Scant and spaced menstrual flow

Specialty: Gynecology and breast.

• oligohypomenorrhea
• very few and infrequent rules

Why it occurs

• Polycystic ovary syndrome (the state of persistent oligoovulation decreases cyclical endometrial proliferation, giving rise to scant and infrequent bleeding)
• Transition to menopause or late perimenopause (marked estrogenic decline progressively reduces menstrual volume and frequency)
• Functional hypothalamic dysfunction (due to drastic weight loss or sports overtraining that alters GnRH secretion)
• Chronic low-grade hyperprolactinemia (excess prolactin inhibits the follicle-stimulating follicular axis resulting in low endometrial stimulation)
• Uncontrolled primary hypothyroidism (thyroid dysfunction interferes with the synthesis and secretion of gonadotropins chronically)

Initial workup

Basal hormonal determination of FSH, LH, Estradiol, Prolactin, TSH, Total and free Testosterone, DHEA-S; transvaginal gynecological ultrasound to evaluate ovarian volume, antral follicle count and rule out adnexal tumors; Basal pregnancy test (b-hCG) to rule out initial active pregnancy.

Standard management

• Oral contraceptives combined with drospirenone or cyproterone acetate — indicated to regularize menstrual cycles and treat hirsutism associated with PCOS
• Metformin — 500-1000 mg daily orally to regulate urinary and ovulation cycles by improving insulin sensitivity
• Cabergoline (0.25 mg once a week if secondary to hyperprolactinemia).