Abnormal Uterine Bleeding During Perimenopause

By Susan J. Momont, MD, FACOG
Obstetrics & Gynecology
Obstetrical & Gynecological Care

Perimenopause is the gradual transition into menopause when periods stop completely. For most women approaching menopause, changes in menstrual bleeding are natural and normal. The process occurs slowly over the course of many years, usually beginning in their late 30s to early 40s.

In perimenopausal women, abnormal bleeding from the uterus may be an indication of a serious health problem. Abnormal uterine bleeding needs to be checked by a health care provider as soon as possible.

What is considered abnormal uterine bleeding?

• Periods that are much heavier than usual, especially bleeding accompanied by blood clots
• Periods lasting more than 7 days, or 2 or more days longer than usual
• Frequent periods ( intervals shorter than 21 days from the start of one period to the start of the next )
• Spotting or bleeding between menstrual periods
• Bleeding after sexual intercourse

Possible Causes of Abnormal Uterine Bleeding:

Hormonal Imbalance ­ Irregular or heavy bleeding can be cased by an imbalance in estrogen and progesterone production. Other hormone abnormalities, such as a low thyroid hormone level can also cause changes.

Hormonal Contraceptives ­ use of oral contraceptive pills, implants, injections and intrauterine devices can cause spotting or breakthrough bleeding.

Pregnancy ­ Uterine bleeding can occur during a normal pregnancy, as well as with ectopic pregnancy or threatened miscarriage.

Fibroids ­ These growths in or around the uterus are a common cause. While many women with fibroid tumors have no symptoms, others may experience abnormal uterine bleeding, menstrual cramps, back pain, or difficulty with bowel movements or urination.

Uterine Lining Abnormalities ­ Noncancerous growths such as polyps

Cancer ­ Cancer in the uterus, vagina, or cervix can cause abnormal bleeding. Regular pelvic examinations, tests and ultrasound can be helpful in diagnosing these serious diseases early enough for effective treatment.

Other Causes ­ Factors that interfere with blood clotting sometimes cause uterine bleeding. Physical conditions of the vagina or cervix could also be the source of the bleeding.

Endometrial Evaluation

For perimenopausal women with abnormal uterine bleeding, your doctor will want details regarding when the bleeding occurs, the amount and color of the blood, the presence of clots, pelvic pain or other associated symptoms. Information about use of contraceptives, other medication and any other medical problems can also help with the diagnosis.

A pelvic examination is standard. Laboratory tests such as a pregnancy test, complete blood cell count (to determine if anemia is present), thyroid-stimulating hormones tests, or blood coagulation studies may also be ordered. An ultrasound, endometrial biopsy, or other diagnostic procedure may be recommended.

Bleeding after Menopause

When a woman is menopausal, periods have stopped completely. Use of hormone replacement therapy (HRT) can cause uterine bleeding to resume. Unless the bleeding is the typical pattern cased by HRT, please see your healthcare provider if you are experiencing irregular bleeding. Women who have uterine bleeding after menopause need to see their doctor immediately to rule out serious causes, such as cancer.

For more information, or to schedule an appointment, contact Dr. Momont
at Obstetrical & Gynecological Care » 715-834-9998 or www.obgycare.com