LIGHT OR IRREGULAR MENSTURAL FLOW

Absence of menstrual flow is medically termed Amenorrhea while ‘light ‘menstruation is termed Oligomenorrhoea. This oligomenorrhea is often characterized with menstrual flow less than nine (9) in total in a year.

There are two types of amenorrhea (absence) of menstruation; Primary (when a girl fails to menstruate by 16 years of age) and Secondary (absence of menstruation for more than six months in a woman that is not pregnant, lactating nor in menopause).

CAUSES OF IRREGULAR OR LIGHT MENSTRUAL FLOW

  1. Premature Ovarian Failure: This is cessation of periods before 40 years of age. This could be due to exposure to radiotherapy, chemotherapy or chromosomal disorder. Hormone replacement therapy or combined oral contraceptive are choices of treatment.
  2. Absence of ovulation as seen in Polycystic Ovarian Syndrome (PCOS). This clinical condition is characterized by menstrual irregularities, obesity, male pattern of hair distribution and thick voice like that of a man. Some women with PCOS often experience recurrent miscarriage and infertility. However, some other times, patient may not show any symptoms. Treatment of Polycystic ovarian syndrome include use of clomiphene to induce ovulation, eflornithine cream for hirsutism, combined oral contraceptives pill to regulate menses, metformin in case of hyperinsulinemia, lifestyle advice and weight reduction.
  3. Asherman Syndrome: This is the scar in the uterus, In most cases, it is seen in women who has had Dilatation and Curettage (D&C) procedures. This can cause lack of menstrual periods and infertility even more miscarriages. Adhesiolysis is the treatment of choice.
  4. Psychosocial factors like excessive exercise, weight loss and stress.
  5. Of cause, PREGNANCY can cause absence of menses
  6. Hyperprolactinemia: This happens when the hormones called Prolactin is high in women. Women with this condition often present with breast milk secretion on expression; infertility, light, irregular and absence of menstrual flow. However, in cases where prolactinemia is the cause, the woman can present with visual-field defects or eyes problems. Treatment option include both medical (using dopamine agonist like bromocriptine or cabergoline) and surgical if medication fails.
  7. Imperforate Hymen: patients with imperforate hymen often have cyclical pain with menstruation. Hymenotomy is an option of treatment.
  8. Thyrotoxicosis

INVESTIGATION
When you present to a doctor because of irregular or absence if menses, your doctor might request for the following investigations:
1. Pregnancy test
2. Hormone profile study- Luteinizing (LH), Follicle Stimulating Hormone (FSH), Day 21 progesterone
3. Hysterosalpingography
4. Transvaginal ultrasound scan
5. Thyroid function test
6. Hysteroscopy in case of Asherman Syndrome

The outcome of those tests will determine the line of management best for you.

Further Reading: Gynaecology by Ten Teachers