What does it mean when menstrual flow comes in drops and then stops?

Menstrual Flow That Comes in Drops and Stops

When menstrual flow comes in drops and then stops, this pattern could indicate an underlying gynecological issue that requires medical evaluation, including pregnancy, STDs, medication interactions, or pathologic uterine conditions. 1

Possible Causes

• Irregular menstrual patterns (flow that comes in drops and stops) may be related to hormonal fluctuations affecting the normal pattern of menstruation 2
• This pattern could be associated with:
  • Underlying gynecological problems requiring evaluation 3
  • Hormonal contraceptive use or discontinuation 4
  • Changes in the body's levels of estrogen and progesterone 2
  • Potential pathologic uterine conditions (e.g., polyps or fibroids) 3

Evaluation Approach

• Determine the pattern and severity of bleeding to guide appropriate management 1
• Consider whether this represents:
  • Light spotting (which may be normal variation)
  • Irregular bleeding requiring further assessment
  • Heavy or prolonged bleeding with intermittent stopping 5
• Rule out pregnancy as a first step, especially if there's an abrupt change in bleeding pattern 3
• Assess for medication interactions, including hormonal contraceptives 3
• Consider STD testing if clinically indicated 3

Management Recommendations

• If using hormonal contraceptives:

  • Unscheduled spotting or light bleeding is common, especially during the first 3-6 months of use 3
  • These bleeding changes generally decrease with continued use 3
  • For contraceptive users with persistent unscheduled bleeding, consider:
    • NSAIDs for 5-7 days during bleeding days 3
    • For combined hormonal contraceptive users, a 3-4 day hormone-free interval may help (but not during first 21 days of use) 3

• If not using hormonal contraceptives:

  • For mild to moderate bleeding, NSAIDs for 5-7 days during bleeding days 1, 4
  • For heavy or prolonged bleeding, low-dose combined oral contraceptives containing 30-35 μg ethinyl estradiol for 10-20 days 1, 4

When to Seek Medical Attention

• If bleeding pattern persists for more than 3 months (95th percentile for time between cycles is 90 days) 6
• If bleeding is accompanied by:
  • Clots ≥1 inch in diameter 5
  • "Flooding" (changing pad/tampon more frequently than hourly) 5
  • Low ferritin/symptoms of anemia 5
  • Personal or family history of bleeding disorders 5

Important Considerations

• Menstrual irregularity can be associated with various health conditions including metabolic syndrome, coronary heart disease, and type 2 diabetes 2
• Irregular menstruation is considered an important health indicator among women 2
• Normal menstrual blood typically accounts for approximately 36% of total menstrual fluid, with significant variation between individuals 7
• Self-reported fluid retention (bloating) often peaks on the first day of menstrual flow 8