Perimenopause and menopause: When to be concerned about bleeding

Triz Smith, MN

Obstetrics and Gynecology

Bleeding after menopause is a cause for concern, but what if it happens during perimenopause? Triz Smith, MD, explained what could be causing it and when to be concerned.

What is menopause vs. perimenopause?

Menopause is the time when a woman’s menstrual periods stop permanently. The years leading up to this point are called perimenopause. 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. You may have irregular bleeding or spotting. Some months, your period may be longer and heavier. Other months, it may be shorter and lighter. The number of days between periods may increase or decrease. You may begin to skip periods,” said Dr. Smith.

When should you be concerned about bleeding?

Although the menstrual period may become irregular during perimenopause, you should be alert for abnormal bleeding or any of the following changes in your monthly cycle such as:

• Very heavy bleeding
• Bleeding that lasts longer than normal
• Bleeding that occurs more often than every three weeks
• Bleeding that occurs after sex or between periods

Dr. Smith shared common causes and treatments for abnormal bleeding during perimenopause:

• Polyps. Polyps are noncancerous growths that develop from tissue lining the inside of the uterus. Surgery may be needed to remove the polyps if they are causing the abnormal bleeding.
• Endometrial atrophy. After menopause, the endometrium may become too thin as a result of low estrogen levels. Endometrial atrophy can be treated with medications.
• Endometrial hyperplasia. In this condition, the lining of the uterus thickens. It is caused by excess estrogen without enough progesterone. In some cases, the cells of the lining become abnormal. This condition, called atypical hyperplasia, can lead to cancer of the uterus. When endometrial hyperplasia is diagnosed and treated early, endometrial cancer often can be prevented. Endometrial hyperplasia can be treated with progestin therapy, which causes the endometrium to shed. Thickened areas of the endometrium may be removed using hysteroscopy or a dilation and curettage, also known as a D&C.

“Any bleeding after menopause is abnormal and should be reported to your doctor,” said Dr. Smith. “If you have concerns, talk to you doctor. We’re here to help you.”