SYMPTOMS

What is scanty menstruation?

Scanty menstruation refers to infrequent menstruation or decreased menstrual flow in women ^[1,2].

1. Infrequent menstruation (oligomenorrhea) occurs when a woman with a previously normal menstrual cycle experiences a delay of more than 7 days but less than 6 months, with normal menstrual flow duration and volume [3].
2. Decreased menstrual flow (hypomenorrhea) refers to a regular menstrual cycle with significantly reduced flow (less than 5 mL) or spotting ^[4].
   Clinically, these two conditions often occur together and are collectively referred to as scanty menstruation.

A normal menstrual cycle in women typically lasts 21–35 days, averaging 28 days, with a menstrual period of 2–8 days (averaging 4–6 days) and a total menstrual volume of approximately 20–60 mL ^[1].

Menstruation is regulated by the endocrine system. When various factors disrupt endocrine balance or cause uterine abnormalities, scanty menstruation may occur. It can persist until the underlying cause is resolved, after which normal menstruation may gradually resume, or it may occur occasionally or irregularly.

TREATMENT

How to relieve scanty menstruation?

1. Maintain a healthy and balanced diet, exercise regularly, control weight, avoid staying up late, and follow a regular daily routine.
2. Use contraception wisely. Avoid emergency contraceptives containing strong progestogens (such as levonorgestrel tablets). Short-acting contraceptives (such as drospirenone and ethinylestradiol tablets) can be used instead. Scanty menstruation caused by short-acting contraceptives usually resolves after discontinuation. Alternatively, try other contraceptive methods like condoms or IUDs to avoid multiple abortions.
3. Unless clearly necessary, do not self-administer progestogen-containing medications (such as progesterone, megestrol, or dydrogesterone) or other health products with unknown ingredients.

Note: If the above measures fail to relieve scanty menstruation or if the condition worsens, seek medical attention promptly to identify the underlying cause and receive targeted treatment.

DIAGNOSIS

Under what circumstances should one seek medical attention for scanty menstruation?

If scanty menstruation is accompanied by any of the following conditions, immediate medical attention should be sought:

1. Scanty menstruation persisting for two or more menstrual cycles, suggesting possible premature ovarian failure;
2. Obesity, hirsutism, acne, infertility, etc., which may indicate polycystic ovary syndrome (PCOS);
3. Anorexia, sluggishness, apathy, constipation, etc., possibly due to hypothyroidism;
4. Galactorrhea, headache, blurred vision, decreased libido, etc., which may suggest hyperprolactinemia.

Which department should be consulted for scanty menstruation?

Gynecology and Obstetrics, Endocrinology.

What tests are needed for scanty menstruation?

1. Physical examination: Measuring weight and height to calculate body mass index (BMI), checking skin condition, hair distribution, and breast condition ^[2]. This helps preliminarily assess whether the patient has PCOS or hyperprolactinemia.
2. Pregnancy test: To determine whether sexually active patients are pregnant or to rule out pregnancy.
3. Sex hormone six-item test: To evaluate the patient's endocrine status, identify potential causes of scanty menstruation, and guide treatment planning ^[3]. This test is recommended 2–4 days after the onset of menstruation.
4. Thyroid function test: To assist in diagnosis by checking for abnormalities in thyroid hormones and thyroid-stimulating hormone (TSH).
5. Insulin release test: To assess pancreatic islet function and help identify or exclude causes of scanty menstruation.
6. Serum prolactin test: To measure prolactin levels in the blood and determine whether scanty menstruation is caused by hyperprolactinemia ^[3].
7. Imaging tests: Primarily vaginal and abdominal ultrasound to examine the endometrium, ovarian follicle development, and assess for structural abnormalities in the uterus.

POTENTIAL DISEASES

What are the possible causes of scanty menstruation?

1. Psychological factors: Depression, psychological trauma, mental stress, environmental changes, or excessive fatigue can disrupt endocrine function, leading to scanty menstruation.
2. Endocrine disorders: Obesity, extreme dieting, or irregular lifestyle and diet can cause hormonal imbalances, resulting in scanty menstruation.
3. Uterine abnormalities: Congenital uterine hypoplasia, intrauterine adhesions after multiple abortions, thinning of the endometrium, or endometrial tuberculosis may all contribute to scanty menstruation.
4. Ovarian diseases: Conditions such as premature ovarian failure or polycystic ovary syndrome (PCOS) can cause abnormal endocrine hormone levels, leading to scanty menstruation ^[3].
5. Endometritis: Chlamydia-induced endometritis may reduce estrogen receptor expression in the endometrium, slow cell proliferation, and decrease the formation of cyclic endometrial blood vessels, endothelial cells, and stroma, resulting in insufficient endometrial repair and scanty menstruation ^[5].
6. Other endocrine disorders: Hypothyroidism or hyperprolactinemia can lead to elevated prolactin (PRL) levels, which act on ovarian PRL receptors, reducing ovarian responsiveness to gonadotropins and inhibiting follicle growth, ovulation, and corpus luteum formation, thereby causing scanty menstruation. Thyroid dysfunction may also affect PRL secretion ^[3].
7. Medication factors: Oral contraceptives (e.g., Diane-35, compound ethinylestradiol tablets) or anti-cancer drugs (e.g., cisplatin, paclitaxel, anastrozole) may also cause scanty menstruation.
8. Perimenopausal symptoms: During perimenopause, declining ovarian function and fluctuating hormone levels can lead to scanty menstruation ^[3].