Notes on Women's Health
Notes on Women's Health

Causes of Abnormal Bleeding Around Menopause: Navigating the Changes

Mature woman sitting on bed with manopause cramping and abnormal bleedingMenopause is the time in a woman’s life when the ovaries stop producing estrogen. If you’ve gone through 12 consecutive months without a menstrual period, it’s official: you’ve reached menopause. For about 40% of women, that’s all there is to it.

For the other 60% of women, the months or years leading up to menopause can bring a host of symptoms. Brought on by hormonal changes, the symptoms can include insomnia, fatigue, hot flashes, chest pain, cramping, moodiness, vaginal dryness, abdominal weight gain, a rapid or irregular heartbeat, a reduced sex drive, urinary incontinence, and abnormal uterine bleeding — that is, irregular or heavy bleeding. Or both. These changes can bring on confusion and anxiety, especially if you’re not expecting them at this point in your life.

What is abnormal uterine bleeding?

In the United States, the average age for reaching menopause is 51 or 52. But this is just an average, and although “perimenopause” — that is, the time around menopause — usually lasts about four years, it can start (and stop, and start again) 10 years or more before menopause. Whether your period has become irregular or if you’re bleeding more than usual, it’s a good idea to check with your doctor.

What causes irregular bleeding before menopause?

As we described in our previous blog on abnormal bleeding during the reproductive years, irregular bleeding can be caused by many different factors. Like many physicians, we use a classification system called PALM-COEIN that covers most of the possible reasons why a woman might experience heavy period flow and other unusual bleeding during her reproductive years — a period of time that includes perimenopause. Each letter stands for a different diagnosis, including polyps (small abnormal growths), fibroid tumors, clotting disorders, ovulation problems and endometriosis (when the tissue that usually grows inside the uterus grows outside the uterus). Bleeding levels can be affected by many other factors, including stress, pregnancy, infections, irritation, blood and thyroid disorders, hormone-based birth control, and hormone fluctuations that can occur during perimenopause.

During perimenopause, these hormonal changes can interfere with ovulation (the release of an egg from the ovaries). If ovulation does not occur, the ovaries continue making estrogen, which causes the endometrium (the lining of the uterus) to keep thickening. This can lead to a late menstrual period followed by irregular bleeding and spotting. It can also lead to endometriosis and other complications.

When to seek medical attention

If you’re bleeding or spotting more (or less) than usual, or if the frequency of your bleeding changes noticeably, then you should check in with your doctor. If you think you might be in perimenopause, remember that there are many other possible causes of irregular bleeding, some of which can have serious health implications. If your bleeding is accompanied by other symptoms such as lightheadedness, severe abdominal pain or fevers, you should be evaluated as soon as possible.

What to tell your doctor

You’ll be able to help your doctor determine the cause of irregular bleeding if you know the answers to a few questions. Your healthcare professional will likely ask you about the following:

  • Details about your most recent episode of vaginal bleeding
  • Your most recent normal menstrual cycle
  • Any previous episodes of abnormal bleeding, including a calendar record or an assessment chart, if you have one
  • If you may be pregnant
  • Your previous pregnancies and their outcomes
  • Your recent sexual activity
  • Your past or current use of any form of birth control
  • Any medications, supplements or illicit drugs you’re taking
  • Any personal or family history of bleeding disorders
  • Any recent surgeries or gynecological procedures

Possible tests and examinations

After asking these questions, your doctor will probably perform a complete physical examination, including a thorough pelvic exam to look and feel for any abnormalities. This may involve use of an ultrasound imaging test. Your doctor may also take fluid or tissue samples to test for pregnancy, bleeding disorders, thyroid problems, sexually transmitted diseases, cancer or other possible conditions.

Supporting your body as it changes

Whatever is causing your symptoms, remember that there are ways to support your body. Eating right and other good lifestyle habits can help, as can daily supplements and progesterone cream. Many women find that with these changes, their symptoms become less bothersome. Likewise, many women who are in the early stages of perimenopause and experiencing a drop in fertility but who are trying to get pregnant have, through lifestyle changes and use of supplements, been able to stabilize their hormones and go through a successful pregnancy.

Treatments for abnormal uterine bleeding during perimenopause

Just as there are many potential causes of irregular bleeding, there are many possible treatments, from medications to advanced surgery. If your bleeding is related to perimenopause or other hormonal irregularities, treatments may involve the use of prescription hormones such as birth control pills to make adjustments to your menstrual cycle. If other causes are found, treatment is generally directed toward the underlying cause. If you think you may be in perimenopause or if you’re simply uncomfortable with the symptoms you’re experiencing, remember that a woman’s body is always changing and that your healthcare provider may be able to help you get through the transition.

Additional information

If you have any questions about abnormal uterine bleeding or perimenopause, feel free to contact us for more information and to discuss your particular situation. Other information resources can be found below.

American Congress of Obstetricians and Gynecologists: perimenopausal bleeding FAQs

About the practice

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

For more information, go to www.garofaloobgyn.com. John Garofalo, MD, and Laury Berkwitt, APRN, can be reached for personal consultations by calling 203.803.1098.