Polymenorrhea Explained

Polymenorrhea
Synonyms:	Polymenorrhoea; Polymenorrhœa; Frequent periods; Frequent menstrual bleeding; Frequent menstruation; Epimenorrhea; Epimenorrhoea; Epimenorrhœa; Abnormally frequent menstruation; Unusually frequent menses
Field:	Gynecology
Symptoms:	Short menstrual cycles (<21days) that are otherwise regular and normal
Complications:	Anemia Iron deficiency; Endometrial cancer (when related to inadequate luteal phase)
Causes:	Anovulation Inadequate/short luteal phase; Short follicular phase; Certain endocrine disorders; Puberty/adolescence; Perimenopause
Differential:	Metrorrhagia (intermenstrual bleeding)
Treatment:	Hormonal agents
Medication:	Progestogen during luteal phase; Combined oral contraceptive pill
Prognosis:	Usually transient and self-limited

Polymenorrhea, also known as frequent periods, frequent menstruation, or frequent menstrual bleeding, is a menstrual disorder in which menstrual cycles are shorter than 21days in length and hence where menstruation occurs more frequently than usual.^{[1] [2]} Cycles are regular and menstrual flow is normal in the condition. Normally, menstrual cycles are 25 to 30days in length, with a median duration of 28days.

Polymenorrhea is usually caused by anovulation (failure to ovulate), an inadequate or short luteal phase, and/or a short follicular phase.^[3] Polymenorrhea is common in puberty and adolescence due to the immaturity of the hypothalamic–pituitary–gonadal axis (HPG axis). Shorter menstrual cycles are also common in the early perimenopause (menopausal transition), during which time the lengths of menstrual cycles may be reduced by 3 to 7days secondary to a shorter follicular phase.^{[4] [5]} Certain endocrine disorders, such as hyperprolactinemia, hypothyroidism, hyperthyroidism, Cushing's syndrome, and acromegaly, can cause polymenorrhea.^{[6] [7]} While not a classical symptom, polymenorrhea can occur as a result of uterine fibroids.^[8] Polymenorrhea may result in anemia and iron deficiency due to blood loss. In addition, when it is due to an inadequate luteal phase and hence progesterone deficiency, polymenorrhea may be related to an increased risk of endometrial cancer.^[9]

Polymenorrhea is usually transient and self-limited, thereby not necessitating treatment.^[10] If it persists, is disturbing, or if there is considerable blood loss due to the frequent periods, treatment may be indicated. The mainstays of treatment are a progestogen during the luteal phase of the cycle or a combined oral contraceptive pill.

Polymenorrhea is sometimes confused with metrorrhagia (menstrual bleeding between periods). It can be distinguished from metrorrhagia by its regularity. Polymenorrhea can be contrasted with oligomenorrhea, in which menstrual cycles are greater than 35 or 37days in length.^[11] The condition can also be distinguished from polymenorrhagia, which is a combination of polymenorrhea and menorrhagia (heavy menstrual bleeding).^[12]

Notes and References

1. Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, Reed BG, Carr BR . The Normal Menstrual Cycle and the Control of Ovulation . Endotext . 5 August 2018 . 25905282 .
2. Book: Tamara Callahan . Aaron B. Caughey . 28 January 2013 . Blueprints Obstetrics and Gynecology . Lippincott Williams & Wilkins . 296– . 978-1-4511-1702-8 . 1023316161 .
3. Oriel KA, Schrager S . Abnormal uterine bleeding . Am Fam Physician . 60 . 5 . 1371–80; discussion 1381–2 . October 1999 . 10524483 .
4. Goldstein SR . Menorrhagia and abnormal bleeding before the menopause . Best Pract Res Clin Obstet Gynaecol . 18 . 1 . 59–69 . February 2004 . 15123058 . 10.1016/j.bpobgyn.2003.10.003 .
5. Book: Prior JC . Endocrine Facets of Ageing . The ageing female reproductive axis II: Ovulatory changes with perimenopause . . Novartis Foundation Symposia . 242 . 172–86; discussion 186–92 . 2002 . 11855687 . 10.1002/0470846542.ch11. 9780471486367 .
6. Unuane . David . Tournaye . Herman . Velkeniers . Brigitte . Poppe . Kris . Endocrine disorders & female infertility . Best Practice & Research Clinical Endocrinology & Metabolism . December 2011 . 25 . 6 . 861–873 . 1521-690X . 10.1016/j.beem.2011.08.001 . 22115162 .
7. Kalro . Brinda N . Impaired fertility caused by endocrine dysfunction in women . Endocrinology and Metabolism Clinics of North America . September 2003 . 32 . 3 . 573–592 . 0889-8529 . 10.1016/S0889-8529(03)00041-0 . 14575026.
8. Book: Swaraj Batra . 2011 . Case Discussions in Obstetrics and Gynecology . Jaypee Brothers Medical Publishers Pvt. Ltd. . 231– . 9789350258484 . 856017557 .
9. Schindler AE . Progestogen deficiency and endometrial cancer risk . Maturitas . 62 . 4 . 334–7 . April 2009 . 19231117 . 10.1016/j.maturitas.2008.12.018 .
10. Tscherne G . Menstrual irregularities. Evidence-based clinical practice . Endocr Dev . 7 . 129–39 . 2004 . 15045790 . 10.1159/000077081 .
11. Book: Walker HK, Hall WD, Hurst JW, Long WN . Abnormal Vaginal Bleeding . 1990 . Butterworths . 21250125 . 9780409900774 .
12. Woolcock JG, Critchley HO, Munro MG, Broder MS, Fraser IS . Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding . Fertil Steril . 90 . 6 . 2269–80 . December 2008 . 18258230 . 10.1016/j.fertnstert.2007.10.060 . free .