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Is Constant Bleeding A Sign Of Menopause

Perimenopausal Bleeding: When Do I Worry

Menopause Symptoms: Bleeding

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.

Ht Forms And Regimens

HT comes in several forms:

  • Oral tablets or pills
  • Vaginal ring
  • Topical gel or spray

HT pills and skin patches are considered “systemic” therapy because the medication delivered affects the entire body. The risk for blood clots, heart attacks, and certain types of cancers is higher with hormone pills than with skin patches or other transdermal forms.

Vaginal forms of HT are called “local” therapy. Doctors generally prescribe vaginal applications of low-dose estrogen therapy to specifically treat menopausal symptoms such as vaginal dryness and pain during sex. This type of ET is available in a cream, tablet, or ring that is inserted into the vagina.

“Bioidentical” Hormones

“Bioidentical” hormone therapy is promoted as a supposedly more natural and safer alternative to commercial prescription hormones. Bioidentical hormones are typically compounded in a pharmacy. Some compounding pharmacies claim that they can customize these formulations based on saliva tests that show a woman’s individual hormone levels.

The FDA and many professional medical associations warn patients that “bioidentical” is a marketing term that has no scientific validity. Formulations sold in these pharmacies have not undergone FDA regulatory scrutiny. Some of these compounds contain estriol, a weak form of estrogen, which has not been approved by the FDA for use in any drug. In addition, saliva tests do not give accurate or realistic results, as a woman’s hormone levels fluctuate throughout the day.

Causes Of Abnormal Uterine Bleeding

While in many cases it is not possible to determine the exact cause, there are a number of reasons a woman may experience abnormal uterine bleeding. Some of the known causes of abnormal uterine bleeding include:

  • spontaneous miscarriage in pregnancy
  • ectopic pregnancy; lodgement of the fertilised egg in the slender fallopian tube instead of the uterine lining
  • hormonal disorders conditions such as hypothyroidism , polycystic ovarian syndrome and hyperprolactinemia can disrupt the menstrual cycle
  • ovulatory dysfunction this is when the ovary does not release an egg each month. Most commonly, this occurs at either end of a woman’s reproductive years, either during puberty or at menopause
  • endometriosis; the cells lining the uterus can travel to, attach and grow elsewhere in the body, most commonly within the peritoneal cavity

Read Also: Is It Normal To Have Menstrual Cramps During Menopause

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.

Causes Of Abnormal Bleeding

Signs of perimenopause

There are a number of possible culprits if you’re experiencing abnormalities in your bleeding habits.

For women who have already gone through menopause , vaginal bleeding could indicate cancer of the endometrium or cervix. Studies show that more than 90% of women with endometrial cancer experience bleeding after menopause.

During perimenopause, though, heavy bleeding may be caused by:

  • Uterine fibroids or polyps
  • Certain medications, such as blood thinners
  • Pelvic infection;
  • Most commonly, anovulation

Anovulation is when the ovary releases estrogen normally but doesn’t release an egg. It makes the uterine lining thicken and shed in an unpredictable manner, which causes irregular and/or heavy bleeding.

A number of simple diagnostic tests, many of which are non-invasive, can determine the cause of abnormal bleeding. These include:

Additionally, if your doctor suspects your heavy bleeding is due to a bleeding disorder or is causing anemia, they may order blood tests.

Also Check: What Age Is The Average Menopause

How To Bring It Up To A Healthcare Professional

Mention symptoms of perimenopause to a healthcare professional as soon as you begin noticing them. This can go a long way toward helping you get relief.

That said, theres no denying many professionals dismiss milder symptoms or seem disinterested in making the effort to understand your distress. This can be disheartening but dont feel obligated to continue seeing a doctor who doesnt respect your understanding of your own body.

If possible, consider seeking out a healthcare professional you can trust who truly listens and works to help you find relief.

If thats not an option, keep restating your concerns until they listen. Be clear and specific about:

  • symptoms you experience
  • how symptoms affect your life
  • the methods youve tried to find relief

It may help to keep a daily diary, noting:

  • physical symptoms
  • mood changes and mental health symptoms
  • self-care strategies or home remedies youve tried

Bring this diary to your appointments, so you can show your doctor.

The most important tool for navigating thoughts of death and suicide is connection and support, Botnick says.

Support might include:

Other Drugs Used For Menopausal Symptoms

Despite its risks, hormone therapy appears to be the most effective treatment for hot flashes. There are, however, nonhormonal treatments for hot flashes and other menopausal symptoms.

Antidepressants

The antidepressants known as selective serotonin-reuptake inhibitors are sometimes used for managing mood changes and hot flashes. A low-dose formulation of paroxetine is approved to treat moderate-to-severe hot flashes associated with menopause. Other SSRIs and similar antidepressant medicines are used “off-label” and may have some benefit too. They include fluoxetine , sertraline , venlafaxine , desvenlafaxine , paroxetine , and escitalopram .

Gabapentin

Several small studies have suggested that gabapentin , a drug used for seizures and nerve pain, may relieve hot flashes. This drug is sometimes prescribed “off-label” for treating hot flash symptoms. However, in 2013 the FDA decided against approving gabapentin for this indication because the drug demonstrated only modest benefit. Gabapentin may cause:

  • Drowsiness

Read Also: What Causes Hot Flashes And Night Sweats Post Menopause

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 .

Mayo Clinic Q And A: Spotting Perimenopause And Menopause

Heavy bleeding during perimenopause / 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.

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Irregular Periods During The Perimenopause

In light of your fluctuating hormones, your cycles may be irregular and fall outside the traditional 28-35-day window. The time between your periods may also vary on a month-by-month basis.Though this can be disconcerting and make everyday life difficult, try to remember these changes eventually cease.You may consider investing in period underwear or wearing black knickers to reduce the risk of spoiling clothing. Disposable panty liners can also help to protect from irregular leaks, and some women find period tracking apps useful.

Perimenopause Bleeding: Symptoms And Treatment

Menopause occurs once youve not had a period for at least one full year. The stage prior to menopause is called perimenopause, a term meaning around menopause. So what is it that triggers perimenopausal bleeding?;Major hormonal changes are largely to blame for symptoms, such as night sweats, hot flashes, sleep disturbances, and perimenopausal bleeding. This particular phase could last anywhere from a few months to 10 years.;

Read Also: What Antidepressant Is Best For Menopause

Perimenopause And Irregular Bleeding

During perimenopause a womans menstrual cycles may be shorter or longer, and the flow may vary from light to heavy. As ovarian function is declining, ovulation may not occur. The ongoing release of estrogen may cause the uterine lining to thicken while the production of progesterone slows down. As a result, the lining continues to build up and may cause irregular bleeding. The thickening of the endometrium may represent a benign change, such as a polyp, or hyperplasia. Most hyperplasia is not a problem but some forms can be precancerous. The bleeding can also represent endometrial . Fortunately, this is the least likely possibility.

Uterine polyps and uterine fibroids, both of which are benign, may also cause changes in bleeding pattern. Polyps are benign growths composed of the endometrial glands and contain no muscle tissue. A fibroid is a fibromuscular type of tumor that often grows within the muscular layer of the uterus. If the fibroid juts out into the endometrial cavity, abnormal bleeding can result. Both fibroids and polyps can cause extra bleeding due to their location within the interior of the uterus.

Ovarian And Uterine Cancers

Pin on Fibroids Natural Treatment

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
  • fatigue
  • 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.

Recommended Reading: What Is The Menopause Age Of A Woman

Should You Get Tested For Perimenopause

The short answer: No.

The blood tests that measure your ovarian reserve are rarely accurate during perimenopause. FSH and estrogen change by the day and throughout the day so they are generally not helpful.

We do consider testing these hormones if you experience perimenopausal symptoms under the age of 45. We generally will also check other pituitary hormones, like TSH and prolactin, if you are experiencing these symptoms prematurely.

Keeping a menstrual diary is generally the best test you can do. This will give you and your OBGYN insight into what your body is doing and for how long.

Any time you experience abnormal uterine bleeding , checking in with your doctor is a good idea to make sure it is normal and that no other work-up is needed.

Spotting Perimenopause And Menopause

Does spotting mean I am not in menopause? Does spotting mean do I need to see a gynecologist or health care provider about this?

In Mayo Clinic Q and A: Spotting, Perimenopause and Menopause the Mayo Clinic elaborate on the answer to the question:

DEAR MAYO CLINIC:

ANSWER: Its possible that you havent reached menopause yet. Clinically, menopause is defined as going without a period for one year. At 10 months, you dont 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.5

Recommended Reading: Why Does Menopause Cause Hot Flashes

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.

Current Testing Practices Supported

Menopause and You: Abnormal Bleeding

Currently, testing for endometrial cancer in women experiencing abnormal vaginal bleeding consists of transvaginal ultrasound imaging, biopsy, or both.

Although people tend to think of biopsies as invasive and frightening, an endometrial biopsy is a simple procedure similar to a Pap smear, Dr. Chu explained. Like a Pap smear, it can be done in the doctors office and doesnt require anesthesia.

In their study, the researchers ran simulations in which they estimated how many women with postmenopausal bleeding would need to undergo additional testing to detect one case of endometrial cancer, based on varied levels of risk and different testing strategies. Assuming a 10% risk of endometrial cancer and that women underwent subsequent testing with ultrasound, they estimated that 7 women would need to have a biopsy to find 1 cancer.

Before sending a woman for testing, doctors should ask themselves: If she has postmenopausal bleeding, how high is her risk of cancer?” explained Dr. Wentzensen. “Our estimate of 10% supports the current practice of further evaluating these women.”

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Treatment For Abnormal Bleeding

Medications, such as the birth control pill, are often the first option when it comes to treating abnormal bleeding during perimenopause. A relatively new type of intrauterine device may also help. Marketed under the trade names Mirena and Skyla, the progestin hormone they use thins the uterine lining, which lessens the amount of lining you have to shed, while also acting as birth control.

Surgical options may be considered if medications dont work. These include procedures such as endometrial ablation or hysterectomy.

Hysterectomy, which 600,000 American women undergo annually, is still considered the gold standard for permanently solving the problem of heavy uterine bleeding in women who aren’t interested in having children. However, it’s also the most invasive option.

Perimenopausal Bleeding And Spotting: What’s Normal

During the perimenopause, your oestrogen and progesterone levels fluctuate, which has a knock-on effect on ovulation and your menstrual cycle. As hormone levels vary month-on-month, youll likely notice that your periods become irregular, heavier or lighter than usual, or that you sometimes miss a period.This is a normal part of the process of reaching the menopause, and while it will be different for every woman, there are certain things to be aware of when it comes to perimenopausal bleeding and spotting.

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How Do You Know The Cause Of Postmenopausal Bleeding

  • Identifying the cause of the bleeding can include the following:
  • Exam by your provider of the vagina and cervix.
  • Pap smear to check the cervical cells.
  • Ultrasound, usually using a vaginal approach, which may include the use of saline to make it easier to see any uterine polyps.
  • Biopsy of the endometrium or uterus. In this procedure, your healthcare provider gently slides a small, straw-like tube into the uterus to collect cells to see if they are abnormal. This is done in the office and can cause come cramping.

Causes Of Postmenopausal Bleeding

MENSTRUAL SCHOOL

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.

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