Low Menstrual Flow: Treatment Options and Considerations

Hypomenorrhea

Since January of this year, my menstrual flow has decreased with each cycle after giving birth.
I have polycystic ovary syndrome (PCOS), and my doctor prescribed 28-day contraceptive pills to regulate my menstrual cycle.
I have been taking them for two months, but my period still only lasts three days with just a few drops each day, and my sanitary pads are almost clean.
My thyroid tests are normal.
On November 7, I underwent a hysterosalpingography, which showed that my right fallopian tube is blocked, and the shape of my uterus has a missing corner on the right side, so it is not triangular.
The doctor mentioned adhesions and suggested that if I want to conceive, I should undergo hysteroscopy; if not, I should continue taking medication to regulate my menstrual flow.
My question is: I have been taking Estradiol/Norethindrone acetate for over two months now, and my menstrual flow has not improved.
If the reduced menstrual flow is due to uterine adhesions, can medication really improve the menstrual flow issue, or is hysteroscopy the only true solution? If surgery is the only option, I am considering trying to conceive again, but I hope to wait until after next summer.
Should I wait until next summer to have the surgery to avoid the risk of adhesions recurring and needing another surgery?

Yu Ling, 30~39 year old female. Ask Date: 2017/11/13

Dr. Huang Jianzhong reply Obstetrics and Gynecology

In January of this year, I gave birth, and since then, my menstrual flow has decreased with each cycle.
I have polycystic ovary syndrome, and my doctor prescribed 28-day birth control pills to regulate my menstruation.
I have been taking them for two months, but my period still only lasts three days with just a few drops each day; my sanitary pads are almost completely clean.
My thyroid tests are normal.
On November 7, I had a hysterosalpingography, which showed that my right fallopian tube is blocked, and the shape of my uterus has a missing corner on the right side, so it is not triangular.
The doctor mentioned adhesions and said that if I want to conceive, I should undergo hysteroscopy; if not, I should continue taking medication to regulate my menstrual flow.
My question is, I have been taking Estradiol/Norethindrone acetate for over two months now, and my menstrual flow has not improved.
If the decrease in menstrual flow is due to uterine adhesions, can medication really improve this issue? Answer: Is the decrease in menstrual flow due to uterine adhesions? Or is hysteroscopy the only real solution? If surgery is the only option, I am considering having another child, but I hope to wait until after next summer.
Should I wait until next summer to have the surgery to avoid the risk of adhesions recurring and needing another surgery? Answer: Consider changing doctors.

Reply Date: 2017/11/13

More Info

Understanding low menstrual flow, particularly in the context of conditions like polycystic ovary syndrome (PCOS) and uterine adhesions, requires a comprehensive approach. Your situation, characterized by reduced menstrual flow following childbirth, the use of hormonal contraceptives, and the presence of uterine adhesions, presents a complex clinical picture.

Firstly, it's important to recognize that hormonal treatments, such as the combination of estradiol and norethindrone acetate you are currently taking, are often prescribed to regulate menstrual cycles and improve flow. However, if the underlying issue is related to anatomical changes in the uterus, such as adhesions (often referred to as Asherman's syndrome), hormonal therapy alone may not be sufficient to restore normal menstrual flow. Adhesions can disrupt the normal shedding of the uterine lining, leading to scanty or absent menstruation.

In your case, the fact that you have been on hormonal therapy for over two months without significant improvement in menstrual flow suggests that the adhesions may be a significant contributing factor. While hormonal treatments can help manage symptoms and regulate cycles, they do not address the structural issues caused by adhesions. Therefore, if the goal is to restore normal menstrual flow and overall uterine health, a hysteroscopic procedure to remove the adhesions may be necessary.

Regarding your question about timing for surgery, if you are considering trying to conceive again, it is generally advisable to address any anatomical issues before attempting to become pregnant. Uterine adhesions can affect fertility and may lead to complications during pregnancy. If you plan to wait until next summer to have the surgery, it is essential to discuss this with your healthcare provider. They can help you weigh the risks and benefits of delaying the procedure versus the potential impact on your fertility and menstrual health.

If surgery is performed, it can significantly improve menstrual flow and overall uterine function, which may enhance your chances of conceiving. After the surgery, your doctor will likely recommend a follow-up plan, which may include hormonal therapy to support the healing process and prevent the recurrence of adhesions.

In summary, while hormonal therapy can help manage menstrual irregularities, it may not resolve the underlying issues caused by uterine adhesions. A hysteroscopic procedure to remove these adhesions may be necessary for restoring normal menstrual flow and improving fertility. If you are considering another pregnancy, addressing these issues sooner rather than later is advisable. Always consult with your healthcare provider to create a personalized plan that aligns with your reproductive goals and health needs.

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