Period Back After More Than Two Years
Now, if you have been more than two years without a period and you get one, or several come back, this is when you go to the doctor. It’s unlikely, although not impossible, to be a hormonal shift going on again, but in this case, we say, “Please don’t worry, but go and see your doctor as soon as you can.”
So I hope this has given you a little bit more of an insight into all the wonderful different ways that our periods can change when we start our approach to the menopause.
If any of you have had any other issues with this and you’d like to share with us, I would love to hear about it. And until then I’ll see you next week on another A.Vogel Talks Menopause.
What Is Hormone Therapy
During menopause, your body goes through major hormonal changes, decreasing the amount of hormones it makes particularly estrogen and progesterone. Estrogen and progesterone are produced by the ovaries. When your ovaries no longer make enough estrogen and progesterone, hormone therapy can be used as a supplement. Hormone therapy boosts your hormone levels and can help relieve some symptoms of menopause. Its also used as a preventative measure for osteoporosis.
There are two main types of hormone therapy:
- Estrogen therapy : In this treatment, estrogen is taken alone. Its typically prescribed in a low dose and can be taken as a pill or patch. ET can also be given to you as a cream, vaginal ring, gel or spray. This type of treatment is used after a hysterectomy. Estrogen alone cant be used if a woman still has a uterus.
- Estrogen Progesterone/Progestin Hormone Therapy : This treatment is also called combination therapy because it uses doses of estrogen and progesterone. Progesterone is available in its natural form, or also as a progestin . This type of hormone therapy is used if you still have your uterus.
Hormone therapy can relieve many of the symptoms of menopause, including:
- Hot flashes and night sweats.
- Vaginal dryness.
How Will I Know If I Am Starting The Transition To Menopause
Sometimes it can be hard for you and your doctor to tell whether you are in perimenopause, the transition to menopause:
- Symptoms: Tell your doctor or nurse about any menopause symptoms, such as hot flashes or trouble sleeping.
- Irregular periods: Track your periods. Irregular periods may be your first sign of menopause.
- Hormone levels: Your doctor may test the amount of hormones in your blood if your periods stopped at an early age . Doctors dont usually recommend this test unless there is a medical reason to do so. This is because, for most women, hormone levels go up and down in an unpredictable way during the transition to menopause. So it is difficult to tell for sure whether you have gone through menopause or are getting close to it based on this blood test.
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What Are The Hormonal Changes During Menopause
The traditional changes we think of as “menopause” happen when the ovaries no longer produce high levels of hormones. The ovaries are the reproductive glands that store eggs and release them into the fallopian tubes. They also produce the female hormones estrogen and progesterone as well as testosterone. Together, estrogen and progesterone control menstruation. Estrogen also influences how the body uses calcium and maintains cholesterol levels in the blood.
As menopause nears, the ovaries no longer release eggs into the fallopian tubes, and youll have your last menstrual cycle.
How Long Does Perimenopause Last
The length of each stage of the menopause transition can vary for each individual. The average length of perimenopause is about four years. Some women may only be in this stage for a few months, while others will be in this transition phase for more than four years. If you have gone more than 12 months without having a period, you are no longer perimenopausal. However, if there are medications or medical conditions that may affect periods, it can be more difficult to know the specific stage of the menopause transition.
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What Is Vaginal Bleeding
Vaginal bleeding can have a variety of causes. These include normal menstrual cycles and postmenopausal bleeding. Other causes of vaginal bleeding include:
- trauma or assault
- cervical cancer
- infections, including urinary tract infections
If youre experiencing vaginal bleeding and are postmenopausal, your doctor will ask about the duration of the bleed, the amount of blood, any additional pain, or other symptoms that may be relevant.
Because abnormal vaginal bleeding can be a symptom of cervical, uterine, or endometrial cancer, you should get any abnormal bleeding evaluated by a doctor.
Sleep Problems And Mood Swings
Try these options to avoid sleep problems:
- Avoid large meals, smoking, coffee, or caffeine after noon.
- Avoid napping during the day.
- Avoid exercise or alcohol close to bedtime.
- Drink warm milk or warm caffeine-free tea before bed.
- Sleep in a dark, quiet, and cool room.
- Treat hot flashes to improve sleep.
Easing stress, eating right, and staying physically active can help with mood swings and sleeping problems. Your doctor may also prescribe medication to help with mood swings.
You should talk to your doctor about managing your symptoms and to rule out other conditions that may be causing your symptoms, like depression or asthma. Its also helpful to join a support group for women in menopause so you have a safe place to share your concerns and issues.
Your doctor may also prescribe menopausal hormone therapy to help treat your symptoms. MHT can ease:
- hot flashes
Studies show that women who take MHT are at an increased risk of heart attack, stroke, and blood clots. The risks are similar for women using contraceptive pills, patches, and rings. However, women taking MHT are older, and the risks increase with age.
Many women cant take MHT because of a previous illness such as cancer or because they take other medications.
Additional research found that the risk of getting breast cancer can increase with five or more years of continuous MHT use .
Women who have had their uterus removed will use estrogen-only therapy.
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General Recommendations For Ht
Current guidelines support the use of HT for the treatment of severe hot flashes that do not respond to non-hormonal therapies. General recommendations include:
- HT may be started in women who have recently entered menopause.
- HT should not be used in women who have started menopause many years ago.
- Women should not take HT if they have risks for stroke, heart disease, blood clots, and breast cancer.
- Currently, there is no consensus on how long HT should be used or at what age it should be discontinued. Treatment should be individualized for a woman’s specific health profile.
- HT should be used only for menopause symptom management, not for chronic disease prevention.
Before starting HT, your doctor should give you a comprehensive physical exam and take your medical history to evaluate your risks for:
- Heart disease
- Breast cancer
While taking HT, you should have regular mammograms and pelvic exams and Pap smears. Current guidelines recommend that if HT is needed, it should be initiated around the time of menopause. Studies indicate that the risk of serious side effects is lower for women who use HT while in their 50s. Women who start HT past the age of 60 appear to have a higher risk for side effects such as heart attack, stroke, blood clots, or breast cancer. HT should be used with care in this age group.
Women who should not take hormone therapy include those with the following conditions:
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.
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After Your Period Stops
The permanent end of menstrual periods doesnt necessarily mean the end of bothersome menopause symptoms, however.
Theres a window of about eight years in which women can feel those flashes and sweats, Dr. Audlin says.
Women who have reached menopause can expect menopause symptoms to become worse than they were during perimenopause, the 2- to 10-year stage leading up to the permanent end of menstruation. Experts dont know exactly why this happens, but its believed to be related to the hypothalamus, the portion of the brain that regulates temperature.
The hypothalamus is acutely responsive to estrogens, Audlin says. Leading up to menopause, your estrogen levels fluctuate. When theyre high, you dont have symptoms. But when you go into menopause and theres a complete lack of estrogen, you start to notice those symptoms more.
Q When Should I Call A Doctor About My Perimenopausal Symptoms
If you have not had a period for 12 months and then experience vaginal bleeding, contact your doctor. It is not normal for bleeding to recur after this period of time. Read our article about when you should see your OBGYN.
Remember, perimenopause and menopause are natural and normal transitions, but they can be stressful. Many symptoms can be managed which can help you regain a sense of control, well-being, and confidence to thrive in your next stage of life.
We want you to feel supported, heard, and cared for as you go through this change.
Sometimes, the biggest help is simply confirmation that what youre experiencing is normal!
Dr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Womens Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.
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Bleeding After 3 Years Of No Periods
I have not had a period for 3 years so I am post-menopausal. Suddenly November 2nd I had a bleeding that lasted for 8 days. Started with bloody streaks and progressed to dark bleeding that was as heavy as a normal period. I had an ultrasound and a transvaginal ultrasound that showed 2 cysts on my left ovary and an abnormal thickening of the lining in the uterus. The bleeding has started again as of November 29th. I am waiting for an appointment with an OB/GYN. I am thinking I have something pretty serious going on. My doctor doesn’t seem to think this is anything to worry about but after losing my Stepdad in July/09 and my Dad was given 3 months to live as of October … both due to cancer … I can’t help but wonder. Does anyone have some insight into my issues?
No Period For Over A Year
Now, for some women, they might find that they have got to a year or even a year and a bit without a period, and suddenly they get one back again. And this is very often the time when they can get a little bit worried. Some schools of thought say that you are through the menopause once you have not had a period for a year. In our experience, we find that a number of women will get periods back, or they’ll get the odd one back after a year or more.
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Early Menopause At 46 Was A Surprise Now I Realize It Was Also A Gift
I spent a chunk of this year crunching the numbers, like some kind of gynecological accountant. It boiled down to this: If I got to the end of July with no period, I had probably reached menopause. If I got to the end of August, I definitely had.
A few weeks before my 46th birthday in September, I reached the 12-month milestone, which officially made me a menopausal woman.
Menopause feels like the world is giving me nutrients back. Like both my body and my soul have been thanked for their hard work and given emeritus status and a big budget to simply explore.
I dont feel wistful about this. With preteen children, my brain has long moved past childbearing years. But its surprising that my body followed, wrapping it all up far sooner than I expected. The average age for menopause is about 52, so reaching menopause between the ages of 40 and 45 is considered early menopause .
But when hot flashes found me last year, I had a feeling I was on a different course than most other women my age. My periods had been erratic since my early 40s. Other things were happening, too. My sex drive was often lackluster, my moods were more noticeable and something unsettling was happening around my midsection.
My doctor first confirmed it wasnt a problem with my thyroid. Then she tested the levels of my follicle-stimulating hormone. While not a perfect indicator, the test suggested I was well on my way through the transition.
Symptoms Of Perimenopause Periods
During perimenopause, some may notice changes to the menstrual period. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of hormone levels.
Many women may experience all of the following changes, others will just experience just some. If it reads like perimenopause is a bit of a rollercoaster ride, thats not surprising – many feel that way!
- Less frequent or irregular periods:Because you start ovulating less as you age, your entire menstrual cycle may not run like clockwork anymore. This can mean less frequent and irregular periods, including skipped months.
- Spotting or lighter periods: Due to fluctuating hormones, you might experience very light periods or spotting between periods. Its worth tracking your periods and any irregular bleeding in a journal or app.
- Longer periods or heavy bleeding: As periods become infrequent, sometimes the lining of the uterus has more time to become thicker. This means that when your uterus sheds its lining, there will be a longer and heavier period.
Other symptoms include:
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What If You Want To Get Pregnant After You’ve Hit Menopause
Okay, so let’s say you’ve already hit menopausemeaning you haven’t had a period in 12 months or morebut you would still like to get pregnant. Luckily, if that’s your choice, science is on your side through a process called in vitro fertilization .
According to the US National Library of Medicine , IVF is essentially the joining of a woman’s egg with a man’s sperm, outside of the woman’s body . In women who are of childbearing age, there are five steps to IVF: stimulation, egg retrieval, insemination and fertilization, embryo culture, and embryo transfer. However, because women who have already gone through menopause are not producing eggs, they do not need to go through the first two steps, and will instead have to use eggs from a donor.
From there, it’s like any other IVF pregnancy: Once a fertilized egg divides and become an embryo outside of the body, per the NLM, it’s placed inside the woman’s womb, where she can carry the embryo, then fetus, to term.
The bottom line: If you havent yet reached menopause but are perimenopausal, you can definitely still get pregnant. But if youve already hit menopause when you decide you want to consider motherhood, its not necessarily too late” for that, either.
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Your Age Affects Your Risk
The longer youve been in menopause, the less likely you are to experience postmenopausal bleeding. Women are significantly more likely to have bleeding in the first year of menopause compared to later on, research shows.
But women whove been postmenopausal for a while still need to pay attention to any bleedingendometrial cancer most commonly affects women in their mid-60s.
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The Diagnostic Process May Involve Multiple Steps
Even though postmenopausal bleeding can have a number of different causes, your doctors first objective is to rule out potential cancers.
Well usually do a physical exam to look for blood or masses, such as fibroids, followed by an ultrasound to see how thick a patients uterine lining is, Mantia-Smaldone explained. A postmenopausal womans uterine lining should be quite thin, since she isnt menstruating.
Endometrial cancer can cause the lining of the uterus to thicken. If your uterine lining appears thicker than normal, your doctor will recommend a biopsy, in which a sample of your uterine lining is removed and examined under a microscope.