typically happens after repeated GNCs or abortions. In this syndrome, the basal layer of the endometrium gets destroyed and the walls of the uterus they tend to get stuck with each other forming adhesions. This is a serious problem.
It may affect the future fertility also and this requires a proper diagnosis and a proper treatment in form of hysteroscopy, release of adhesions and probably medicines to build up the endometrium once again.
2. Second most common cause which we see mostly in India is genital tuberculosis, which is tuberculosis of the endometrium. Once again this is also a serious matter because of the infection the endometrium tends to get destroyed.
It tends to form adhesions with scarring inside and this also typically might affect the fertility also. This also requires proper diagnosis and proper treatment.
Tests for Scanty Period
So what are the tests we doctors like to do when a patient comes to us with scanty periods? So number one are the blood tests. In case the doctor is suspecting PCOD we could also do some tests to check the androgen excess in the body. We also like to do an ultrasound of the pelvis.
We might even like to test the menstrual blood on first or second day of the periods for the tuberculosis test and in some cases we might also like to do a hysteroscopy and an endometrial biopsy.
Closing thought
So having a good period having an adequate period is a sign of good health. In case you are not getting your periods properly or your periods are scanty or painful your body is trying to tell you that there is something wrong.
Do not resort to taking a magic pill or magic concoction or some magic card to bring on the periods. It is important to get the right diagnosis made. At the same time most of the reasons for having a scanty period are not very serious which means maybe handling your stress, handling your diet or exercise or even correcting your hormones is very easy.
But it is important to get the right diagnosis made and get it treated properly.
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