Bleeding Markers Of The Early And Late Menopausal Transition
At the turn of the millennium, the stages of ovarian aging were not yet understood. Recognizing the importance of clearly defining the stages of reproductive aging as well as of identifying valid, reliable and clinically useful criteria for the onset of each stage of the menopausal transition, the Stages of Reproductive Aging Workshop was convened in 2001. Based on a consensus discussion of scientific evidence, STRAW recommended that reproductive life be characterized by 7 stages. Prior to menopause, reproductive life was divided into the reproductive years and the transition years . Postmenopausal years follow the final menstrual period . Given limitations at that time in the scientific understanding of ovarian aging and in the availability of valid, reliable, and widely available assays, STRAW staging criteria were limited to menstrual markers and qualitative changes in follicle-stimulating hormone . STRAW characterizes entry into the early transition by increased levels of follicle stimulating hormone and increased variability in menstrual cycle length, defined as menstrual cycle length > 7 days different from normal. Entry into the late transition was characterized by the continued elevation of FSH and the occurrence of > = 2 skipped cycles or amenorrhea of > = 60 days.
How Long Is Too Long For A Period During Perimenopause
The road to menopause comes with many changes. Night sweats, hormonal imbalances, and vaginal dryness are a few of the well-known symptoms of perimenopause. Heavy, painful periods are also a symptom thats quite common roughly 25 percent of women report experiencing them. Read on to learn the basics of perimenopause bleeding and how to manage extended perimenopause periods.
Common Changes To Periods During The Menopause And Perimenopause
This is a cry I hear every day! Changing periods are often one of the first signs that you are starting the approach to the menopause. Today I’m discussing some of the common changes you can expect to see to your periods as you approach the menopause such as missing periods, short or long periods, or heavy periods.
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Premature And Surgical Menopause Also Known As Induced Menopause: What To Know
A small number of women enter menopause much earlier than the average. When it occurs in women age 40 or younger, it is termed premature menopause, according to NAMS. This happens to about 1 percent of women in the United States.
In some cases, menopause is surgically induced, such as when a woman has her ovaries removed for cancer prevention or treatment. Women with induced menopause often experience more intense symptoms than women going through the process naturally.
Your Health Questions Answered
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Ovulation bleeding is light bleeding or spotting that happens when you ovulate, usually in the middle of your period cycle. As you approach menopause, youre less likely to ovulate, as your egg reserves reduce and eventually disappear. So, although ovulation bleeding isnt usually a sign of menopause, any changes in your periods including bleeding more frequently or in the middle of your cycle can be. Mid-cycle bleeding can have lots of different causes, so its best to get it checked out by a doctor, especially if youre already menopausal and youre bleeding or even spotting.
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Do Periods Get Heavier Before Menopause
Many women do experience heavier periods in perimenopause. In the beginning stages of perimenopause, estrogen levels are high, which means that heavy bleeding is more likely to occur. Also, if your cycle is all over the place, and you didnt shed your uterine lining last month, it can mean an even heavier flow this month.
In some cases, a condition known as endometrial hyperplasia can develop, which can become problematic and in some instances, cancerous.
Some women have the incredibly frustrating experience of bleeding through a tampon and a pad during this time. They have to diligently change protection every hour. Now is the time to invest in black underwear or period panties, ladies.
Perimenopause Or Menopause How To Tell The Difference
Menopause is diagnosed when youve gone 12 consecutive months without a period, signaling the end of your menstrual cycles, ovulation, and fertility.
In the months and years leading up to menopause, you experience symptoms like hot flashes and night sweats that indicate menopause is coming. This time is known as perimenopause.
Knowing when perimenopause ends and menopause begins can be tricky. At Capital Womens Care, the board-certified gynecologists help you manage this hormonal transition to ease any unpleasant symptoms and keep your hormones in check.
Heres what these experts say can help you distinguish between perimenopause and menopause.
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Hormonal Highs And Lows
During perimenopause your ovaries are winding down. This means that some months you will ovulate, sometimes twice in a cycle, while in other months, no egg will be released. “The pattern of hormonal fluctuations can become quite erratic and feel chaotic,” says Jean Hailes endocrinologist, Dr Sonia Davison. “Flushes and night sweats may occur some months and not others. They are often triggered by a drop in oestrogen before the menstrual period. Then oestrogen can shoot back up again causing issues like swollen, tender breasts.”
Perimenopause typically starts in a woman’s 40s, but may also occur in 30-something women. Symptoms can come in waves, increasing and receding for months at a time. Though four to six years is average for most women, perimenopause can be as short as a year or last for more than 10 years. Next stop? Menopause.
For some, perimenopause causes few health issues. But around 20% of women experience moderate to severe symptoms, which can include:
- Hot flushes
Low oestrogen levels before menstruation can cause hot flushes and night sweats Treatments such as hormone therapy can help
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:
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What Is Intermenstrual Bleeding
It is bleeding that occurs before or after the period rather than being part of the cycle and is another common change to your body in your 40s. However, it is always prudent to rule out dysfunctional uterine bleeding. For instance, by booking a cervical smear to rule out cervical cancer. Or an ultrasound scan of the pelvis to check the womb for uterine cancer. These diagnoses are the very worst case scenario, but it is useful to know which symptoms are a cause for concern.
Nutrition And Lifestyle Recommendations For The Transition To Menopause
A little extra attention in the nutrition and lifestyle department can go a long way to an easier transition to menopause.
- Prioritize sleep hygiene. Turn of screens and turn lights down an hour before bed, and read or practice a relaxing activity to wind down. Head back to bead at a regular time each night.
- Take active steps to manage stress and cortisol. Yoga, breathwork, and meditation can help mitigate stress and modulate the extra stress hormones women can have during the transition to menopause.
- Nutrition. Eat a diet that is rich in whole foods.
- Movement. Prioritize regular exercise that you enjoy.
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When To See A Doctor About Perimenopause Periods
When youre going through perimenopause, its normal to experience changes to your periods, but sometimes, an abnormal bleeding pattern may be a sign of an underlying issue that needs medical attention.
- severe tummy pain
- very heavy bleeding that wont stop that is, youre having to change your sanitary products every hour, or are passing blood clots larger than 2.5cm
- tummy pain that wont go away and you think you may be pregnant
- you feel tired and lack energy , youre short of breath, have heart palpitations and a pale complexion
- a fever, you feel faint or very unwell, or have any other signs of
Although it’s common during the perimenopause and usually nothing to worry about, sometimes, bleeding can point to an underlying medical problem, so see a doctor as soon as possible if you’re bleeding from your vagina and:
- its lasted longer than 7 days
- its happening every 2 to 3 weeks or more frequently
- its happening during or after sex, or between your periods
- you havent had a period for 1 year or more before it started
- you could be at risk of an STI
Also, see a doctor if your periods have become unusually heavy for you, or theyre painful.
Does Perimenopause Make You Feel Crazy
If you consider the fact that many perimenopausal women suffer from sleep deprivation, sudden changes in body temperature, mood swings, and weight gain, then yes, sometimes, women in perimenopause can feel like theyre going crazy.
If your symptoms feel overwhelming or begin to disrupt your functioning in everyday life, open a conversation with your doctor.
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What Are The Stages Of Perimenopause
The process happens slowly over three stages:
- Perimenopause. Your cycles will become irregular, but they havent stopped. Most women hit this stage around age 47.
- Menopause. This is when youll have your final menstrual period.
- Postmenopause. This begins when you hit the year mark from your final period.
My Experience Of Periods Changing Prior To Menopause By Aisling Grimley Founder My Second Spring
“At 47 I missed my period one month and thought I might be pregnant as I also experienced some hormone surges that reminded me of pregnancy. I had some red rage moments and very tender breasts.
During the following 5/6 years of perimenopause, I went through times of having regular monthly periods in my classic pattern for a few months. Then I might skip up to 6 months only to have periods return to normal again. During the gaps with no period, I sometimes had PMS like symptoms and mild cramps when I reckon I should have had a period. Sometimes my cramps were very painful, at other times I had no pain at all. My last periods were quite light and I never experienced flooding but I know it is very usual to have one or two very heavy periods before they stop altogether.
At 53 I had my last period and I am now period-free for 15 months so I declare myself to be in The Menopause!” Aisling
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Can Periods Start Again After Menopause
The other question that we often get asked is, “Can periods start again well after the menopause?” This is really not common and very often, there are other health issues involved. So if you have been without periods for two years or a lot longer, and your periods come back, then it’s really important to get this checked out by your doctor.
There can be a number of reasons. We’ve had women who’ve forgotten that they’ve had the coil in, and it’s been left in for years and years and years, and suddenly, it’s starting to irritate the womb and causes bleeding. It can be things like a prolapse where your internal organs can shift and that can cause bleeding as well. So this is one instance where it’s really important that you get things checked out by your doctor.
So hopefully this has given you a little bit more information on what exactly can happen to your periods as you start the approach to the menopause. If any of you have any questions on this then please leave your comments and I’ll get back to you. And I’ll look forward to seeing you next week on another edition of A.Vogel Talks Menopause.
What Other Changes Should You Expect
Your period evolves in a number of ways once youve entered perimenopause. While some women have perimenopausal periods closer together, others might notice them occurring further apart. Further changes in your menstrual cycle after 40 often include:
- Heavier periods: Your flow may become more intense over time. If bleeding is unusually heavy, however, be sure to consult your doctor.
- Lighter periods: Inversely, a lot of women experience decreased flow for up to a year before their periods stop completely.
- Skipped periods: Anovulatory cycles are another possibility during perimenopause. Keep in mind, though, that youre still fertile at this stage. So if youve recently had sex and missed your period, consider taking a pregnancy test.
- Longer or shorter periods: Perhaps your period has always lasted for 4 days, but now its 2 or 6 days. You might even experience a random combination of both shorter and longer cycles while in perimenopause. This, too, is a fairly common occurrence.
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Can A Woman Orgasm After Menopause
A great sex life is still achievable in perimenopause and beyond.
The hormonal changes experienced during this time may present some challenges. Dropping estrogen levels mean vaginal dryness, decreased pelvic floor muscle strength, vaginal atrophy, and less sensitivity in the clitoris. Declining levels of testosterone can mean lowered libido. So several things are working against sexual pleasure at this stage in the game.
However, many women find that with a regimen of pelvic floor exercises, along with lube and some small lifestyle tweaks, that they can enjoy orgasm well after menopause. Some of the suggestions for increasing orgasm and sex drive before and after menopause include:
- Reducing alcohol intake
- Exercise and diet these measures can help reduce health conditions that can decrease blood flow and the need for medications that may affect the same
Of The Reproductive Journey
We usually diagnose menopause in hindsight, after that full year of absent periods. Ive found that most women know theyve reached menopause when they get there.
Even if your irregular periods turn out to be something else, youll face menopause eventually. Talk with your ob-gyn about what youre experiencing. Together we can work through this part of your health journey.
The views expressed in this article are those of Dr. Eisenberg and do not reflect the views of the National Institutes of Health, the Department of Health and Human Services, or the United States government.
Copyright 2021 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.
This information is designed as an educational aid for the public. It offers current information and opinions related to women’s health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOGs complete disclaimer.
Dr. Esther Eisenberg
Is It Normal To Bleed For 3 Weeks During Perimenopause
As you go through perimenopause, your periods may last longer and become further apart. Evidence shows that having periods that last 8 days or longer is common when youre going through this natural stage in your life.
You may also bleed more heavily if youre obese or have a fibroid, and as you approach the time when your periods stop altogether.
So, for some people, it may be normal to bleed for 3 weeks during the perimenopause, but its best to see a doctor for their advice, as they may want to do some tests to make sure there’s nothing else causing your longer periods, and that youre not losing too much blood and becoming anaemic. Read below for when else to see a doctor about periods in perimenopause.
Causes Of Irregular Periods
Did you know?
On average, a women has 500 menstrual cycles throughout her lifetime, between the time of her first period at about age 12 to her last period just prior to menopause.
Several factors can cause irregular periods, but for women approaching menopause, the most likely cause is fluctuating hormone levels. These hormonal changes are typically experienced between the ages of 45 and 55. A woman’s menstrual cycle inextricably linked to her hormones because hormones, particularly estrogen and progesterone, drive the process. When hormone production begins to taper off, periods often become irregular.
To better understand the hormonal cause of irregular periods, it’s helpful to learn what functions the hormones play during menstruation.
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What Causes This Change In The Body
It mainly comes down to hormones, your bodys messengers, which travel through the bloodstream to affect various functions and processes. When a woman enters middle age, her ovaries start to produce less oestragen. They also produce less ovarian follicles making the ovaries become less responsive to Luteinizing Hormone and Follicle-Stimulating Hormone , two hormones necessary for reproduction and the regulation of oestrogen, progesterone and testosterone. This decline in oestragen and fluctuating hormones can be the cause of almost any imaginable bleeding pattern. This also includes intermenstrual bleeding, which is separate to irregular menstruation.