Perimenopausal Bleeding and Bleeding After Menopause

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 ... Skiptomaincontent HealthyLiving Screening&Prevention SexualHealth&Relationships BirthControl HealthyTeens HealthyAging Pregnancy GettingPregnant DuringPregnancy LaborandDelivery AfterPregnancy PregnancyBook TopicsA-Z TopicsA-Z COVID-19 Cancer MentalHealth PrenatalTesting Menopause MenstrualHealth HeartHealth Vaccines SpecialProcedures DiseasesandConditions BrowseAllTopics ViewAllFrequentlyAskedQuestions Experts&Stories TheLatest AskACOG Menu FAQs PerimenopausalBleedingandBleedingAfterMenopause Share Facebook Twitter Email Link URLhasbeencopiedtotheclipboard Close Print FrequentlyAskedQuestions ExpandAll Whataremenopauseandperimenopause? Usuallybeginninginthemid-40s,womenenteraphasecalledperimenopause.Duringthisphase,hormonelevelsandthemenstrualcyclebegintochange.Perimenopausemaylastfromages45to55,althoughthetimingvariesfrompersontoperson.Duringthistime,theovariesgetsmallerandmakelessestrogen.Thebodygoesthroughotherchangesaswell. Becausethesechangeshappenslowlyovertime,womenmaynotbeawareofthematfirst.Menopauseisdefinedastheabsenceofmenstrualperiodsfor1year.IntheUnitedStates,theaverageageofthelastmenstrualperiodis51. Whatisanormalmenstrualcycle? Thelengthofthemenstrualcycleistypicallybetween24and38days.Anormalperiodgenerallylastsupto8days.Duringyourreproductiveyears,yourperiodsmayberegular.Yourbleedingmaybethesamefrommonthtomonth.Withperimenopause,thingschange. Whathappensduringamenstrualcycle? Duringanormalmenstrualcycle,thelevelsofthehormonesestrogenandprogesteroneincreaseanddecreaseinaregularpattern.Ovulationoccursinthemiddleofthecycle.Ifawomandoesnotgetpregnant,aperiodstartsabout2weekslater. Whatchangesduringperimenopause? Duringperimenopause,theovariesbegintomakelessestrogen.Somemonths,theovariesmayreleaseanegg.Othermonths,theydonotreleaseanegg.Inyour40s,yourperiodsmaybeshorterorlonger,andthedaysbetweenmayincreaseordecrease.Yourbleedingmaychangetoo—itmaybeheavierorlighter.Youalsomayskipperiods. HowdoIknowifmybleedingisabnormal? Itisnotnormaltohave bleedingorspottingbetweenperiods bleedingorspottingaftersex heavybleedingduringyourperiod bleedingthatisheavierorlastsformoredaysthanusual bleedingaftermenopause ShouldItalkwithmyob-gynaboutmybleeding? Yes.Althoughit’snormalforperiodstochangeasyounearmenopause,youshouldstilltalkwithyourobstetrician–gynecologist(ob-gyn)aboutbleedingchanges.Abnormalbleedingsometimescanbeasignofhealthproblems.It’sespeciallyimportanttotellyourob-gynifyouhavebleedingaftermenopause. Whataresomeofthecommoncausesofabnormalbleeding? Ifyouhaveanybleedingaftermenopause,orifyouhaveanyoftheabnormalchangesinyourmonthlycyclelistedabove,it’simportanttoseeyourob-gyntofindoutthecause.Manythingscancauseabnormalbleeding,including polyps endometrialatrophy endometrialhyperplasia endometrialcancer Whatarepolyps? Polypsarenoncancerous(benign)growthsthatattachtothewalloftheuterus.Theyalsomaydevelopontheendometrium(liningoftheuterus).Thesegrowthsmaycauseirregularorheavybleeding.Polypsalsocangrowonthecervixorinsidethecervicalcanal.Polypsonthecervixmaycausebleedingaftersex. Whatisendometrialatrophy? Aftermenopause,theuterineliningmaybecometoothin.Thiscanhappenwhenawomanhaslowlevelsofestrogen.Theconditioniscalledendometrialatrophy.Astheliningthins,awomanmayhaveabnormalbleeding. Whatisendometrialhyperplasia? Endometrialhyperplasiaisaconditionthatcausestheliningoftheuterustogettoothick.Theconditionisnotcancer,butinsomecases,itcanleadtocancer.Endometrialhyperplasiamostofteniscausedwhenawomanhastoomuchestrogenandnotenoughprogesterone.Earlytreatmentmayreducetheriskofendometrialcancerdeveloping. Whatisendometrialcancer? Endometrialcanceriscanceroftheliningoftheuterus.Itisthemostcommontypeofcancerofthefemalereproductivesystem.Bleedingisthemostcommonsignofendometrialcancerinpostmenopausalwomen.Whendiagnosedearly,mostcasesofendometrialcancercanbetreatedsuccessfully. Whatareriskfactorsforendometrialcancer? Theriskfactorsforendometrialcancerinclude gettingolder earlyagewhenperiodsstarted olderageatmenopause neverhavingbeenpregnant irregularperiods historyofinfertility long-termuseofmedicationscontaininghighdosesofestrogen obesity polycysticovarysyndrome(PCOS) treatmentwithadrugcalledtamoxifen certaintumorsoftheovaries historyofdiabetesmellitus,highbloodpressure,gallbladderdisease,orthyroiddisease personalorfamilyhistoryofcertaintypesofcancer(suchasovariancancerorcoloncancer) smoking Endometrialcanceralsocanoccurwithoutanyoftheseriskfactors. Whataresomeothercausesofbleedingaftermenopause? Othercausesofbleedingaftermenopauseinclude hormonetherapy infectionoftheuterusorcervix useofsomemedications othertypesofcancer Howisabnormalbleedingdiagnosed? Todiagnosethecauseofabnormalbleeding,yourob-gynshouldreviewyourpersonalandfamilyhealthhistory.Youmayhaveaphysicalexam.Youalsomayhaveoneormoretests.Someofthesetestscanbedoneinyourob-gyn’soffice.Othertestsmaybedoneatahospitalorsurgicalcenter. Whatisanendometrialbiopsy? Thisproceduretakesasmallpieceoftissuefromtheliningoftheuterus.Athintubeispassedthroughthecervixandintotheuterustotakethesample.Thesampleissenttoalabwhereitislookedatunderamicroscope. Whatisapelvicultrasound? Anultrasoundexamusessoundwavestocreateapictureofthepelvicorgans.Atransducersendsoutthesoundwaves.Thesoundwavesreachtheorgansandbounceback,likeechoes.Thetransducerreceivestheseechoesandturnsthemintoimagesthatareshownonavideoscreen.Forapelvicultrasound,thetransducercanbemovedacrosstheabdomenoritcanbeplacedinthevagina. Whatissonohysterography? Thisisaspecialkindofultrasoundexam.Athintubeispassedthroughthecervixandintotheuterus.Fluidisinjectedintotheuterusthroughthetube.Whentheuterusisfilledwithfluid,ultrasoundimagesaremadeoftheinsideoftheuterusandtheuterinelining.Forthisprocedure,thetransducerisplacedinthevagina. Whatishysteroscopy? Thisprocedureusesathin,lightedtubewithacameraattheend.Thetubeisinsertedthroughthecervixandintotheuterus.Thecameragivesaviewoftheinsideoftheuterus. Whatisdilationandcurettage(D&C)? Thisprocedureremovestissuefromtheliningoftheuterus.Tostartthisprocedure,alsocalledaD&C,aseriesofrodsisinsertedintotheopeningoftheuterus.Eachrodwillbeslightlylargerthanthelastone.Thisexpandsthecervixsoinstrumentscanpassthrough.Whenthecervixisexpanded,theob-gyninsertsaninstrumentcalledacurette.Thisisasharpinstrumentthatalsomayusesuction.Theremovedtissueissenttoalab,whereitislookedatunderamicroscope. Whattreatmentisavailableforabnormalbleeding? Treatmentforabnormalbleedingduringperimenopauseoraftermenopausedependsonthecause(seebelow). Howarebenigncausesofabnormalbleedingtreated? Polypsmayberemovedwithasurgicalprocedure. Endometrialatrophycanbetreatedwithmedications. Endometrialhyperplasiacanbetreatedwithprogestintherapy,whichcausestheendometriumtoshed.Sincewomenwithhyperplasiaareatincreasedriskofendometrialcancer,theyneedregularbiopsiestomakesurethatthehyperplasiahasbeentreatedanddoesnotreturn. EndometrialhyperplasiaalsocanbetreatedwithaD&Cprocedure. Whatifabnormalbleedingiscausedbycancer? Endometrialcancerusuallyistreatedwithsurgery.Duringsurgery,thecervixanduterusareremoved(hysterectomy),aswellasbothovariesandfallopiantubes.Lymphnodesandothertissuemayberemovedandtestedtoseeifthecancerhasspread. Whathappensaftersurgeryforendometrialcancer? Aftersurgery,thestageofdiseaseisdetermined.Staginghelpsdetermineifadditionaltreatment,suchaschemotherapyorradiationtherapy,isneeded.StagesofcancerrangefromItoIV.StageIVisthemostadvanced.Thestageofcanceraffectsthetreatmentandoutcome. Glossary Cervix:Thelower,narrowendoftheuterusatthetopofthevagina. Chemotherapy:Treatmentofcancerwithdrugs. DiabetesMellitus:Aconditioninwhichthelevelsofsugarinthebloodaretoohigh. EndometrialHyperplasia:Aconditioninwhichtheliningoftheuterusgrowstoothick. Endometrium:Theliningoftheuterus. Estrogen:Afemalehormoneproducedintheovaries. FallopianTubes:Tubesthroughwhichaneggtravelsfromtheovarytotheuterus. HighBloodPressure:Bloodpressureabovethenormallevel.Alsocalledhypertension. Hormone:Substancemadeinthebodythatcontrolsthefunctionofcellsororgans. HormoneTherapy: Treatmentinwhichestrogenandoftenprogestinaretakentohelprelievesymptomsthatmayhappenaroundthetimeofmenopause. Hysterectomy: Surgerytoremovetheuterus. LymphNodes:Smallgroupsofspecialtissuethatcarrylymph,aliquidthatbathesbodycells.Lymphnodesareconnectedtoeachotherbylymphvessels.Together,thesemakeupthelymphaticsystem. Menopause:Thetimewhenawoman’smenstrualperiodsstoppermanently.Menopauseisconfirmedafter1yearofnoperiods. MenstrualCycle:Themonthlyprocessofchangesthatoccurtoprepareawoman’sbodyforpossiblepregnancy.Amenstrualcycleisdefinedasthefirstdayofmenstrualbleedingofonecycletothefirstdayofmenstrualbleedingofthenextcycle. MenstrualPeriods: Themonthlysheddingofbloodandtissuefromtheuterus. Obstetrician–Gynecologist(Ob-Gyn):Adoctorwithspecialtrainingandeducationinwomen’shealth. Ovaries:Organsinwomenthatcontaintheeggsnecessarytogetpregnantandmakeimportanthormones,suchasestrogen,progesterone,andtestosterone. Ovulation:Thetimewhenanovaryreleasesanegg. Perimenopause:Thetimeperiodleadinguptomenopause. PolycysticOvarySyndrome(PCOS):Aconditionthatleadstoahormoneimbalancethataffectsawoman’smonthlymenstrualperiods,ovulation,abilitytogetpregnant,andmetabolism. Polyps: Abnormaltissuegrowthsthatcandevelopontheinsideofanorgan. Progesterone:Afemalehormonethatismadeintheovariesandpreparestheliningoftheuterusforpregnancy. Progestin:Asyntheticformofprogesteronethatissimilartothehormonemadenaturallybythebody. RadiationTherapy:Treatmentwithradiation. Stage:Stagecanrefertothesizeofatumorandtheextent(ifany)towhichthediseasehasspread. Tamoxifen: Anestrogen-blockingmedicationsometimesusedtotreatbreastcancer. Transducer:Adevicethatsendsoutsoundwavesandtranslatestheechoesintoelectricalsignals. UltrasoundExam:Atestinwhichsoundwavesareusedtoexamineinnerpartsofthebody.Duringpregnancy,ultrasoundcanbeusedtocheckthefetus. Vagina:Atube-likestructuresurroundedbymuscles.Thevaginaleadsfromtheuterustotheoutsideofthebody. Articlecontinuesbelow Advertisement Ifyouhavefurtherquestions,contactyourob-gyn. Don'thaveanob-gyn?Searchfordoctorsnearyou. FAQ162 Published:October2020 Lastreviewed:October2020 Topics: HealthyAging MenstrualHealth Copyright2022bytheAmericanCollegeofObstetriciansandGynecologists.Allrightsreserved.Readcopyrightandpermissionsinformation. Thisinformationisdesignedasaneducationalaidforthepublic.Itofferscurrentinformationandopinionsrelatedtowomen'shealth.Itisnotintendedasastatementofthestandardofcare.Itdoesnotexplainallofthepropertreatmentsormethodsofcare.Itisnotasubstitutefortheadviceofaphysician.ReadACOG’scompletedisclaimer. Clinicians:SubscribetoDigitalPamphlets ExploreACOG'slibraryofpatienteducationpamphlets. Pamphlets Advertisement AGuidetoPregnancyfromOb-Gyns Fortrusted,in-depthadvicefromob-gyns,turntoYourPregnancyandChildbirth:MonthtoMonth. LearnAbouttheBook FindanOb-Gyn Searchfordoctorsnearyou. StartYourSearch WhattoReadNext FAQs EndometrialCancer ExpertView 5oftheMostCommonQuestionsAboutMenopause ExpertView ExperiencingVaginalDryness?Here'sWhatYouNeedtoKnow. PatientStory LearningtoCopeWithHotFlashes BacktoTop