Polymenorrhea

Specialty: Gynecology and breast.

• Very frequent rules
• short menstrual cycles
• tachymenorrhea
• shortening of the menstrual cycle

Why it occurs

• Luteal insufficiency (short luteal phase with early drop in progesterone)
• Anovulatory cycles (common in adolescents in the first years post-menarche or in the menopausal transition)
• Decreased ovarian reserve (accelerated follicular phase due to early elevation of FSH)
• Subclinical endometritis or endometrial polyps that simulate frequent menstruations
• Intramural uterine fibroids with endometrial destabilization

Initial workup

Recording of menstrual cycles and monitoring of ovulation (basal temperature curve or luteal progesterone levels mid-cycle). Complete hormonal profile (FSH, LH, Estradiol, Progesterone on day 21 of the cycle, Anti-Mullerian Hormone to assess ovarian reserve). Transvaginal ultrasound to rule out occult uterine or endometrial structural pathology.

Standard management

• Combined oral contraceptives to regularize the cycle and prolong the intermenstrual interval
• Micronized progesterone 100-200 mg orally from day 14 to 25 of the cycle to correct luteal insufficiency
• Tranexamic acid 1000 mg every 8 hours during the days of bleeding if it is abundant (note: in adolescents in early post-menarche stages, clinical observation is usually the appropriate initial conduct given the immature and self-limiting nature of the hypothalamic-pituitary-ovarian axis).