Things To Know About Postmenopausal Bleeding
Spotting or light bleeding after menopause might not seem like a serious problem, but you should never ignore it or wait to bring it up with your doctor. After a womans periods have stopped, vaginal bleeding could be a sign of a health issueincluding endometrial cancer. Heres what every postmenopausal woman should know.
Is Spotting Between Periods Normal
Is spotting normal during perimenopause? If you observe small amounts of blood on your underwear between cycles , its considered spotting.;
Aside from hormonal changes, perimenopause spotting is also the direct result of endometrial buildup. It happens either before your period starts or near the end of it. If youre spotting between periods, however, it might be an indication of hormonal imbalance and should be discussed with your doctor.;
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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Mayo Clinic Q And A: Spotting Perimenopause And Menopause
DEAR MAYO CLINIC:;I am 52 and recently had gone 10 months without a period, so I had assumed I was in menopause. But, over the past three months, I’ve noticed some light spotting. Does this mean I’m not in menopause? How do I know when I’m in menopause, and do I need to see a gynecologist or health care provider about this issue?
ANSWER:;It’s possible that you haven’t reached menopause yet. Clinically, menopause is defined as going without a period for one year. At 10 months, you don’t quite meet that threshold, but it is possible that you are just beginning menopause. However, depending upon when you last saw your health care provider and had a pelvic exam, it might be worthwhile to make an appointment, as there are a number of conditions where breakthrough bleeding is the first indication of an issue.
Menopause is the natural process that marks the end of a woman’s reproductive years when menstrual cycles stop. It typically happens during the 40s or 50s, with the average age of menopause in the U.S. at 51.
Skipping periods as you approach menopause a stage sometimes called perimenopause is common and expected. During that time, menstrual periods often will skip a month and return, or skip several months and then start monthly cycles again for a few months. Periods also tend to happen on shorter cycles during perimenopause, so they may be closer together than is typical for you.
What Is Considered Abnormal Perimenopause Bleeding
Typical irregularities aside, certain cases of perimenopausal bleeding could require closer medical attention. The following are considered abnormal perimenopausal bleeding patterns:
- Very heavy menstrual bleeding, particularly with clotting
- Bleeding after sexual intercourse
Approximately 25 percent of women experience heavy perimenopausal bleeding, also referred to as menorrhagia, flooding, or hypermenorrhea. Potential reasons for increased menstrual flow include:
- An imbalance of estrogen and progesterone hormones
- Fibroids: benign tumors, which may grow larger and cause heavy perimenopausal bleeding ;
- Endometrial hyperplasia: a thickening of the uterine lining that leads to irregular bleeding
- Endometrial polyps: small, noncancerous tissue growths in the uterine lining enlarged by the onset of perimenopause;
- Thyroid problems: heavy perimenopausal bleeding is sometimes brought on by an underactive thyroid, or hypothyroidism
- Polycystic ovarian syndrome: an endocrine disorder that produces irregular periods along with abnormal bleeding in the uterus;
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Is Vaginal Bleeding An Early Sign Of Pregnancy
No, vaginal bleeding is not an early sign of normal pregnancy. If you are pregnant and experience vaginal bleeding, you should visit your OBGYN for evaluation. Vaginal bleeding can be caused by many things other than pregnancy, including sexually transmitted infections, uterine growths called fibroids, and certain types of cancers.
How Does The Perimenopause Impact Your Periods
In your peak reproductive years, levels of your reproductive hormones oestrogen and progesterone rise and fall somewhat consistently throughout your menstrual cycle. When you enter the perimenopause, however, your ovaries stop ovulating regularly.Since ovulation is more infrequent than before, circulating levels of oestrogen and progesterone become unpredictable and erratic, which can result in unusual bleeding patterns.
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What Causes Bleeding After Menopause
Bleeding after menopause is rarely cause for concern. It does need to be;investigated, however, because in very few cases it will be an indicator of something more serious.;
In about 90 per cent of cases, a particular cause for bleeding after menopause will not be found. This is not a cause for alarm, if there is a serious problem it will be identified through investigations. Most of the time, postmenopausal bleeding is caused by:
- inflammation and thinning of the lining of your vagina
- thinning of the lining of your uterus
- growths in the cervix or uterus which are usually not cancerous
- thickened endometrium often because of hormone replacement therapy
- abnormalities in the cervix or uterus.
These are generally not serious problems and can be cured relatively easily.
However, about 10 per cent of the time, post-menopausal bleeding is linked to cancer of the cervix or uterus and so it is very important to have it investigated.
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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Heavy Periods And Flooding During Perimenopause
Alongside changes in regularity, you may notice your period is heavier than usual. Before the perimenopause, your ovaries secreted oestrogen to thicken the lining of the womb. Once the ovaries released the egg, they produced progesterone.The synergetic relationship between oestrogen and progesterone ensured your periods werent too heavy or light. However, as you enter the menopause, ovulation becomes more sporadic, even though your ovaries continue to secrete oestrogen. Since there isnt enough progesterone to stabilise the effects of oestrogen, you may experience heavier periods.Some perimenopausal women can experience extremely heavy periods with flooding, medically known as Perimenopausal Dysfunction Bleeding . In this, bleeding can be so heavy that sheets or seating become soaked with blood when lying or sitting down.1 Naturally, this can interfere with your everyday life.Though heavy bleeding is common during the menopause, you shouldnt ignore it. We recommend discussing this with your GP.
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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Perimenopausal Bleeding: When Do I Worry
Women in their forties often experience changes in the amount and/or frequency of their menstrual flow. This can affect lifestyle by causing fatigue and limiting activity. Some women must remain confined to home or at least within immediate proximity to a bathroom for days at a time. A womans mother or aunt may have had a hysterectomy for similar bleedingraising concerns that surgery might also be in her future. We are often asked, When do I get concerned?
In general, menstrual cycles tend to shorten as menopause approaches. This is a slow process occurring over the course of several years. They usually stay regular during this transitionevery 23 or 24 days versus every 28-30 days previously. As the ovaries age and become less efficient, ovulation occurs less frequently. This is reflected in the menstrual cycle as a more pronounced irregularity; for example, cycles that will vary from 14-40 days or more in length. These patterns are generally hormonal and therefore benign.
How Often Should I Get A Pap Smear Now That I Am Menopausal
You can get a Pap test every three years if both of these are true for you:
Women who have a higher risk of cancer may need a Pap test more often. Your doctor can recommend what is best for you.
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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.
When Do Periods Stop At Menopause
There can be gaps of up to 12 months between periods. You could go for 3-4 months without a period and the have a regular period for a few months
When having sex it is well advised to use contraception for up to 24 months after our last period. If you are having intermittent periods then you are most likely still ovulating and could become pregnant.
Changes in the monthly cycle are an indication that you are in perimenopause.;There is no typical pattern of change -;each woman can experience a combination of different symptoms.
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Why Am I Experiencing Vaginal Bleeding After Menopause
Vaginal bleeding after menopause may be due to medications, hyperplasia of the uterus, or some types of uterine cancer. Certain medications containing estrogen or progesterone can cause either hyperplasia or an increase in the amount of tissue in the uterus, which may cause bleeding or an excess sloughing off of tissue both of which will be seen as vaginal bleeding.
Problems With Memory And Concentration
During the menopause, you might find you have trouble concentrating or remembering things. You may also have difficulty multitasking.
Its normal to forget things from time to time. However, if its a regular problem and its affecting your day to day life, you should see a doctor and have it checked. This is in case its a sign of a more serious condition.
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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.
How Your Doctor Will Investigate Postmenopausal Bleeding
If you do experience unusual or postmenopausal bleeding, make an appointment with your doctor to have the problem investigated, says Dr. Berkowitz. Your doctor will likely recommend an ultrasound, a biopsy, or both. Ultrasound can measure the thickness of the lining inside the uterus. In some women with endometrial cancer, this lining becomes thicker than usual, which alerts doctors to the possibility that it is cancerous. Not all thickened linings mean cancer, though. The ultrasound should be followed by a biopsy, even if the ultrasound doesnt show any thickening of the uterine lining, says Dr. Berkowitz. A biopsy can often be done as an in-office procedure, in which the doctor uses a thin tube with a collection device on the end to gather some uterine cells. The sample is then examined under a microscope to check for cancer or precancerous changes.
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Why Am I Still Spotting After My Period Ends
Continuous bleeding after a period can be caused by a many things. Most commonly, an abnormally long period may have no discernible cause. If it does not recur, it may require no further investigation. Continuous spotting may be a sign of a disorder in coagulation caused by either medication or a genetic disorder. It may also be a sign of infection of the vagina or cervix.
How Is It Diagnosed
To find the cause of your bleeding, the doctor will do a physical exam and review your medical history. You may need one or more of the following tests:
Transvaginal ultrasound: This image helps your doctor check for growths and look at the thickness of your endometrium. Theyâll place a small probe into your vagina. It sends off sound waves to create a picture of the inside of your body.
Endometrial biopsy: The doctor uses a thin tube to take a small sample of the tissue that lines your uterus. Theyâll send it to a lab where scientists will look for anything unusual, like an infection or cancerous cells.
Sonohysterography: Your doctor may use this test to measure the size of a polyp. Theyâll put a saltwater solution inside your uterus to create a clearer ultrasound image.
Hysteroscopy: When the doctor needs to look inside your uterus, theyâll use a hysteroscope. This thin, lighted tube has a camera on one end.
D&C : During this procedure, the doctor opens your cervix. They use a thin tool to scrape or suck a sample of the uterus lining. They send this to a lab that will check for polyps, cancer, or a thickening of the uterine lining .
Ultrasound and biopsy are usually done in your doctorâs office. Hysteroscopy and D&C require anesthesia on one part of or your whole body. Youâll either go to a hospital or an outpatient surgical center.
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Prolonged And Heavy Bleeding During Menopause Is Common
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ANN ARBORWomen going through menopause most likely think of it as the time for an end to predictable monthly periods. Researchers at the University of Michigan say its normal, however, for the majority of them to experience an increase in the amount and duration of bleeding episodes, which may occur at various times throughout the menopausal transition.
The researchers from the U-M School of Public Health and U-M Health System offer the first long-term study of bleeding patterns in women of multiple race/ethnicities who were going through menopause. They say the results could impact patient care and alleviate undue concern about what to expect during this life stage that can last anywhere from 2-to-10 years.
For most women in their 30s, menstrual periods are highly predictable. With the onset of the menopausal transition in their 40s, womens menstrual periods can change dramatically. These dramatic changes can be disconcerting and often provoke questions about whether something is wrong, said Sioban Harlow, U-M professor of epidemiology.
Women need more descriptive information about the bleeding changes they can expect. We need clear guidance to help women understand what changes in bleeding patterns do and do not require medical attention.
The study, Menstruation and the Menopausal Transition, is reported in the current issue of BJOG: An International Journal of Obstetrics and Gynaecology.