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Can You Start Your Period Again After Menopause

Why You Should See A Gynecologic Oncologist

Why did I start spotting a few days after my period?

When postmenopausal bleeding is diagnosed as endometrial cancer, most cases can be cured with a hysterectomy. However, because endometrial cancer can spread into the lymph nodes, many patients also should have a lymph node dissection at the time of hysterectomy. Gynecologic oncologists are specifically trained to perform this procedure when it is indicated.If only a hysterectomy is performed and it turns out the lymph nodes are at risk, were left with difficult decisions. Should the patient start radiation therapy, or should she go back into the operating room to perform the lymph node dissection? Seeing a gynecologic oncologist immediately after diagnosis can avoid these complications, simplifying care and improving the chance of survival.Its not always easy to travel to a gynecologic oncologists office. Dallas-Fort Worth residents are lucky in this respect, as there are a number of us in the area. I have patients who come from several hours away because were the closest available clinic. While making the trip to see a gynecologic oncologist may be inconvenient, its important for your care.

Should You Be Worried About Postmenopausal Bleeding

You’ve endured the hot flushes and the mood swings. You’ve survived the heavy, irregular bleeding. Once you come out the other side, maybe the menopause isn’t so bad – after all, you don’t have to put up with periods every month. But then you start bleeding again, and you’re not sure if it’s normal.

Reviewed byDr Hayley Willacy
17-Apr-18ยท3 mins read

Sound familiar? If it does, you’re in good company. Bleeding after the menopause is remarkably common, and accounts for 1 in 20 of all referrals to gynaecologists.

Bleeding After Menopause: Its Not Normal

    Too often I see women with advanced endometrial cancer who tell me they experienced postmenopausal bleeding for years but didnt think anything of it. This shows we need to do a better job educating our patients about what to expect after menopause.

    Women need to know postmenopausal bleeding is never normal, and it may be an early symptom of endometrial cancer. Any bleeding, even spotting, should trigger a visit to your doctor as soon as possible. Dont wait to make an appointment until after the holidays or even next week. Do it today.

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    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:

    Will Being Super Healthy Help Delay Menopause

    Period during pregnancy: Is it possible?

    Although maintaining good overall health is important for a variety of reasons, it wont necessarily translate to later menopause, says Streicher. I have women who tell me, I have a healthy diet, Im thin, I work out all the time, and I look young. Im sure Im not going to go through menopause early, and when I do, I wont have hot flashes and other symptoms. I wish I could say that was true, but its not, she says.

    Body weight might matter, though. We do know that the extremes of weight, in someone who is very obese or someone with very low body weight, may impact the onset of menopause, but for the majority of women in the middle it doesnt seem to have a big impact, says Streicher.

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    Q When Should I Call A Doctor About My Perimenopausal Symptoms

  • If you are experiencing hot flashes and night sweats under the age of 45, contact your OBGYN to see what else might be causing them. When you have abnormal uterine bleeding, it is important to alert us regardless of age as we may recommend an ultrasound or endometrial biopsy to rule out abnormal changes in the uterus.
  • 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.

    Myth #: Theres No Difference Between Natural Menopause And Surgical Menopause

    Natural menopause and surgical menopause are very different. Natural menopause is a gradual shift of the sex hormones, but with surgical menopause following a total hysterectomy youll experience an immediate and significant change in hormonal balance. Removing your uterus and cervix, along with your ovaries and fallopian tubes, drastically affects the production of hormones.

    With a partial hysterectomy when only the uterus is removed changes become less predictable. Some women immediately suffer severe menopausal symptoms while others wont experience many. The truth is that every woman experiences menopause differently.

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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.

    Related information

    How Is Postmenopausal Bleeding Treated

    How to have great sex after menopause

    Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments.

    Medications include:

    • Antibiotics can treat most infections of the cervix or uterus.
    • Estrogen may help bleeding due to vaginal dryness. You can apply estrogen directly to your vagina as a cream, ring or insertable tablet. Systemic estrogen therapy may come as a pill or patch. When estrogen therapy is systemic, it means the hormone travels throughout the body.
    • Progestin is a synthetic form of the hormone progesterone. It can treat endometrial hyperplasia by triggering the uterus to shed its lining. You may receive progestin as a pill, shot, cream or intrauterine device .

    Surgeries include:

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    Generations Of Women Have Trusted Chapel Hill Obgyn

    Often, several different diseases present similar symptoms. Thats why its so important to have a local gynecologist who understands your medical history and has been a partner in your care. Generations of women have entrusted their care to us for decades. If youre experiencing any bleeding after menopause, we encourage you to schedule an appointment with us today.

    For more than 40 years, Chapel Hill OBGYN has served women in the Triangle area, sharing the joy of little miracles and supporting them during challenges. Our board-certified physicians and certified nurse midwives bring together the personal experience and convenience of a private practice with the state-of-the-art resources found at larger organizations. To schedule an appointment, please contact us for more information.

    Harvard Medical School. Postmenopausal Bleeding: Dont Worry But Do Call Your Doctor. Online.

    Mayo Clinic. Bleeding After Menopause: Is It Normal? Online.

    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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    When Does Menopause Occur

    Most women reach menopause between 45-55 years of age, and the average age for women in Australia to reach menopause is 51-52 years. Some women will have a later menopause, at up to 60 years of age, especially if there is a family history of late menopause.

    Menopause sometimes occurs earlier than expected as a result of cancer treatment, surgery or unknown causes. This is discussed further in ‘Causes of menopause’.

    Practice Good Sleep Hygiene

    I got menopause at 13 but after around a month my period ...

    Another routine youll want to adopt? A healthy bedtime. When women go into menopause and their hormones are out of balance, they may have trouble getting to sleep and staying asleep, Dr. Richardson says. Study after study shows that sleep really helps your metabolism, so not getting the right amount and type of sleep can really affect your ability to lose or maintain weight as you age and in times of stress.

    Get into bed early, aim for seven hours, and make your bedroom a place where you can achieve undisturbed sleep, if possible. She recommends taking L-theanine in the evening to calm you down and achieve deep sleep, but check with your doctor first. Try to think of your bedtime as a respite from the daily anxiety of a global pandemic.

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    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.

    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.

    When your estrogen levels are high in comparison to your progesterone levels, your uterine lining builds. This results in heavier bleeding during your period as your lining sheds.

    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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    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.

    What Treatments Are Available

    I’ve been bleeding for 2 weeks. Is it my period or something else?

    If you havent completely gone through menopause and your cramps indicate that your periods are tapering off, you can treat them as you would period cramps. Your doctor might recommend an over-the-counter pain reliever such as ibuprofen or acetaminophen .

    Warmth can also help soothe your discomfort. Try putting a heating pad or hot water bottle on your abdomen. You can also try exercise if you are not in too much pain. Walking and other physical activities help relieve discomfort as well as ease stress, which tends to make cramps worse.

    When your cramps are caused by endometriosis or uterine fibroids, your doctor might recommend a medicine to relieve symptoms. Surgery can also be an option to remove the fibroid or endometrial tissue thats causing you pain.

    How cancer is treated depends on its location and stage. Doctors often use surgery to remove the tumor and chemotherapy or radiation to kill cancer cells. Sometimes, doctors also use hormone medicines to slow the growth of cancer cells.

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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.

    Perimenopausal Bleeding Or Spotting

    Perimenopause is the period that leads to menopause. Its usually characterized by menopausal symptoms and irregular periods. Perimenopause can last up to 10 years. During perimenopause, its normal to experience heavier periods or irregular spotting due to hormonal changes.

    Talk to your doctor if your perimenopausal bleeding:

    • lasts longer or is heavier than expected
    • occurs more often than normal
    • occurs after intercourse

    There are many conditions that can cause bleeding after menopause. Here weve listed the most common causes of postmenopausal bleeding.

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    Weight Gain And Obesity

    Weight gain and obesity can affect the frequency of your period in a couple of ways. Rapid weight gain can throw your cycle off because it affects the hypothalamus, which is a part of your brain that regulates hormones. That can lead to hormonal fluctuations that may cause periods to be more frequent or less frequent.

    Obesity has a complex relationship with menstruation. High levels of fat, also called adipose tissue, can upset the balance of sex hormones and lead to more estrogen than you need. Too much estrogen can make you have short menstrual cycles and more periods. It also can cause heavier bleeding, more cramps, and more prolonged pain during your period. These problems are most severe when fat is mostly around the belly.

    Losing weight, or maintaining a healthy weight, can help keep your menstrual cycle regular. If you need help losing weight, talk to your doctor about what options you have.

    What Is Vaginal Bleeding

    Light Menstrual Flow: Is There A Cause For Concern?

    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.

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    Make Your Health A Priority

    Women are known to focus on their families first and put their own health second. But you cant care for loved ones if youre not healthy yourself. Listen to your body. Alert your doctor to any changes or abnormal issues such as postmenopausal bleeding as soon as possible.Dont stop seeing your general gynecologist for an annual exam when you hit menopause. Just because your reproductive years have ended doesnt mean those body parts go away! Your cancer risk increases as you age, and your gynecologist can screen for the disease and help you manage any conditions caused by hormone changes.If youre experiencing postmenopausal bleeding or have any concerns about your gynecologic health, request an appointment online or by calling .

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