hypomenorroe

Hypomenorrhea, or hypomenorrhoea, is defined as abnormally light menstrual bleeding with a shorter or reduced flow compared with a person’s typical menses. Normal menstrual blood loss is roughly 30 to 80 mL per cycle; hypomenorrhea involves a flow that is markedly less and may be accompanied by shorter duration of bleeding.

Causes of hypomenorrhea can be physiologic or pathologic. Physiologic factors include use of hormonal contraception (especially low-dose estrogen combined pills, progestin-only regimens, or hormonal intrauterine devices) and perimenopause, which often bring lighter, shorter menses. Breastfeeding and certain states of hypoestrogenism can also reduce flow. Pathologic causes include endometrial thinning or atrophy from chronic anovulation or aging, intrauterine adhesions (Asherman syndrome) after uterine surgery or infection, uterine fibroids or polyps that alter shedding, and hypothalamic-pituitary disorders, thyroid disease, malnutrition, or excessive exercise. Pregnancy must be considered in the differential as well, since early pregnancy or changes in bleeding patterns can mimic hypomenorrhea.

Diagnosis relies on history and targeted testing. Clinicians assess cycle length, flow, and associated symptoms; a pregnancy test is essential. Laboratory evaluation may include complete blood count, thyroid function tests, and prolactin levels. Pelvic ultrasound helps evaluate the uterus and adnexa for structural causes. Endometrial sampling or biopsy is considered if risk factors for endometrial pathology exist or if bleeding patterns are abnormal and persistent, particularly in women beyond reproductive age.

Treatment is directed at the underlying cause. Management options may include changing or stopping hormonal contraception, treating thyroid or pituitary disorders, addressing nutritional or exercise-related factors, iron supplementation for anemia, or surgical intervention for intrauterine adhesions or structural lesions. Most cases resolve with appropriate management, but persistent hypomenorrhea warrants medical evaluation to exclude pathology.