When people think of abnormal vaginal bleeding they usually think of too much bleeding. Infrequent or absent bleeding can be problematic as well. This can be a cause of infertility; if the menstruation is infrequent, the production of eggs will be infrequent or absent. Infrequent or absent bleeding is also a risk factor for endometrial hyperplasia or even uterine cancer. If the periods are infrequent, they can be too heavy when they do come, instead of having a small amount of bleeding every month. Some women may occasionally have an abnormally large amount of bleeding. This can cause anemia and potentially even require blood transfusions. Women that do not have regular periods, because they are on a birth control method that decreases the periods by design, are safe. Examples of this are some forms of birth control pills, the progesterone IUD, and the contraceptive implant.
Amenorrhea means the absence of periods. The most common reason for amenorrhea is pregnancy. If your periods have completely stopped, do a home pregnancy test, you may be surprised. Amenorrhea is classified as primary amenorrhea (have never had a period), and secondary amenorrhea (had periods in the past but they have since stopped). Primary Amenorrhea is often due to genetic problems and can be quite complicated but is rare. Oligomenorrhea is the term for infrequent periods.
Secondary amenorrhea is most often caused by a hormonal abnormality but can also be caused by scarring of the uterus. Asherman’s syndrome is the name for scarring of the inside of the uterus that causes the periods to stop. It is usually caused by some trauma to the inside lining of the uterus. This can be from a previous infection, D&C, infected miscarriage or abortion, or bleeding after delivery of a baby requiring surgical intervention. The treatment of Asherman’s syndrome is to surgically remove the scar tissue.
If the menstrual periods are absent or infrequent due to a hormone problem the treatment will depend on the specific issue and the desire for pregnancy. If the hormonal problem is low thyroid hormone, the treatment is thyroid hormone replacement. Occasionally the problem can be too much prolactin. Prolactin is a hormone made in the brain that helps the breasts produce milk during breast feeding. Prolactin also diminishes the periods and can make them stop. In some cases the brain will make prolactin inappropriately. This is called hyperprolactinemia. The treatment for this is usually a medication that decreases the formation of prolactin. Most commonly the problem is an imbalance of the progesterone and estrogen. Polycystic ovarian syndrome (PCOS) is the most common reason for estrogen-progesterone imbalance. This is also referred to as anovulatory bleeding.
The treatment for anovulatory bleeding is hormonal birth control (pills, patch, ring, shot, IUD, or implant) for women who do not desire pregnancy. For women that desire pregnancy, Clomiphene Citrate is usually the first line agent. For women that do not need birth control but do not want pregnancy, Provera can be used. Ten days of Provera use will trigger a menstrual period sometime within a week after the last pill has been taken. This is often used if a women goes more than two months without a period. This helps protect the uterine lining from developing a uterine cancer and helps keep the overall blood loss to a minimum.