Menstruation

Menstruation is the monthly shedding of the endometrium or uterine lining. The menstrual cycle is controlled by rise and fall of hormone levels. In anticipation of an egg that is released during a month, the uterine lining is thickened with blood, tissue and fluid. This is in preparation for fertilization and possible pregnancy. When no fertilization occurs, the egg along with the uterine lining are shed throuh the cervix and into the vagina. This menstrual period occurs nearly once every 28 - 35 days. Each time it lasts for about 3 - 7 days.

Hypomenorrhea

If there is continuous reduced menstrual flow and the bleeding lasts for less than 2 days for repeated cycles, it is considered a menstrual disorder and medically termed as Hypomenorrhea. This condition is also known as scanty menstruation, scanty bleeding or scanty discharge. Sometimes Hypomenorrhea may result in infertility because there is not enough uterine lining each month to sustain a pregnancy. Scanty menstruation in itself is not a disease as long as ovulation is taking place regularly.

Hypomenorrhea causes

In few cases, Hypomenorrhea may run in families.

Any imbalance in the production of hormones gives rise to menstrual disorders. Estrogen is responsible for creating the inner lining of the uterus and low levels of this hormone causes very thin womb lining leading to hypomenorrhea. Likewise excess release of a male hormone called testosterone also contributes to the Hypomenorrhea. Prolonged use of pills or IUDs often results in endometrial atrophy leading to scanty bleeding during periods.

Hypothyroidism, one of the causes for hormonal imbalance, occurs when the pituitary gland does not function to its full potential and fails to secret the required TSH hormone. Most often hypothyroidism causes anovulation resulting in Hypomenorrhea.

Thickness of the uterine lining or endometrium determines the amount of blood flow, insufficient thickness of uterine lining causes scanty flow. Any scar, surgery or illness may cause damage to the tissues of the endometrium and also reduces the cavity of the uterine lining leading to scanty blood flow. Asherman's Syndrome, a rare uterine disease leads to adhesions on the endometrium and can be a likely cause for hypomenorrhea.

Working out or intense physical exercise for long duration on a regular basis and losing weight drastically also results in short and light periods. Excess exercise may drop the fat content abnormally and disturbs the hormone production causing light periods.

Hypomenorrhea can also be associated with emotional disturbances and extreme stress. Such mental state for a prolonged period disturbs the pattern of blood flow. Stress hormones block the release of the luteinizing hormone; a precondition for normal bleeding.

Other causes of scanty bleeding include malnutrition, kidney disease, perimenopause, PCOS, blocked fallopian tubes and ectopic pregnancy.

Asherman's syndrome refers to the formation of adhesions or scar tissues on the endometrium (uterine lining). Most often endometrial scarring occurs as a result of scraping of tissue from the uterine wall while performing dilation and curettage (D& C). Though D&C is mainly responsible for adhesions, uterine surgery and severe infections of the endometrium such as genital tuberculosis are some of the other factors that cause Asherman's syndrome. Normally, Asherman's syndrome shows up with decreased menstrual flow or even amenorrhea, cramping, abdominal pain and is even associated with infertility and recurrent miscarriages.

Causes of Asherman's syndrome

D&C procedure is performed for miscarriages, excess bleeding, elective abortion or to remove the retained products of conception. Some gynecological disorders call for uterine surgery. Sometimes trauma occurs to the uterine lining while performing D&C procedure or other surgery. In case of damage, the wound begins to heal and in the process, fuses with the affected portion causing adhesions. The risk of Asherman's syndrome increases with repeated D&Cs.

Symptoms of Asherman's syndrome

Infertility
Menstrual disorders such as Hypomenorrhea or amenorrhea
Repeated miscarriage
Pelvic pain as scar tissue blocks the menstrual flow.

Diagnosis and treatment of Asherman's syndrome

Hysteroscopy is the widely used method to diagnose the Asherman's syndrome as it allows the doctor to have a complete view of the uterus directly. However other methods such as sonohysterography (SHG), hysterosalpingogram (HSG) and transvaginal ultrasound examination are also used to evaluate adhesions. Blood tests are done to detect tuberculosis or schistosomiasis.

Asherman's syndrome is normally treated with surgery to remove the adhesions or scar tissue. The surgery involves hysteroscopy procedure wherein scar tissue is removed by using small instruments, micro scissors and a camera. Once the scar tissue is removed, an intra uterine balloon is placed inside the uterus to keep the uterine cavity open. This procedure aids the healing process and prevents adhesions from returning. Patient may also be prescribed oral estrogen medications for promoting growth of regular uterine lining. Patient may be called in for review hysteroscopy after two weeks of the procedure to make sure that there is no reformation of adhesions.