What are menopause and perimenopause?

•       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, it 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?

•       Irregular bleeding or spotting

•       Longer and heavier periods alternate with shorter and lighter periods

•       The number of days between periods may increase or decrease

•       You may begin to skip periods

How can I tell if bleeding is abnormal?

•       Very heavy bleeding

•       Bleeding that lasts longer than normal

•       Bleeding that occurs more often than every 3 weeks

•       Bleeding that occurs after sex or between periods

What are some of the common causes of abnormal bleeding?

Polyps - Polyps are usually noncancerous growths of tissue that grow on the inside of the uterus. They may cause irregular or heavy bleeding. Polyps also can grow on the cervix or inside the cervical canal. These polyps may cause bleeding after sex.

Endometrial atrophy - After menopause, the endometrium may become too thin as a result of low estrogen levels causing abnormal bleeding.

Endometrial hyperplasia - The lining of the uterus thickens which can cause irregular or heavy bleeding. It is most often caused by excess estrogen without enough progesterone. In some cases, the cells of the lining become abnormal, called atypical hyperplasia which can lead to cancer of the uterus. When endometrial hyperplasia is diagnosed and treated early, endometrial cancer often can be prevented. Bleeding is the most common sign of endometrial cancer in women after menopause.

How is abnormal bleeding evaluated?

•       Endometrial biopsy

•       Transvaginal ultrasound 

•       Sonohysterography

•       Hysteroscopy

•       Dilation and curettage

What treatment is available for abnormal bleeding?

•       Surgical removal of polyps

•       Endometrial atrophy can be treated with medications

•       Thickened areas of the endometrium may be removed by using hysteroscopy or D & C

•       Endometrial cancer is treated usually surgery, typically with hysterectomy

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