Usually beginning in the mid-40s, women enter a phase called perimenopause. During this phase, hormone levels and the menstrual cycle begin to change. Perimenopause may last from ages 45 to 55, although the timing varies from person to person. During this time, the ovaries get smaller and make less estrogen. The body goes through other changes as well.
Because these changes happen slowly over time, women may not be aware of them at first. Menopause is defined as the absence of menstrual periods for 1 year. In the United States, the average age of the last menstrual period is 51.
The length of the menstrual cycle is typically between 24 and 38 days. A normal period generally lasts up to 8 days. During your reproductive years, your periods may be regular. Your bleeding may be the same from month to month. With perimenopause, things change.
During a normal menstrual cycle, the levels of the hormones estrogen and progesterone increase and decrease in a regular pattern. Ovulation occurs in the middle of the cycle. If a woman does not get pregnant, a period starts about 2 weeks later.
During perimenopause, the ovaries begin to make less estrogen. Some months, the ovaries may release an egg. Other months, they do not release an egg. In your 40s, your periods may be shorter or longer, and the days between may increase or decrease. Your bleeding may change too—it may be heavier or lighter. You also may skip periods.
It is not normal to have
Yes. Although it’s normal for periods to change as you near menopause, you should still talk with your obstetrician–gynecologist (ob-gyn) about bleeding changes. Abnormal bleeding sometimes can be a sign of health problems. It’s especially important to tell your ob-gyn if you have bleeding after menopause.
If you have any bleeding after menopause, or if you have any of the abnormal changes in your monthly cycle listed above, it’s important to see your ob-gyn to find out the cause. Many things can cause abnormal bleeding, including
Polyps are noncancerous (benign) growths that attach to the wall of the uterus. They also may develop on the endometrium (lining of the uterus). These growths may cause irregular or heavy bleeding. Polyps also can grow on the cervix or inside the cervical canal. Polyps on the cervix may cause bleeding after sex.
After menopause, the uterine lining may become too thin. This can happen when a woman has low levels of estrogen. The condition is called endometrial atrophy. As the lining thins, a woman may have abnormal bleeding.
Endometrial hyperplasia is a condition that causes the lining of the uterus to get too thick. The condition is not cancer, but in some cases, it can lead to cancer. Endometrial hyperplasia most often is caused when a woman has too much estrogen and not enough progesterone. Early treatment may reduce the risk of endometrial cancer developing.
Endometrial cancer is cancer of the lining of the uterus. It is the most common type of cancer of the female reproductive system. Bleeding is the most common sign of endometrial cancer in postmenopausal women. When diagnosed early, most cases of endometrial cancer can be treated successfully.
The risk factors for endometrial cancer include
Endometrial cancer also can occur without any of these risk factors.
Other causes of bleeding after menopause include
To diagnose the cause of abnormal bleeding, your ob-gyn should review your personal and family health history. You may have a physical exam. You also may have one or more tests. Some of these tests can be done in your ob-gyn’s office. Other tests may be done at a hospital or surgical center.
This procedure takes a small piece of tissue from the lining of the uterus. A thin tube is passed through the cervix and into the uterus to take the sample. The sample is sent to a lab where it is looked at under a microscope.
An ultrasound exam uses sound waves to create a picture of the pelvic organs. A transducer sends out the sound waves. The sound waves reach the organs and bounce back, like echoes. The transducer receives these echoes and turns them into images that are shown on a video screen. For a pelvic ultrasound, the transducer can be moved across the abdomen or it can be placed in the vagina.
This is a special kind of ultrasound exam. A thin tube is passed through the cervix and into the uterus. Fluid is injected into the uterus through the tube. When the uterus is filled with fluid, ultrasound images are made of the inside of the uterus and the uterine lining. For this procedure, the transducer is placed in the vagina.
This procedure uses a thin, lighted tube with a camera at the end. The tube is inserted through the cervix and into the uterus. The camera gives a view of the inside of the uterus.
This procedure removes tissue from the lining of the uterus. To start this procedure, also called a D&C, a series of rods is inserted into the opening of the uterus. Each rod will be slightly larger than the last one. This expands the cervix so instruments can pass through. When the cervix is expanded, the ob-gyn inserts an instrument called a curette. This is a sharp instrument that also may use suction. The removed tissue is sent to a lab, where it is looked at under a microscope.
Treatment for abnormal bleeding during perimenopause or after menopause depends on the cause (see below).
Endometrial cancer usually is treated with surgery. During surgery, the cervix and uterus are removed (hysterectomy), as well as both ovaries and fallopian tubes. Lymph nodes and other tissue may be removed and tested to see if the cancer has spread.
After surgery, the stage of disease is determined. Staging helps determine if additional treatment, such as chemotherapy or radiation therapy, is needed. Stages of cancer range from I to IV. Stage IV is the most advanced. The stage of cancer affects the treatment and outcome.
Contact us if you have any further questions about perimenopausal bleeding and bleeding after menopause.
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