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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Myth #: Weight Gain Is Inevitable In Menopause
Unwanted weight gain is common in menopause but not inevitable. As you enter perimenopause and menopause, estrogen levels drop naturally and may create a hormonal imbalance. Your body reacts by trying to protect itself by actually storing fat especially around the waist, hips and thighs. Since fat tissue also acts as a source of estrogen, your body holds on to it even more as your estrogen levels continue to fluctuate.
With these changes taking place in your body, youll find a healthy weight by shifting your diet and establishing exercise habits. One of the most important things you can do is eat! Weve seen again and again how good nutrition helps women balance their hormones and find a way to overcome menopause weight.
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’.
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Follow The Moon Cycle
If you are in menopause and you want to discover your wild power, then do this 90-day programme with me. Choose the next new moon as your day of menstruation and the following full moon as your day of ovulation. To follow the moon cycle makes it easy to relive the menstruation / ovulation cycle. Write down your observations about all that is happening in you on a daily basis. Do it at least for three months.
If you find the observation a daunting task then a bit of meditation, yoga and tantra can just be the thing the doctor ordered. After you have done this for one month then I invite you to write to me with your questions and observations. I would love to hear from you about what you have discovered within yourself.
Are You Headed Toward Early Menopause
There are many negative health consequences linked to early menopause, including a higher risk of osteoporosis and fracture, heart disease, cognitive impairment and dementia, and early death, says Dr. Faubion.
If you have questions about when youll experience menopause and if you can do anything to change it, keep reading for answers.
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Postmenopausal Bleeding Is Never Normal
Whether its light spotting or a heavier flow, vaginal bleeding after menopause can signal potential health problems.
It should always be brought up with your provider, said Gina M. Mantia-Smaldone, MD, a gynecologic oncologist at Fox Chase Cancer Center. And the sooner, the better. Rather than waiting for your next planned checkup, give your gynecologist a call quickly to schedule an evaluation.
Itisdefinitely True That Sex After Menopause Can Be Painful At Least For Some Time
The most prominent change I hear about from my patients is that sometimes sex can become painful after menopause, board-certified ob/gyn Antonio Pizarro, M.D., tells SELF. Most of the time, this is related to a loss of estrogen. That can cause whatâs known as vaginal atrophy or genitourinary syndrome of menopause, in which the vaginal tissue becomes thinner and more delicate, Dr. Pizarro explains. Issues like pain, vaginal dryness, and urinary problems can crop up as a result of vaginal atrophy. Around half of postmenopausal people experience these symptoms, according to the Mayo Clinic.
Doctors mainly treat vaginal atrophy with some form of estrogen supplementation, but there can be drawbacks. Pizarro notes that theres a small risk the amped up estrogen can contribute to uterine cancer unless a woman pairs it with the synthetic hormone progestin. But combining the two may then increase a womanâs risk of breast cancer, according to The American Cancer Society, which has a comprehensive breakdown of the benefits and drawbacks of using hormones to deal with menopause symptoms.
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Menopause Can Have Mental And Emotional Effects Too
Most people dont like their period, but when it goes away you feel your age, Dr. Rowen tells SELF. For some people, the idea of losing their period can be psychologically distressing.And as we mentioned, your hormones, specifically estrogen and progesterone, change during menopause. And this change may cause feelings of anxiety and depression. Lower estrogen can also trigger hot flashes that make it difficult to sleep, leading to mood swings and anxiety. Coupled with any emotional distress from losing your period, and you understandably may not be in the mood to have sex. If you feel down for more than two weeks, you may be depressed and want to speak with a therapist, the Cleveland Clinic recommends. However, finding a therapist can be a long, and often stressful, process. . Generally, you will want to start by asking your insurance company for a list of providers. If you dont have insurance, websites like Open Path include therapists who offer reduced-fee sessions.
What Treatments Are Available
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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Review Of Indian Literature On Postmenopausal Syndrome
The average age of menopause in India is 47.5 years, with an average life expectancy of 71 years. Therefore, Indian women are likely to spend almost 23.5 years in menopause .
About 3540% women between 40 and 65 years have been diagnosed to suffer from osteopenia and 830% suffer from osteoporosis. All women over 65 years have been found to suffer from osteopenia or osteoporosis .
A study which analyzed a sample consisting of menopausal, premenopausal and postmenopausal women in the age range of 3550 years using a two-stage screening procedure for identifying and screening psychiatric morbidity General Health Questionnaire and Standard Psychiatric Interview, found highest psychiatric co-morbidity in the menopausal group, in terms of age maximum number of cases with psychiatric co-morbidity were from 41 to 45 years. Menopausal women suffered more symptoms of menopause as well as psychiatric symptoms as compared to premenopausal women. Both set of symptoms was found to be less in the postmenopause group also. The most common reported symptoms in the group were depression, depressive thoughts, anxiety, and excessive concern about bodily functions. Supporting the findings of the earlier study the predominant symptom in menopausal women was depression.
Examining Endometrial Cancer Worldwide
To get a comprehensive picture of the relationship between endometrial cancer and postmenopausal vaginal bleeding, researchers led by DCEGs Dr. Clarke and Nicolas Wentzensen, M.D., Ph.D., performed a meta-analysis of 129 studies, which included more than 40,000 women. Data for the studieswhich were conducted in Europe, North America, and Asiawere collected between 1977 and 2017.
The researchers estimated the overall prevalence of endometrial cancer among women with postmenopausal bleeding across all the studies combined and within different regions of the world. They also examined whether factors such as use of hormone replacement therapy affect the prevalence of endometrial cancer.
Overall, the analysis showed that, consistent with what had been seen in earlier studies, 90% of women diagnosed with endometrial cancer had experienced postmenopausal bleeding.
The number of women with postmenopausal bleeding who were diagnosed with endometrial cancer varied around the globe. While the rate was 9% overall, it ranged from 5% in North America to 13% in Western Europe.
Among the studies included in the analysis, the risk of endometrial cancer in women with postmenopausal bleeding was lower in studies that included women using hormone replacement therapy. This may be due, in part, to the fact that hormone replacement therapy itself can cause bleeding, especially during the first 6 months of use, explained Dr. Clarke.
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And Keep In Mind That You Can Still Get Pregnant Even After The Menopause Process Starts
Because menopause is defined by not having a period for 12 months straight, when you’re perimenopausal, or transitioning towards menopause, your period may go MIA but then make a comeback at some point. Some people have breakthrough bleeding or periods in between, according to The American College of Obstetricians and Gynecologists. And while that doesnt necessarily mean that youve ovulated, it could mean that you have. And that means you could potentially get pregnant.
Myth #: Menopause Gives You Weak Bones
Menopause and excessive bone loss do not have to go hand in hand. According to Womens Health Network bone expert Susan E. Brown, PhD On average, a woman loses 10% of her bone mass during the menopause transition an entirely normal part of the bone breakdown and build up process. After we reach our peak bone mass at age 30, we naturally experience more breaking down than building up. While most women have enough bone mass to handle this loss just fine, added risk factors like poor diet, family history and lifestyle can lead to excessive bone loss of up to 20%.
Dr. Brown also points out there are plenty of factors you can control to prevent excessive bone loss in perimenopause and menopause, including getting enough of the proper nutrients, managing extreme hormonal fluctuations, developing a bone-strengthening exercise program and reducing stress.
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Perimenopause: Rocky Road To Menopause
What are the signs of perimenopause? Youâre in your 40s, you wake up in a sweat at night, and your periods are erratic and often accompanied by heavy bleeding: Chances are, youâre going through perimenopause. Many women experience an array of symptoms as their hormones shift during the months or years leading up to menopause that is, the natural end of menstruation. Menopause is a point in time, but perimenopause is an extended transitional state. Itâs also sometimes referred to as the menopausal transition, although technically, the transition ends 12 months earlier than perimenopause .
Predicting Natural Menopause: Why Does Age Matter
If theres not a lot that women can do to change when theyll experience menopause, why does predicting it even matter?
It would be helpful for every woman to know exactly when menopause will arrive. Beyond recognizing and addressing issues such as increased cardiovascular disease risk and risks related to bone health, if a woman knows her age of menopause and how long the perimenopause transition will last, it could help her make important health decisions, says Faubion.
If youre bleeding like crazy it would be helpful to know, she says.
As of now, research hasnt uncovered a way to determine when a women will go into menopause, but having that information could be useful in making decisions such as whether to have a hysterectomy or other invasive procedures, says Faubion. If menopause is going to be a few months or a year from now, you may choose to wait it out if it’s going to be five years from now, you might want to go ahead and have an invasive procedure, she says.
The ability to predict when menopause will occur could also help with managing menopause symptoms or deciding which type of birth control to use, adds Faubion.
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Or You Might Find That Youre Not As Interested In Sex And Be Totally Fine With That
A lot of my patients who are many years past menopause report that their lives have changed in that way: The emphasis on and impact of sexual intercourse arent what they were before, says Pizarro. When talking through potential treatment options, many of his patients decide its not a big enough deal for them to pursue a medical solution to lowered libido. Its just not something that concerns them. Their life has transitioned to a point where theyre more focused on spending time with their partner or traveling, he explains.
The Reassuring News On Postmenopausal Bleeding
The analysis found that most post-menopausal bleeding is caused by a noncancerous condition, such as vaginal atrophy, uterine fibroids, or polyps. That information doesnt really differ from what doctors have historically thought about the incidence of endometrial cancer and bleeding, says Dr. Berkowitz. But it does finally put solid data behind those figures, which was missing in the past, he says. The researchers who conducted this study were looking for clues about postmenopausal bleeding and how it relates to endometrial cancer.
When To Stop Your Birth Control
In most cases, you should stop the combined pill when youâre at the age of 50. Women in this age group may have other health issues that could make it dangerous to use. Talk to your doctor to see if itâs safe for you to use it if youâre 50 or older.
If you donât want to be on the combined pill anymore but still want protection against pregnancy, you can use a progestogen-only pill or other forms of birth control, like condoms. If youâre over the age of 55, you can probably stop hormonal methods since your chances of pregnancy are very low. But to be safe, donât stop any type of birth control until you havenât had a period for a full year.
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Myth #: Menopause Only Causes Physical Symptoms
Menopause symptoms can be related to thinking and emotions. Sudden shifts in our hormones can lead to changes in mood, memory and concentration. Estrogen and progesterone are key hormones that have an impact on our neurotransmitters. For example, estrogen acts by inhibiting the breakdown of serotonin making higher levels available in the brain and keeping us happy. It also increases acetylcholine which is our neurotransmitter related to memory. Progesterone has an effect on Gaba like receptors in the brain which is our inhibitory neurotransmitter and helps us to relax and not be so anxious.
Overall, menopause can be a time of great stress, also influencing your emotions. In fact, perimenopause and menopause are sometimes referred to as the flip side of puberty with similar emotional ups and downs. Luckily, we dont have to be teenagers again!
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It Might Be Worth Seeing A Specialist
Your gynecologist should be able to perform your initial evaluation. But, if he or she suspects that your bleeding might be related to cancer, its important to see a gynecologic oncologist, Mantia-Smaldone said.
Endometrial cancer is usually treated with surgery that includes a hysterectomy, which may be followed by radiation and/or chemotherapy. Because gynecologic oncologists deal with female reproductive cancers every day, they have more experience operating on cancers, staging them correctly, and determining the best course of therapy. And that can add up to a more successful treatment outcome.
Ovarian And Uterine Cancers
Cancer of the ovary or uterus can cause abdominal cramps. Your risk for these cancers increases in your 50s and beyond. Cramps alone arent reason to assume you have cancer. Women who have cancer usually have other symptoms along with cramps, such as:
- vaginal bleeding
- unexplained weight loss
Any worrisome symptoms warrant a visit to your doctor just to make sure theyre not due to something serious.
You may be more likely to get one of the conditions that causes cramps after menopause if you:
- took estrogen for menopause symptoms
- have a family history of ovarian or uterine cancer
- got your first period before age 12
- started menopause after age 52
- used an IUD to prevent pregnancy
Think about whether you have any of these risk factors. Then, discuss them with your doctor.
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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