What are menopause and perimenopause?
Menopause is defined as the absence of menstrual periods for 1 year. The average age of menopause is 51 years, but the normal range is 45 years to 55 years.
The years leading up to this point are called perimenopause. This term means “around menopause.” This phase can last for up to 10 years. During perimenopause, shifts in hormone levels can affect ovulation and cause changes in the menstrual cycle.
What are some of the common changes that occur in the menstrual cycle during perimenopause?
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, and menstruation occurs about 2 weeks later. During perimenopause, hormone levels may not follow this regular pattern. As a result, you may have irregular bleeding or spotting. Some months, your period may be longer and heavier. Other months, it may be shorter and lighter. The number of days between periods may increase or decrease. You may begin to skip periods.
How can I tell if bleeding is abnormal?
Any bleeding after menopause is abnormal and should be reported to your health care provider. Although the menstrual period may become irregular during perimenopause, you should be alert for abnormal bleeding, which can signal a problem not related to perimenopause. A good rule to follow is to tell your health care provider if you notice any of the following changes in your monthly cycle:
What are some of the common causes of abnormal bleeding?
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How is abnormal bleeding diagnosed?
To diagnose the cause of abnormal perimenopausal bleeding or bleeding after menopause, your health care provider will review your personal and family health history. You will have a physical exam. You also may have one or more of the following tests:
Some of these tests can be done in your health care provider’s office. Others may be done at a hospital or surgical center.
What treatment is available for abnormal bleeding?
Treatment for abnormal perimenopausal bleeding or bleeding after menopause depends on its cause. If there are growths (such as polyps) that are causing the bleeding, surgery may be needed to remove them. Endometrial atrophy can be treated with medications. Endometrial hyperplasia can be treated with progestin therapy, which causes the endometrium to shed. Thickened areas of the endometrium may be removed using hysteroscopy or D&C.
Women with endometrial hyperplasia are at increased risk of endometrial cancer. They need regular endometrial biopsies to make sure that the hyperplasia has been treated and does not return.
Endometrial cancer is treated with surgery (usually hysterectomy with removal of nearby lymph nodes) in most cases. Discuss your options with your health care provider.
Cervix: The lower, narrow end of the uterus, which protrudes into the vagina.
Estrogen: A female hormone produced in the ovaries.
Hysterectomy: Removal of the uterus.
Lymph Nodes: Small glands that filter the flow of lymph (a nearly colorless fluid that bathes body cells) through the body.
Ovulation: The release of an egg from one of the ovaries.
Progesterone: A female hormone that is produced in the ovaries and prepares the lining of the uterus for pregnancy.
Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.
Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.