What's abnormal bleeding in peri and post menopause?
It can be tricky working out what is just irregular peri-menopausal periods and what might be abnormal bleeding that needs investigation so let’s look at what is considered normal as you transition through perimenopause into postmenopause, and then what are some cures for when to see your doctor
PERIMENOPAUSE PERIODS
In perimenopause your ovaries stop releasing eggs as regularly, until you stop altogether at menopause. The changes in ovulation and periods can start as early as your late 30s, but for most women it starts in their early to mid 40s. Changes that are typical at this stage include those related to lower progesterone (which you make after ovulation – so if you don’t ovulate you don’t make progesterone that cycle) and a relatively high oestrogen. The oestrogen effect is two-fold: firstly, you can have normal oestrogen levels but when there is no progesterone the effect is oestrogenic, and secondly, in about half of all women they have an increase in their oestrogen before it then drops as menopause approaches.
Low progesterone changes
- shorter cycles
- heavier periods
- premenstrual spotting
Higher oestrogen changes
- heavier periods
- clotting
- erratic periods
- shorter cycles
Possible causes of abnormal bleeding in perimenopause and postmenopause
In addition to changes brough on by fluctuating oestrogen and progesterone, other conditions can cause irregular or unusual bleeding, including:
- uterine polyps
- uterine fibroids
- cervix ectropian
- adenomyosis
- low thyroid function
- blood disorders
- some medications (including hormone therapy)
- and malignant changes to the cervix or uterus
WHEN TO SEE YOUR DOCTOR
- an unusual increase in blood loss
- periods lasting more than 7 days
- very heavy bleeding or flooding (especially if using ‘super’ pads or tampons)
- clots 3cm or more in diameter
- bleeding during or after sex
- any vaginal bleeding post-menopause
- note; genitourinary syndrome of menopause can cause spotting post-menopause
Also, see you doctor if you have symptoms of iron deficiency or anaemia such as fatigue, pale skin, shortness of breath, racing heart, feeling lightheaded or fainting.
Remember, most often the changes are due to perimenopause, but if in doubt, or concerned, please speak with your doctor.
