Decreased Menstrual Flow: Causes and Concerns

Hypomenorrhea

Hello Doctor: Since the end of last year, I have noticed that my menstrual flow has decreased compared to previous months.
My menstrual cycle is approximately 26-30 days, with no significant changes, but the volume is less than before.
In the past, I would have a heavy flow for the first three days, with a decrease on the fourth day, and it would end by the seventh day.
However, in recent months, it has changed to a heavy flow on the first day, lighter on the second day, and by the third day, I only need to use panty liners.
Sometimes, in the following days, there are only traces of blood when I wipe after using the restroom.
"This month, it only lasted three days and then stopped." I would like to ask the doctor what could be the reason for this? (In April of this year, I underwent a medical abortion, and follow-up ultrasound showed no issues.)

C, 20~29 year old female. Ask Date: 2021/09/29

Dr. Wu Xianghui reply Obstetrics and Gynecology

"Menstrual irregularities" have numerous causes, including lifestyle habits, stress, age, vaginal infections, benign gynecological conditions, and malignant tumors, among others.
However, due to a recent history of medical abortion, it is recommended to arrange for a hysteroscopy to rule out the possibility of intrauterine adhesions resulting from the medical abortion.

Reply Date: 2021/09/29

More Info

Decreased menstrual flow, or hypomenorrhea, can be concerning for many women, especially when there is a noticeable change from their usual menstrual patterns. Based on your description, it seems that your menstrual flow has significantly decreased over the past several months, with a shift from a heavier flow in the initial days to a much lighter flow that barely requires the use of sanitary products.
There are several potential causes for decreased menstrual flow, and understanding these can help in addressing your concerns.
1. Hormonal Changes: The menstrual cycle is regulated by a complex interplay of hormones, including estrogen and progesterone. Any disruption in these hormone levels can lead to changes in menstrual flow. Factors such as stress, significant weight loss or gain, and changes in physical activity can impact hormone levels and, consequently, menstrual flow.

2. Age and Perimenopause: If you are approaching your late 30s or early 40s, it’s possible that you are experiencing perimenopause, a transitional phase leading up to menopause. During this time, hormonal fluctuations can lead to irregularities in menstrual cycles, including changes in flow.

3. Medical Conditions: Certain medical conditions can also affect menstrual flow. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, and uterine abnormalities (like fibroids or polyps) can lead to changes in menstrual patterns.
4. Medications: If you are taking any medications, including hormonal contraceptives or other treatments, these can also influence your menstrual cycle. Since you mentioned a medication-induced abortion in April, it’s worth considering that hormonal changes following this event could still be affecting your cycle.

5. Stress and Lifestyle Factors: Psychological stress and lifestyle changes, such as increased exercise or changes in diet, can also impact menstrual flow. Stress can lead to hormonal imbalances that may result in lighter periods.

Given that you had a medication-induced abortion in April and subsequent follow-up ultrasounds showed no issues, it is possible that your body is still adjusting hormonally. However, if the changes in your menstrual flow are concerning to you, it is important to consult with a healthcare provider. They may recommend blood tests to check hormone levels, a pelvic exam, or imaging studies to rule out any underlying conditions.

In summary, while decreased menstrual flow can be a normal variation for some women, especially after significant life events like pregnancy termination, it is essential to monitor the situation. If you experience any additional symptoms such as severe pain, irregular cycles, or other changes in your health, seeking medical advice would be prudent. Your healthcare provider can help determine the underlying cause and suggest appropriate management strategies to ensure your reproductive health remains optimal.

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