For women, not only the regularity of menstruation is important, but also its quality. It is necessary to evaluate the abundance of discharge and the color of menstrual blood. Patients, depending on the reasons, describe it differently - as brown, black, bright red and pink.
Normal menstrual discharge is bright red in color without lumps or clots. Changes in color and density may be caused by medications, hormonal problems, infection, or gynecological diseases.
Menstrual cycle and vaginal bleeding - what's the difference?
The content of the article
The amount of blood during menstruation, its consistency and color vary individually, as does the length and frequency of the cycle. The color of menstruation can be very different - bright red, brown, dark and even black. On average, each adult woman loses 20-60 ml of blood during one menstrual cycle, which is from 4 to 12 teaspoons. The normal color of discharge is bright red.
Some women experience scanty bleeding, while others may have profuse bleeding, causing discomfort and the need for additional protection in the form of various hygiene products. Sometimes even clots are observed in the blood.
Clotting during menstruation is usually natural, especially when blood loss is significant. From time to time, small fragments resembling scales appear in menstrual blood.
Any change in color should be differentiated primarily from possible bleeding, which may be caused by diseases of the uterus, ovaries and vagina, as well as abnormal discharge. Strange periods may turn out to be bleeding. Any strange symptoms should be a warning sign and prompt the woman to visit a gynecologist.
Bleeding can last up to eight days, but the average duration is five days. In the first two days, the discharge is the most abundant. A typical symptom of menstruation is menstrual pain in the lower abdomen. Not all women experience pain in the ovaries, and usually this symptom also precedes the onset of menstruation.
general characteristics
With scanty periods, small spotting appears.
Less commonly, they appear as dark brown bloody drops. Regular daily and even ultra-thin pads work well to protect underwear during such menstruation. Often, the duration of the menstrual period is reduced to 1-2 days (oligomenorrhea), and the cycles are extended to 2-3 months (opsomenorrhea) and even longer (spaniomenorrhea). Typically, such menstruation occurs without pain and deterioration in well-being. You should consult an obstetrician-gynecologist if an adult woman, instead of the usual menstruation, experiences scanty discharge for 3 cycles or longer. A cause for concern should also be the combination of prolonged spotting (up to 2 weeks or more) with pain in the lower back and lower abdomen, which “shoots” in the sacrum, tailbone, and rectum. What is alarming is a decrease in discharge against the background of a constant or periodic increase in temperature, drowsiness, apathy, and weight gain.
Brown blood during periods - is there a problem?
Dark blood can sometimes also be confused with discharge.
Brown menstrual bleeding may be a consequence of starting hormonal therapy, including taking birth control pills. Then menstruation does not appear, but so-called withdrawal bleeding occurs. If the discharge is brown and contains mucus, accompanied by an unpleasant odor, and the bleeding itself appears outside the time of the expected menstruation, you need to contact a gynecologist to be examined for infections.
Clots in the discharge are also a cause of great concern among women. If there are many of them, it can lead to anemia. As a rule, this symptom implies massive and regular exfoliation of the uterine epithelium. But in some cases, this may indicate uterine fibroids or endometrial polyps. It is especially dangerous when the blood is very red, dark, and the menstruation itself is extremely heavy.
Dark discharge and large clots are also characteristic of endometriosis.
Menstruation can also be confused with discharge during pregnancy - implantation bleeding. This bleeding usually lasts a few hours, although it can last up to three days. Typically, pregnant women have scanty discharge, the blood is brown and looks more like dirt than blood.
Scanty periods after childbirth
Often a small number of periods or cycle irregularities can occur after a woman has given birth if there is no lactation. Then menstruation is recorded 6-8 weeks after birth. Also in such cases, menstruation may be profuse and lack regularity. The first discharge in the critical days after childbirth may be brown. After childbirth, hormones change their ratio again, and the cycle returns to normal gradually, over several months.
The cycle can begin to establish itself even in those who are breastfeeding, especially with the transition to complementary feeding. The hormone prolactin, without which lactation is impossible, is not produced. This allows the egg to mature and be released from the ovary. Scanty periods after childbirth for several months are not considered a pathology. But, if they are constantly like this, you need to be examined for various pathologies.
Strange scanty and heavy menstruation - is it dangerous?
The regularity and abundance of bleeding is an important factor in women's health. It is difficult to accurately determine blood loss during one menstrual cycle. Menstruation is considered heavy if a woman has to use double protection, blood gets on her bed linen, clots appear in the blood, or if her usual lifestyle has to be changed due to her period.
If your periods change and become more abundant than before, you definitely need to see a gynecologist. There are many reasons for heavy menstrual periods. However, in most women, the uterus is functioning properly and hormone levels are normal. Appropriate treatment can reduce heavy menstrual bleeding.
Can menstruation guarantee that pregnancy has not occurred?
First, let's remember what the menstrual cycle is.
This is the alternation of menstruation itself (lasts 3-7 days), the follicular phase, ovulation and the luteal phase. During menstruation, the lining of the uterus is shed. The process is accompanied by bleeding (this happens at the end of the ovulatory cycle). If there was no ovulation, then the bleeding is called menstrual-like. It is extremely rare for two eggs to mature in one cycle (but it happens!): one is fertilized, and the second is rejected by the body and causes the onset of menstruation.
Normally, there can be no menstruation during pregnancy.
However, do we always understand the nature of vaginal bleeding without medical diagnosis? If during the expected menstruation a woman notices bloody discharge, but its character is different from the usual menstruation (the discharge is scanty, ends quickly, has a brown or bright scarlet color) and you remember that unprotected sexual intercourse took place - this is a reason to do take a pregnancy test and consult a doctor.
Bleeding before and between periods
If blood appears between menstrual cycles, a visit to the doctor is also necessary. Especially if bleeding occurs after sexual intercourse or after menopause.
Bleeding after intercourse is often caused by soreness or inflammation of the cervix. The most common causes of this condition are infections, such as chlamydia, and hormonal changes. Bleeding between cycles can also be caused by other infections, polyps, endometrial hyperplasia, and cancer of the reproductive organs. Polyps are small nodules that may appear on or inside the cervix.
Sometimes bleeding may also occur in the first months after starting birth control pills.
The interval between individual menstrual cycles in women can vary. Irregular periods may indicate that a woman is not ovulating every month or that her hormonal balance is imbalanced. At a young age, irregular periods require consultation with a gynecologist. This situation is also quite common in women approaching menopause.
Diseases that accompany hypomenorrhea
Synechiae (fusions, adhesions) in the uterine cavity
This condition is called “Asherman's syndrome” in gynecology. Numerous abortions and uterine curettages lead to the formation of intrauterine adhesions, during which the walls of the uterus were injured. Sometimes this may be just one abortion or a single curettage (for example, for the remnants of placental tissue after childbirth), but under conditions of infection. Trauma and inflammation lead to the formation of adhesions in the uterine cavity and cervix.
Women complain that before abortion or curettage they had a regular menstrual cycle, but now menstruation is scanty, usually sharply painful. In some cases, menstruation may stop altogether, and the adhesive process will progress in the uterine cavity and cervical canal.
Sex hormones in this case are produced by intact ovaries, and when examining the level of sex hormones in the blood, their compliance with the norm will be determined.
Ultrasound in the uterine cavity describes adhesions and adhesions between the walls, the uterine cavity is narrow, the mucous layer of the endometrium is insufficient in height. In conditions of adhesive and inflammatory process, the endometrium is not able to menstruate and accept a fertilized egg. Therefore, in addition to hypomenorrhea, a woman is diagnosed with infertility or recurrent miscarriage.
Fusion (atresia) of the cervical canal of the cervix
This condition is observed after operations on the cervix, during which the wall of the cervical canal is injured. For example, after removal of the vaginal part of the cervix due to the initial stage of cancer (cervical amputation according to Sturmdorff), after diathermoexcision of the cervix due to dysplasia.
After injury and inflammation, an adhesive process also develops in the wall of the cervix, making the outflow of menstrual blood difficult.
Women complain of painful cramping and nagging pain in the lower abdomen, scanty discharge, sometimes with a stagnant odor. In this case, menstruation can last for a long time - “smear” for up to 2-3 weeks, until the uterus empties through a narrow opening. If the adhesive process has led to complete overgrowth of the uterus, then hematometra occurs - a sharply painful condition in which a large number of menstrual clots accumulate in the uterus. With a hematometer, there may be a rise in temperature up to 38 degrees.
PCOS: polycystic ovary syndrome
Oligomenorrhea and opsomenorrhea are very common in patients with PCOS. Sometimes women complain of infrequent (up to once every 2-6 months) menstruation.
With scleropolycystic disease, the membrane of the ovary and follicles (sclera) thickens. At the same time, many follicles with eggs mature in the ovaries. Due to the dense membrane, the follicle cannot rupture, which should release the egg (ovulation does not occur). The ovaries increase in size, the capsule is dense, white; ultrasound describes many enlarged follicles in the ovary, like small cysts (polycystic). Many ripening and overripe follicles secrete sex hormones chaotically. Against the background of excess androgens and an imbalance of sex hormones in a woman’s body, carbohydrate metabolism is also disrupted - insulin resistance increases. Many women gain weight; blood tests reveal periodic increases in glucose levels, a condition called “prediabetes” type 2. Fluctuations in blood pressure (increase) are common.
During an external examination, you can sometimes notice signs of excess androgens: acne on the skin, increased growth of coarse hair on the face and body, sebaceous glands, fat deposition on the abdomen and shoulder girdle (male type). Such symptoms are not observed in all patients, but only in those whose blood testosterone levels are significantly elevated.
Due to the lack of ovulation and normal development of the endometrium, such women have difficulty becoming pregnant. If pregnancy occurs, hyperandrogenism (excess male hormones) can cause early loss.
Hyperandrogenism can also occur with pathology of the adrenal cortex. You can find out the cause of hyperandrogenism (ovarian or adrenal) by analyzing the hormonal levels of the blood.
Hyperprolactinemia
When the hormone prolactin increases in the blood, an imbalance occurs between the amounts of estrogens and androgens, inhibition of the production of sex hormones, impaired insulin sensitivity, and impaired lipid metabolism.
In addition to scanty or cessation of menstruation, a woman notices a general apathetic sluggish state, drowsiness, fatigue, puffiness of the face, milky discharge from the breasts, hair loss, dull skin and face color, weight gain. Blood tests show increased prolactin levels. Hyperprolactinemia often accompanies thyroid dysfunction. Such patients also have problems conceiving and bearing a child.
Inflammatory diseases of the pelvic organs: chronic endometritis, adnexitis, tuberculosis of the genital organs and other genital tract infections
Inflammatory processes of the reproductive system can occur with severe symptoms, or they can pass with virtually no symptoms. For example, with genital herpes, a woman may only remember an episode of herpetic rash in the vulva area, but in fact, in the small pelvis, adhesions in the fallopian tubes and chronic endometritis in the functional layer of the endometrium may develop asymptomatically.
In any case, after suffering an infectious process, normal organ tissue may become inoperative. In the ovaries, after inflammation, tissue with follicles that secrete hormones and eggs is replaced by connective tissue. The mucous layer of the endometrium in the uterus becomes “bald”, scanty, so it cannot be shed normally and painlessly during menstruation and replaced with a fresh layer. Such patients subsequently have problems not only with menstrual irregularities, but also with the onset of pregnancy and gestation.
Tuberculosis of the genital organs
Tuberculosis of the genitourinary tract is very difficult to suspect and establish. Characteristic signs of tuberculosis infection:
- constant low-grade fever - up to 38°C - temperature,
- mental disorders (irritability, nervousness, tearfulness),
- decreased appetite,
- chronic adnexitis or endometritis that cannot be treated.
Chronic endometritis
Constant or periodic pain in the lower abdomen, increased temperature during an exacerbation, menstrual flow with an unpleasant odor.
Chronic adnexitis
Periodic aching pain in the groin areas, increased temperature during exacerbation, heaviness and adhesions in the appendage area, which are determined during a gynecological examination, infertility.
Sexually transmitted diseases
STDs include:
- chlamydia,
- ureaplasmosis,
- cytomegalovirus infection, etc.
More often they are asymptomatic or with minor complaints (discharge from the genital tract with an unpleasant odor, itching and burning in the perineum, pain during sexual intercourse, signs of chronic endometritis and/or adnexitis).
In inflammatory diseases of the pelvic organs, it is usually always possible to identify a connection with a provocative factor: with a change of sexual partner, with the occurrence of active inflammation after an abortion or other manipulation of the uterus, with hypothermia.
Ovarian wasting syndrome and resistant ovarian syndrome
In this case, the uterus and endometrium remain healthy, but there are not enough sex hormones for a normal menstrual reaction. Disturbance in the production of sex hormones occurs at the ovarian level. In the body of a woman with these diseases, premature menopause occurs at a young age (at 35-40 and less than 35 years).
With ovarian wasting syndrome (OVS), the hormone-producing tissue in them is replaced by connective tissue. This sometimes occurs due to hereditary factors, sometimes after inflammation in the ovaries, after a toxic effect on the body. A woman who has previously menstruated and may even have given birth notices that her periods become more and more scanty, and then gradually stop altogether. When examined by a gynecologist, the uterus and ovaries are reduced in size. Follicles in the ovaries are not visualized at all on ultrasound. An analysis of anti-Mullerian hormone in the patient's blood may show that there is no supply of follicles and eggs left in the ovaries.
The content of sex hormones in the blood is at the level of menopause, a woman notices aging skin, hot flashes, fluctuations in blood pressure, anxiety, irritability, sweating, discomfort in the vagina - symptoms characteristic of menopause.
With resistant ovarian syndrome (ROS), a young woman’s menstruation also gradually becomes scanty and stops due to the lack of sufficient amounts of sex hormones in the blood. With this disease, the ovarian tissue retains the required number of follicles and eggs and is not replaced by connective tissue.
Here the cause of the disease is a failure of regulation in the brain. The ovary becomes insensitive to stimulation by hormones from above (from the pituitary gland-hypothalamus). The body signals that there is a deficiency of estrogen in the blood, but the ovaries remain insensitive to FSH (follicle-stimulating hormone) and LH (luteinizing hormone).
The clinic also observes scanty periods with their gradual complete absence and the inability to conceive. The difference between SOC and SUS: when the ovaries are resistant, follicles remain in them, and the symptoms of menopause are less clinically pronounced.
Psycho-emotional stress, excessive sports or study (“excellent student syndrome”), sudden weight loss, difficult working conditions can disrupt the release of hormones that control the ovaries by the pituitary gland and hypothalamus. Here, menstruation becomes scanty or disappears completely with a healthy uterus and ovaries. Control of the production of sex hormones is also disrupted by tumors, injuries to the pituitary gland and hypothalamus, brain infections and after hemorrhages in the brain.
Strange menstruation - no periods
Pregnancy is the main cause of amenorrhea among women under 50 years of age. However, amenorrhea without any reason is quite common, but missing your period for several months in a row is a warning sign. Besides pregnancy, other reasons for missing periods include stress, weight loss, over-exercising (long-distance running, etc.), hormonal problems and menopause.
You need to contact a gynecologist if you have not had your period for 2 months in a row. Additionally, you should make an appointment with your doctor if your first menstrual period does not start by age 16.
Menopause is the last menstruation for every woman. The cessation of menstruation occurs because over time the ovaries stop producing eggs and the amount of estrogen decreases. Menopause usually occurs around age 52. Premature menopause occurs before a woman turns 45, but it is rare.
There are other symptoms that indicate the passage of menopause, the most common being hot flashes. In case of bleeding after menopause, you should visit a gynecologist, then it is associated with suspected uterine cancer.
Scanty periods after curettage
Cycle disturbances can be provoked by any intrauterine interventions, be it surgery for polyps, curettage for diagnostic purposes, abortion with complications, etc. As a result of these operations, the ratio of hormones changes, which provokes inferiority of the endometrial layer of the uterus.
If after curettage there are not only scanty periods, but also elevated body temperature, abdominal pain, and an unpleasant odor from the genital tract, then you urgently need to go to the gynecologist for an appointment. In such cases, inflammation is likely. If during an abortion the membranes are not completely removed, the pathological process will also begin.
Unusual vaginal bleeding – when to contact a gynecologist?
If unusual bleeding occurs, you should make an appointment with your gynecologist. The doctor will conduct an interview and order an examination to determine the type of bleeding.
You will have to answer questions about your last menstrual cycles, how much bleeding you have had, and whether blood stains appear on your bed linen. Information indicating the pharmacological treatment and gynecological procedures being carried out is important for the doctor. Issues related to sexuality, forms of contraception used and possible sexually transmitted infections are important.
The doctor will also perform a gynecological examination. During the examination, the gynecologist uses two fingers to check the condition of the organs, determining the size of the uterus and its sensitivity to touch. The doctor also uses a speculum to gently open the vagina and examine the cervix.
During a gynecological examination, a smear of the vagina and cervix is performed. This sample is then sent to a laboratory to determine whether the discharge is the result of an infection. After receiving all the results, the gynecologist, in collaboration with the patient, decides on the need for further tests, including ultrasound.
Survey
Since scanty periods are more common in diseases of the reproductive system, a gynecologist is usually involved in searching for the causes of the disorder. During a comprehensive examination, the condition of the uterus, fallopian tubes, ovaries, and the patient’s hormonal background is primarily assessed. To quickly make a preliminary diagnosis, the following is prescribed:
- Gynecological examination
. Using vaginal speculum, abnormalities in the structure of the genital organs, changes in the visible part of the cervix, and pathological vaginal discharge are detected. The chairside examination is complemented by a bimanual examination to assess the uterus and appendages. - Ultrasonography
. During an ultrasound of the pelvic organs, the size of the uterus and ovaries is determined, developmental anomalies, signs of inflammation, and tumor formations are detected. To clarify the diagnosis, folliculometry and cervicometry are performed according to indications. - Instrumental inspection
. For a detailed study of the mucous membrane of the vagina, cervical canal, and uterus, colposcopy, cervicoscopy, and hysteroscopy are prescribed. If there are questionable areas, a biopsy is recommended. Diagnostic laparoscopy is performed if ovarian damage is suspected. - Laboratory methods
. To exclude the inflammatory process and identify the pathogen, a smear on the flora, culture with an antibiogram, and serological tests (RIF, ELISA, PCR) are indicated. Tests for the level of estradiol, progesterone, pituitary hormones (FSH, prolactin) and thyroid gland are informative.
If the role of gynecological pathology in the appearance of scanty menstruation has not been established, brain damage must be excluded. For this purpose, a consultation with a neurologist, an examination of the fundus by an ophthalmologist, an X-ray of the skull or a targeted image of the sella turcica, MRI of the pituitary gland, and electroencephalography (EEG) are prescribed.
Gynecological examination
What can periods mean during pregnancy?
After the fertilization of the egg and the onset of pregnancy, menstruation does not occur throughout the entire process of gestation.
It should be remembered that the appearance of any bloody discharge from the vagina during a confirmed pregnancy (positive urinary pregnancy test, ultrasound data, hCG levels) indicates possible pathologies. For example, when there is a threat of miscarriage and termination of pregnancy (spontaneous abortion that has begun), placenta previa (low, marginal, complete).
Scanty spotting during the first days of pregnancy may represent nothing more than implantation bleeding. Implantation of a fertilized egg (blastocyst) into the endometrium occurs 7-10 days after conception, that is, essentially around the days when menstruation should come in case of late ovulation.
The penetration of the blastocyst is accompanied by the destruction of capillaries, and, consequently, a small amount of blood is released. But, unlike true menstrual bleeding, implantation bleeding does not last long: in most cases, a day, or even less.
How often do periods occur during pregnancy?
15–20% of pregnancies end in spontaneous abortion in the early stages.
However, it is important to understand that although bloody vaginal discharge against the background of a live intrauterine pregnancy is designated by doctors as a “threat of miscarriage,” in a large number of cases, despite the dire diagnosis, such a pregnancy is successfully carried to term. If an interruption does occur, in most cases (overwhelming) we are talking about genetic abnormalities of the fetus that are incompatible with life. Other reasons include infectious diseases in the early stages, hormonal imbalances, physical overload, and so on.
