Causes Of Postmenopausal Bleeding
There can be several causes of postmenopausal bleeding.
The most common causes are:
- inflammation and thinning of the vaginal lining or womb lining caused by lower oestrogen levels
- cervical or womb polyps growths that are usually non-cancerous
- a thickened womb lining this can be caused by hormone replacement therapy , high levels of oestrogen or being overweight, and can lead to womb cancer
Less commonly, postmenopausal bleeding is caused by cancer, such as ovarian and womb cancer.
There Are Several Potential Causes But Some Are More Serious Than Others
In most cases, postmenopausal bleeding is caused by issues such as endometrial atrophy , vaginal atrophy, fibroids, or endometrial polyps. The bleeding could also be a sign of endometrial cancera malignancy of the uterine lining, but only in a small number of cases. A 2018 study by the National Cancer Institute found that only about 9 percent of postmenopausal women who saw a doctor for bleeding later received a diagnosis of endometrial cancer.
Still, we want the option to intervene early if it is cancer, since treating it sooner leads to better outcomes, Mantia-Smaldone said.
If endometrial cancer is found early, a woman has a 95 percent chance of surviving the cancer for at least 5 years.
When Spotting Happens During Menopause
If bleeding or spotting occurs at any point during menopause, a woman needs to be seen by her doctor. During your visit, there will likely be a pelvic ultrasound and a possible biopsy of the uterine lining . Dr. Hoppe explains that this is to rule out any precancerous conditions.
If a woman is menopausal, she should not have spontaneous bleeding, Dr. Hoppe says, adding, Sometimes might be due to a thyroid abnormality. Signs of anemia and fatigue, along with spotting or bleeding, is also cause for concern and lab tests should be performed.
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How Long Are Normal Perimenopause Periods
Ordinarily, your menstrual cycle occurs every 21 to 35 days and lasts from 2 to 7 days. However, perimenopause periods can last much longer. Some months, the ovaries might not produce sufficient levels of estrogen and progesterone, preventing menstruation altogether. Other months, the imbalance might cause the uterine lining to become overly thick, which means it will take longer to be shed by your body to shed.
Excessive bleeding and long periods are fairly common during perimenopause. Many women experience an increased flow and extended perimenopause periods before entering menopause.
If youve had periods that are several days longer or more frequent or heavier than usual, its a good idea to see your doctor.
How To Treat Abnormal Bleeding And Spotting During Perimenopause
How to effectively manage heavy bleeding and perimenopause spotting is generally determined according to whats causing it.
Various medications, such as nonsteroidal anti-inflammatory drugs , are available to decrease vaginal bleeding and provide pain relief. Tranexamic acid, for example, is known to significantly reduce menstrual flow. Additionally, oral contraceptives have the potential to regulate your cycles while also addressing bleeding problems. However, the use of contraceptives to inhibit perimenopausal bleeding is widely debated.
When prescription drugs prove insufficient, a more advanced medical procedure may be necessary. If endometrial polyps are to blame for heavy bleeding, your doctor will likely advise surgical removal. Endometrial hyperplasia, on the other hand, is treated with progestin therapy to shed the endometrium. Thickened areas of the endometrium can also be eliminated by dilatation and curettage, which is the surgical removal of the lining or contents of the uterus.
Be sure to consult your doctor immediately should you experience any of the following symptoms:
- Very heavy perimenopausal bleeding
- Menstrual bleeding that lasts for more than a week
- Bleeding which occurs more often than every three weeks
The stage prior to menopause is known as perimenopause and is characterized by sharply fluctuating hormone levels each month. This hormonal shift has a major impact on ovulation and your menstrual cycle.
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Treating Post Menopause Bleeding
If you have postmenopausal bleeding it is important to have it investigated.
You will most likely be referred to a gynaecologist who may:
- ask you questions about the history of your health
- examine you
- do a blood test
- look at the inside of your vagina and cervix using special tongs . At the same time, they may take a tiny sample of your cervix for testing .
The kind of treatment you have will depend on what is causing the bleeding.
- Atrophic vaginitis and thinning of the endometrium are usually treated with drugs that work like the hormone oestrogen. These can come as a tablet, vaginal gel or creams, skin patches, or a soft flexible ring which is put inside your vagina and slowly releases the medication.
- Polyps are usually removed with surgery. Depending on their size and location, they may be removed in a day clinic using a local anaesthetic or you may need to go to hospital to have a general anaesthetic.
- Thickening of the endometrium is usually treated with medications that work like the hormone progesterone and/or surgery to remove the thickening.
Before treatment there are a number of tests and investigations your gynaecologist may recommend.
All treatments should be discussed with you so that you know why a particular treatment or test is being done over another.
How Is Perimenopause Treated
There isnt any treatment to stop perimenopause. Perimenopause is a natural part of life. The cure for perimenopause occurs when your periods stop and you enter menopause.
But your healthcare provider may recommend over-the-counter or prescription perimenopause treatment to help ease symptoms. Your provider may recommend:
- Antidepressants: These medications help with mood swings or depression.
- Birth control pills. These medications stabilize your hormone levels and typically relieve symptoms.
- Estrogen therapy: This treatment stabilizes estrogen levels. You may take estrogen therapy as a cream, gel, patch or swallowable pill.
- Gabapentin : This medicine is a seizure medication that also relieves hot flashes for some women.
- Vaginal creams: Your provider can tell you about prescription and over-the-counter options. Treatment can decrease pain related to sex and relieve vaginal dryness.
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Is It Normal To Have Longer And Heavier Periods During Perimenopause
Excessive bleeding and long periods are fairly common during perimenopause. Many women experience an increased flow and extended perimenopause periods before entering menopause.
In fact, one in four women say that their periods are heavy enough to interfere with day-to-day activities, such as going to work or attending social events. According to University of Michigan researchers, 91 percent of women aged 4252 surveyed reported heavy menstruation for 10 or more days during their transition to menopause. This phenomenon occurred one to three times within a three-year period.
There are various other health factors which come into play, including body mass index , use of hormones, and the presence of uterine fibroids.
Why These Changes Occur
In the years leading up to menopause, your ovaries stop ovulating regularly. As ovulation becomes infrequent, the hormones produced by the ovaries estrogen and progesterone also begin to fluctuate and decline. These hormones are typically responsible for regulating the menstrual cycle.
As these hormonal changes take place, it can have an effect on more than just your period. You may also experience:
- breast tenderness
- changes in mood
While its difficult to estimate how long these symptoms will last, they can be expected to continue well into menopause. This can be anywhere from a few months to as many as twelve years from when symptoms first begin.
When youre in perimenopause, its normal for your periods to be irregular and to come closer together. But sometimes these abnormal bleeding patterns can signal an underlying problem.
See your doctor if:
- bleeding is unusually heavy for you or you soak through one or more pads or tampons in an hour
- you get your period more often than every three weeks
- your periods last longer than usual
- you bleed during sex or between periods
Although abnormal bleeding in perimenopause is usually due to hormone fluctuations, it could also be a sign of:
Your doctor will do an exam to check for causes of abnormal perimenopausal bleeding. You might need one or more of these tests:
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Treatment For Heavy Bleeding In Perimenopause
How heavy bleeding is treated will be determined by the diagnosis. If there is no pathologic cause for the bleeding , continued observation and re-evaluation may be the best plan, explains Dr. Bolton.
For growths such as fibroid tumors or endometrial polyps, minimally invasive gynecologic surgery such as hysteroscopic myomectomy, hysteroscopic polyp removal or endometrial ablation may be recommended. The ablation is a heat technique that removes the endometrial lining causing bleeding to slow down or in some cases, stop completely.
For persistent abnormal bleeding, hormone therapy may be an option. Hormone therapy can often help the bleeding problem while also alleviating the associated symptoms of perimenopause, such as hot flashes and night sweats. Oral contraceptives can be offered as treatment in the appropriate patient. Oral progestins can be given cyclically or only when the flow is heavy.
Some women respond well to a progesterone-containing IUD. This provides the endometrial lining with a boost in progesterone while not requiring a dose of hormones to the whole body. Placement of this type of IUD is done in a doctors office with no need for anesthetics. One newer option is a medication called tranexamic acid, a nonsteroidal medication in the same family as ibuprofen. It only needs to be taken at the beginning of the menses for three to five days, when there is a heavy flow.
Stop Suffering And Get Help For Abnormal Perimenopausal Bleeding
Over your reproductive years, youve come to expect a certain degree of predictability with regard to your menstrual cycle. Whether its timing, length or amount of flow, there is generally not much variation from month to month. But as you enter perimenopausethe three to five years leading up to menopauseall of this changes. And while some of these changes are manageable, some are not.
Just as every womans menstrual cycle is different, so is her experience of perimenopause, says Beverly M. Vaughn, MD, a gynecologist at Lankenau Medical Center, part of Main Line Health. Many women are caught off guard by the many changes that occur during these premenopausal years and I see a lot of women suffer through heavy bleeding even though there are very effective and minimally invasive treatments for it.
Can Stress Cause Postmenopausal Bleeding
As we women age, our bodies go through some drastic and remarkable changes. After the childbearing years, the 40s and the 50s, the female body begins to change away from procreation as the production of reproductive hormones naturally begins to decline. This phase of a womans life is called menopause and is signaled by 12 continuous months since the last menstrual cycle.
The average age in the United States for women to start menopause is around 51 years of age. There are three phases of menopause that women typically go through and they are perimenopause , menopause, and then postmenopause .
Many questions surround this phase of female life, and for the purpose of this article, we are going to look at the postmenopause phase and a common question that arises often.
Abnormal Uterine Bleeding In Peri
When should you see a clinician about excessive or unexpected bleeding?
Abnormal uterine bleeding is a common problem for women of all ages, accounting for up to one-third of gynecologic office visits. The two main types are heavy bleeding that occurs at an appropriate or expected time, such as a heavy menstrual period , and any type of bleeding that occurs unexpectedly . The absence of regular menstrual periods for several months is also considered an abnormal bleeding pattern. AUB can be tricky to identify, because what’s normal depends on a woman’s reproductive age.
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What Causes Longer
During a regular menstrual cycle, your levels of estrogen and progesterone rise and fall in a relatively consistent pattern. However, while in perimenopause, your hormones dont follow a set pattern and your ovaries produce erratic and unpredictable perimenopause periods.
When youre about to enter menopause, youll ovulate less frequently, creating one of two possible scenarios. In the first scenario, your ovary doesnt release an egg, and the lining of the uterus doesnt shed, which causes a missed period.
In the second scenario, the lining of your uterus has grown extra thick and requires more time to shed. The excessive buildup of tissue means longer periods and intense menstrual flow.
Gradually, however, your periods will become less frequent and eventually stop altogether. Experts consider the transition to menopause complete once a woman has gone without having a period for at least 12 consecutive months.
Several uterine conditions become more prevalent during the perimenopausal phase. Be sure to pay close attention to any abnormal symptoms such as:
Have you noticed your menstrual symptoms growing more pronounced and uncomfortable during perimenopause? Consider the following remedies:
Hormone therapy is capable of reducing bleeding, shortening periods, and alleviating PMS by hindering the buildup of your uterine lining.
Over-the-counter pain relievers
What You Can Do
Consider keeping a journal to track your periods. Include information such as:
- when they start
- whether you have any in-between spotting
You can also log this information in an app, like Eve.
Worried about leaks and stains? Consider wearing panty liners. Disposable panty liners are available at most drugstores. They come in a variety of lengths and materials.
You can even buy reusable liners that are made of fabric and can be washed over and over again.
A skipped period can also cause the lining to build up, leading to heavy bleeding.
Bleeding is considered heavy if it:
- soaks through one tampon or pad an hour for several hours
- requires double protection such as a tampon and pad to control menstrual flow
- causes you to interrupt your sleep to change your pad or tampon
- lasts longer than 7 days
When bleeding is heavy, it may last longer, disrupting your everyday life. You may find it uncomfortable to exercise or carry on with your normal tasks.
Heavy bleeding can also cause fatigue and increase your risk for other health concerns, such as anemia.
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Can I Still Get Pregnant During Perimenopause
Yes. You may be less likely to get pregnant during perimenopause, but it’s still possible. As long as you have a period, you can still get pregnant. If you want to expand your family during this time, speak with your healthcare provider about your health, fertility and possible fertility treatment options.
When your periods are irregular, you may be more likely to get pregnant unexpectedly. If you dont want to expand your family at this age, continue using birth control until your healthcare provider tells you its safe to stop. Continue to practice safe sex to prevent sexually transmitted diseases throughout your life.
Not Sure What To Do Next
If you are still concerned about bleeding after menopause, use healthdirects online Symptom Checker to get advice on when to seek medical attention.
The Symptom Checker guides you to the next appropriate healthcare steps, whether its self care, talking to a health professional, going to a hospital or calling triple zero .
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Will I Need A D& c
A D& C is a short name for dilatation and curettage. Whether you need to have one depends on your problem. When you have a D& C, the opening of your cervix is stretched just enough so a surgical tool can be put into your uterus. The tool is used to scrape away the lining of your uterus. The removed lining is checked in a lab for abnormal tissue. A D& C is done under anesthesia, while you’re asleep.
If you’re having heavy bleeding, a D& C may be done both to find out the problem and to treat the bleeding. A D& C often makes heavy bleeding stop.
How Does Perimenopause Affect My Body
During perimenopause, estrogen levels decrease. Estrogen is a key female hormone. It plays a role in maintaining many body systems, including the female reproductive system. Estrogen levels may continue to be irregular throughout perimenopause.
When you reach menopause, your body makes so little estrogen that your ovaries no longer release eggs. At this point, you stop having your period.
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Perimenopause And Irregular Bleeding
During perimenopause a womans menstrual cycles may be shorter or longer, and the flow may vary from light to heavy. As ovarian function is declining, ovulation may not occur. The ongoing release of estrogen may cause the uterine lining to thicken while the production of progesterone slows down. As a result, the lining continues to build up and may cause irregular bleeding. The thickening of the endometrium may represent a benign change, such as a polyp, or hyperplasia. Most hyperplasia is not a problem but some forms can be precancerous. The bleeding can also represent endometrial . Fortunately, this is the least likely possibility.
Uterine polyps and uterine fibroids, both of which are benign, may also cause changes in bleeding pattern. Polyps are benign growths composed of the endometrial glands and contain no muscle tissue. A fibroid is a fibromuscular type of tumor that often grows within the muscular layer of the uterus. If the fibroid juts out into the endometrial cavity, abnormal bleeding can result. Both fibroids and polyps can cause extra bleeding due to their location within the interior of the uterus.