Is Irregular Bleeding Normal During Perimenopause?

woman speaking with doctor

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Perimenopause is the natural decline in reproductive hormones a woman experiences when she reaches her 40s or 50s. And irregular bleeding can be a common byproduct of this shift in hormone levels. It's important to understand, however, that not all menstrual problems are caused by perimenopause or menopause.

What Level of Bleeding Should You Expect?

You will likely experience changes in your menstrual cycle during perimenopause. Your periods may be either shorter or longer. You might experience heavy or lighter bleeding during your period. You may even skip periods altogether. The length and flow of uterine bleeding should remain fairly predictable when your periods do arrive, however, so it may be cause for concern if it becomes unpredictable.

There are several things that can cause abnormal bleeding. Call your health care provider if you experience:

  • Very heavy bleeding, necessitating that you wake up several times a night to change your pad or tampon
  • Large blood clots during menstruation
  • Periods lasting over one week
  • Spotting between periods
  • Bleeding after sex
  • Dizziness or fatigue from extra blood loss

What Might Be Causing These Abnormalities in My Bleeding?

There are a number of possible culprits if you're experiencing abnormalities in your bleeding habits.

For women who have already gone through menopause (a complete cessation of periods for 12 months or longer), vaginal bleeding could indicate uterine or cervical cancer. But during perimenopause, which is the period leading up to full menopause, there might be another explanation.

Heavy bleeding may be caused by uterine fibroids or polyps; endometriosis; bleeding disorders; certain medications, such as blood thinners; or a pelvic infection. Though the most common reason for heavy bleeding during perimenopause is anovulation, which is what happens when the ovary withholds an egg but continues releasing estrogen. Because of this, the uterine lining thickens and sheds in an unpredictable manner, causing irregular and/or heavy bleeding.

A number of simple diagnostic tests, many of which are non-invasive, can determine the cause of abnormal bleeding. These include a vaginal ultrasound, an endometrial biopsy, and a hysteroscopy. Additionally, doctors may perform a blood test on women with heavy bleeding to determine if they have a bleeding disorder or suffer from anemia.

Treatment for Abnormal Bleeding During Perimenopause

Medications are often the first option when it comes to treating for abnormal bleeding. Even the birth control pill may help regulate period length and flow. A relatively new intrauterine device (IUD) is also available that both acts as an effective form of birth control and releases a hormone that thins the uterine lining.

Surgical options may be considered if medications don’t work. These include procedures such as endometrial ablation or a hysterectomy.

Hysterectomies, which 600,000 American women undergo annually, are still considered the gold standard for permanently solving the problem of heavy uterine bleeding in women unconcerned with future childbearing. However, it is also the most invasive option.

If you start to feel concerned about any abnormal bleeding you're experiencing, take note of the length and amount of flow and bring your concerns to your doctor.

If there is a history of endometriosis or other such conditions in your family, it may be worth it to seek out a doctor who specializes in such maladies.

Either way, don't keep quiet and assume it the problem will fix itself. It's better to get a diagnosis than to leave untreated something that may be serious.

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