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.
How Your Period Might Change
Perimenopause can make your once-regular periods suddenly irregular.
Before perimenopause, your estrogen and progesterone levels rise and fall in a consistent pattern during your menstrual cycle. When youre in perimenopause, hormone changes become more erratic. This can lead to unpredictable bleeding patterns.
During perimenopause, your periods may be:
- Irregular. Rather than having a period once every 28 days, you might get them less or more often.
- Closer together or further apart. The length of time between periods can vary from month to month. Some months you might get periods back to back. In other months, you might go more than four weeks without getting a period.
- Absent. Some months you might not get a period at all. You might think youre in menopause, but its not official until youve been period-free for 12 months.
- Heavy. You may bleed a lot, soaking through your pads.
- Light. Your bleeding might be so light that you barely need to use a panty liner. Sometimes the spotting is so faint that it doesnt even look like a period.
- Short or long. The duration of your periods can change, too. You might bleed for just a day or two or for more than a week at a time.
What Changes To Expect During Perimenopause
Over time, a womans estrogen levels decrease, thinning the lining of the uterus. Periods happen less often until they stop altogether.
But when hormones are still in flux during perimenopause, its common for women to experience significant changes to their menstrual cycle. This can include:
Shorter, longer, or missed cycles
The hormone changes during perimenopause are because of a in the ovaries. This can result in a longer time between cycles at least 38 days apart or missing your period entirely. Women with lower estrogen levels may experience shorter cycles than normal.
Spotting between periods
Changes in the time between periods can also cause spotting between periods. It’s common for thicker walls of the uterus to cause spotting thats red, brown, or dark-colored.
Abnormally heavy flow
As higher estrogen levels thicken the lining of the uterus, there can be more bleeding as it sheds. Unusual changes in your period cycle like missed or infrequent periods can also trigger heavier blood flows.
Other physical and mental symptoms can accompany perimenopause as well, including:
- Manage healthy stress and sleep levels to avoid greater hormone imbalance
- Replenish your body with iron to prevent anemia which causes symptoms like tiredness and may contribute to heavier bleeding
- Track your period cycles to gain better control over a heavier bleeding pattern
- Using pads or tampons that give heavy-flow comfort and avoid leakage
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Other Physical And Mental Changes At Midlife
Some common midlife changes that are often attributed to menopause are not necessarily related to the fluctuating or decreasing hormone levels of menopause. The four most commonly reported changes include mood changes and depression insomnia or other sleep problems cognitive or memory problems and decline in sexual desire, function, or both. Other physical changes that crop up in the middle years include weight gain, urinary incontinence, heart palpitations, dry skin and hair, and headaches. For these, a hormonal link is possible, but has not been proved. Consider the fact that men, who don’t experience a dramatic drop in hormone levels in their early 50s, often notice many of these same symptoms!
When Does Perimenopause Start
The average age of menopause is 51, and perimenopause symptoms typically begin about four years before your final period. Most women start to notice perimenopause symptoms in their 40s. But perimenopause can happen a little earlier or later, too. The best predictor of when your final period will be is the age at which your mother entered menopause .
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What Changes In Menstruation Can You Expect
During perimenopause, your body undergoes a shift in progesterone and estrogen levels. Estrogen, specifically, rises and falls in an arbitrary manner, which in turn affects ovulation and menstrual cycles. Expect to see irregular periods, spotting, missed periods, and certain perimenopausal bleeding patterns.
Major hormonal changes are largely to blame for symptoms, such as night sweats, hot flashes, sleep disturbances, and perimenopausal bleeding.
Occasionally, youll notice heavier and longer periods , while at other times, youll notice lighter and shorter periods . Early perimenopause tends to produce shortened menstrual cycles as well as periods lasting 2 to 3 days less. In contrast, late perimenopause creates longer cycles , often associated with anovulatory menstruation .
Furthermore, missed periods might sometimes be followed by normal periods as perimenopausal bleeding patterns and cycles are highly irregular. In this phase, menstrual blood ranges in color from dark brown to bright red. You might notice brown discharge or perimenopause brown spotting throughout the month. The texture of your discharge will also vary from thin and watery to thick and clumpy.
Why Am I Bleeding Again Common Causes And Treatments For Postmenopausal Bleeding
Imagine making it through menopause a whole year without a period then suddenly start bleeding again. You may find that surprising, but postmenopausal bleeding happens more often than you might think.
I have many women come to me confused and frightened understandably so. They feel that something serious might be wrong. After all, how could this happen if theyve gone through menopause already?
Heres an important note: if youve had a period within the past year you arent through menopause yet, no matter how infrequently those periods come. But if you begin to spot or get what feels like a period after more than a year with no bleeding, theres no need to panic.
Be sure to see your health care provider as soon as possible to calm your fears about this sudden bleeding. However, as I will go over in this article, quite often there is a reasonable explanation for this postmenopausal bleeding.
This time of life can bring a host of symptoms directly related to lifestyle issues, and postmenopausal bleeding is no exception. Sudden bleeding or spotting is often a message from your body its asking you to slow down and take a closer look at your life, and how you are taking care of yourself. Lets examine some things that cause bleeding after menopause, and talk about what you should do if it happens to you.
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Dealing With The Symptoms Of Menopause
You could argue that the physical and mental changes that occur during menopause aren’t really “symptoms.” The term is usually associated with a disease, which menopause is not. Also, it is often hard to say which changes are a direct result of a drop in hormone levels and which are natural consequences of aging. Some of the symptoms overlap or have a cascade effect. For example, vaginal dryness may contribute to a lower sex drive, and frequent nighttime hot flashes may be a factor in insomnia.
Hot flashes and vaginal dryness are the two symptoms most frequently linked with menopause. Other symptoms associated with menopause include sleep disturbances, urinary complaints, sexual dysfunction, mood changes, and quality of life. However, these symptoms don’t consistently correlate with the hormone changes seen with menopause transition.
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.
Irregular Periods In Your 40s Is It Perimenopause Or Something Else
If youre in your mid- to late 40s and your periods are becoming irregular, you may be in the menopausal transition, or perimenopause. This is the natural stage your body goes through as you approach menopause.
This stage lasts about four years on average, although some women may experience only a few months or many more years of symptoms. It is characterized by fluctuations in hormones as your ovaries are nearly out of eggs. Your estrogen levels drop and you may have markedly irregular menstrual cycles. On top of irregular periods, hormonal changes can lead to weight gain, hot flashes, trouble sleeping, vaginal dryness, mood changes, and depression.
Perimenopause ends with menopause, at which point you have not had a period for 12 months.
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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When To See A Doctor
Speak with your healthcare provider if youre experiencing any of these:
- Abnormal length of period
- Bleeding with intercourse
While these are common during perimenopause and usually not a cause for concern, its best to keep your doctor in the loop and notify them of any changes. Anytime youre unsure or concerned about perimenopause symptoms, speak with your doctor.
What’s Your Menopause Timetable
Your body has its own timeline for when menopause will start and how long it will last probably a similar timeline to the one your mother or sister followed. But certain health conditions, medical treatments, and lifestyle choices can influence your timeline, and as a result, menopause may occur earlier than you expect. Some of these factors include:
- Smoking. Judith Albert, MD, gynecologist, cofounder, and medical director of Reproductive Health Specialists in Pittsburgh, Pennsylvania, says that on average, women who smoke reach menopause one and a half years earlier than those who don’t. The longer you have smoked and the more you smoke, the more likely you are to experience this effect.
- Removal of the pituitary gland. Many key hormones are secreted from this gland in the brain.
- Medical treatments. Chemotherapy or radiation therapy can trigger menopause.
- Certain diseases, especially genetic and autoimmune disorders.
- Ovary abnormalities. Removal of both ovaries or premature ovarian failure can disrupt hormone action.
- A radical diet that limits foods groups going vegan or following a no-carb/high protein diet.
- Body fat.“Being too low in body fat or too high can wreak havoc with hormones and spark menopause,” says ob-gyn Chad Friedman, MD, clinical associate professor at Ohio State University College of Medicine, Department of Obstetrics and Gynecology. Maintain a healthy weight.
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Starting Or Changing Birth Control Methods
In this particular case, you may see spotting throughout your cycle or right before your period, which is also known as breakthrough bleeding. All types of birth control can cause this situation including the pill, IUD, the patch, a vaginal ring, or an implant.
This sporadic spotting between periods is caused by the introduction of estrogen present in the birth control medication. It will usually resolve itself within a few months time. Should you continue to have spotting beyond that time, see Pacific Gynecology Surgical Group for a diagnosis.
Many women first discover they have fibroids when they see their provider for spotting or extended heavy periods. These benign cysts occur in the uterus and can cause these bleeding symptoms.
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.
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Menopause And Nausea Symptoms
Hormones nausea and menopause can develop for various reasons. Often a woman is sick as a result of hormonal changes that occur in the body. However, it should be borne in mind that nausea can indicate serious illness.
Nausea and menopause symptoms may be:
- a feeling of disgust for food
- increased blood pressure
First of all, it is necessary to find out the cause of menopause nausea. Nausea should not be taken as a variant of the norm. In any case, correct treatment is necessary. It involves a whole range of different methods. If the reason that a woman is nauseous is hormonal changes during menopause, hormonal drugs â hormone replacement therapy, can be recommended.
However, in some cases, hormonal medication may be contraindicated. This is due to the fact that drugs containing hormones have a number of side effects. Sometimes, the doctor recommends taking homeopathic and sedatives containing phytoestrogens for menopause and nausea. All medications must be prescribed by a specialist. Self-medication can aggravate the unpleasant manifestation of climacteric changes.
Behavioral therapy is essential in the treatment. The patientâs well-being is largely determined by her lifestyle. In order to prevent menopause nausea feeling attacks, a woman must adhere to the following rules:
- follow a healthy diet, not eat fatty, fried, and smoked dishes and sweets
- avoid overeating
- spend a lot of time outdoors and avoid stuffy rooms.
Current Testing Practices Supported
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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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 womans 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
S To Ease Perimenopausal Symptoms
Relieve unwanted symptoms of perimenopause by trying one of the following:
Hormone therapy helps relieve both hot flashes and vaginal discomfort. Estrogen therapy, when administered orally or transdermally, is shown to reduce bone loss.
When applied vaginally at very low doses , estrogen alleviates certain symptoms of perimenopause, including vaginal dryness, itching, and painful intercourse. However, it will not prevent osteoporosis or hot flashes.
Antidepressants, primarily those referred to as SSRIs, can help lessen mood swings and hot flashes in some patients. This treatment is recommended for those with perimenopausal symptoms of anxiety and depression.
Normally an anti-seizure drug, it can also effectively relieve hot flashes. Gabapentin is especially helpful for women who cannot use hormone therapy due to specific medical conditions.
Regular physical activity is known to help relieve numerous perimenopausal symptoms, including stress, sleeplessness, and weight problems.
Maintaining a regular sleep schedule is very important during perimenopause. Caffeine and alcohol disrupt sleep, so its better to cut back or avoid them entirely. Engaging in a stress-free, pre-bedtime activity, such as gentle yoga or a warm bath may help you have better sleep.
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I Have Spotting After Menopause On My Underwear What Do I Do
Dr. Jessie: Please call your doctor and make an appointment. As long as the bleeding is minimal, this is not an emergency, but I like to get patients in for this problem within the next week. While seeing your gynecologist is generally not as fun as, say, buying some new shoes , the work up for post-menopausal bleeding is pretty straight forward and can bring some peace of mind.
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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