Decreased Menstrual Flow: Causes and Solutions for Women

Menstrual flow reduction

Dr.
Chen: Hello! I started my menstruation at the age of 11-12, and I am now 38 years old, unmarried, and have never had children.
My menstrual cycle is typically 24-28 days.
Over the past year, I have noticed a decrease in menstrual flow, approximately only half of what it used to be.
Previously, my period lasted about 4-5 days, with heavier flow on the 2nd and 3rd days (requiring about two sanitary pads per day).
Now, the cycle remains the same at 24-28 days, but it ends in 2-3 days, with only the second day being heavier, and the overall volume has significantly decreased (now only needing one sanitary pad).
The menstrual blood is also thinner than before (previously it was darker and thicker).
I used to have many blood clots resembling sloughed mucosa, but now there are very few.
Last month, I visited a gynecologist and had a Pap smear, which showed mild inflammation (I sometimes experience vaginal itching).
The doctor palpated my lower abdomen and prescribed some medications for me: 1.
Antifungal Vag.
100mg (Medication name: Miconazole Vag.
100mg) - 7 tablets 2.
Canesten Cream 20gm (Medication name: Canesten Cream (Clotrimazole)) - 1 tube.
Could you please explain the reasons for the decreased menstrual flow? What should I do about it? I would greatly appreciate your response! Thank you! - Confused Hua Hua

Hua Hua, 30~39 year old female. Ask Date: 2008/05/25

Dr. Chen Xuhui reply Obstetrics and Gynecology

Common causes of reduced menstrual flow include uterine adhesions after miscarriage, thyroid dysfunction, elevated prolactin levels, use of contraceptives, advanced age, and hormonal deficiencies.
Please consult a physician for diagnosis and treatment.

Reply Date: 2008/05/25

More Info

Decreased menstrual flow, or hypomenorrhea, can be a concerning issue for many women, especially when it represents a significant change from their normal menstrual patterns. In your case, you have reported a reduction in menstrual flow over the past year, with periods lasting only 2-3 days and a notable decrease in the volume of blood, which is now described as thinner and less substantial than before. This change can be attributed to several potential causes, and understanding these can help guide appropriate management strategies.

Possible Causes of Decreased Menstrual Flow
1. Hormonal Imbalances: The menstrual cycle is regulated by a complex interplay of hormones, including estrogen and progesterone. Any disruption in this hormonal balance can lead to changes in menstrual flow. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or even stress can affect hormone levels and subsequently alter menstrual patterns.

2. Uterine Conditions: Structural abnormalities within the uterus, such as fibroids or polyps, can impact menstrual flow. These growths can lead to changes in the endometrial lining, which may result in lighter periods or changes in the consistency of menstrual blood.

3. Infections: As you mentioned experiencing some inflammation and itchiness, it’s important to consider that infections, particularly those affecting the reproductive tract, can influence menstrual flow. Infections can lead to inflammation of the endometrium (the lining of the uterus), which may affect how the body sheds this lining during menstruation.

4. Age-Related Changes: At 38 years old, you are approaching perimenopause, a transitional phase leading up to menopause. During this time, hormonal fluctuations are common, and many women experience changes in their menstrual cycles, including decreased flow.

5. Lifestyle Factors: Stress, significant weight changes, excessive exercise, or dietary changes can also impact menstrual flow. These factors can lead to hormonal changes that may result in lighter periods.

Recommended Solutions and Management
1. Follow-Up with a Healthcare Provider: It’s crucial to maintain open communication with your healthcare provider. Since you have already had a Pap smear and received treatment for a vaginal infection, ensure that you follow up to monitor your symptoms and discuss any ongoing concerns.

2. Hormonal Evaluation: If hormonal imbalance is suspected, your doctor may recommend blood tests to evaluate hormone levels, including estrogen, progesterone, and thyroid hormones. This can help identify any underlying issues that may be contributing to your symptoms.

3. Ultrasound Examination: A pelvic ultrasound can help visualize the uterus and ovaries, allowing for the detection of any structural abnormalities such as fibroids or polyps that may be affecting your menstrual flow.

4. Lifestyle Modifications: Consider evaluating your lifestyle for factors that may contribute to hormonal imbalances. Stress management techniques, a balanced diet, and regular exercise can all play a role in regulating menstrual cycles.

5. Medication Review: If you are taking any medications, including those for the treatment of infections, discuss with your doctor whether they could be influencing your menstrual flow.

6. Consideration of Future Family Planning: If you are considering pregnancy in the future, it may be beneficial to discuss your menstrual health and any potential fertility concerns with your healthcare provider.

Conclusion
In summary, decreased menstrual flow can result from various factors, including hormonal imbalances, uterine conditions, infections, and lifestyle changes. It is essential to work closely with your healthcare provider to identify the underlying cause and develop an appropriate treatment plan. Regular monitoring and open communication about your symptoms will be key in managing your menstrual health effectively. If you have further concerns or if your symptoms persist, do not hesitate to seek additional medical advice.

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