Menopause Symptoms & Long-Term Bleeding

According to the Mayo Clinic, the average age for a woman to reach menopause in the United States is 51, although it can occur at an earlier or later age. Perimenopause begins the the late 30s, when hormone production slows. After a woman has gone 12 months without a menstrual period, she is considered menopausal. Post-menopausal vaginal bleeding is never considered "normal."

Perimenopause

• In a woman's late 30s, several symptoms indicate that menopause is nearing. Normally regular periods may become irregular. Fat begins to increase in the abdominal area, hair thins and the breasts start to lose fullness. Discomfort including vaginal dryness, sleep disruptions, mood swings and hot flashes can be present. These are related to a slowing in hormone production. The ovaries no longer produce the same amount of estrogen and progesterone to produce eggs and induce ovulation, and the post-ovulatory increase in progesterone declines. These changes become more pronounced in the 40s, until the ovaries stop producing eggs entirely and periods cease.

Menopause

• After 12 months without a period, a woman is considered to have reached menopause. Conception is no longer possible. This does not signal that the end of life is nearing or that a woman cannot or should not engage in sexual activity.

  Menopause may be triggered by other medical issues. Women who have received a hysterectomy in which only the uterus was removed will not generally experience menopause immediately. The ovaries continue to release eggs and produce hormones. After a total hysterectomy, which is the removal of both ovaries and uterus, menopause begins immediately. Chemotherapy and radiation therapy treatment can induce menopause. If symptoms begin, it is usually during treatment or within six months of treatment ceasing. Women who experience premature menopause (before age 40) often do so as a result of an ovarian deficiency in which not enough hormones are produced.

Postmenopause

• According to Dr. Mary Gallenberg, "Vaginal bleeding after menopause is not normal and should be evaluated by your doctor. The cause of your bleeding may be entirely harmless. However, it's important to know that postmenopausal bleeding has a number of serious causes, including cancer." Other potential complications can include cardiovascular disease, urinary incontinence, osteoporosis and weight gain.

Uterine Conditions That Cause Bleeding

• Tissues lining the uterus can thin out during postmenopause. This is the most common issue that causes spotting and bleeding and is treated with vaginal estrogen. Hormone therapy and certain blood thinners may also cause bleeding.

  Uterine fibroids, non-cancerous growths within the uterus, tend to shrink after menopause when estrogen levels decline, though sometimes they grow and cause bleeding. They need to be removed due to potential malignant changes bleeding can cause. Uterine polyps cause bleeding and always need to be removed if present. In rare instances, they can be a host site for cancerous growths.

Bleeding Related to Cancer

• Dr. Rosalina Abboud of the Mayo Clinic says that "one in 10 women with postmenopausal bleeding has endometrial hyperplasia, and another one in 10 has endometrial cancer."

  Women with endometrial hyperplasia (thickened uterine lining) can experience bleeding. This is most common in obese women, women with prolonged estrogen exposure, polycystic ovarian syndrome sufferers, those who began periods at an earlier age, women who experienced late menopause and those who never had children. It should be treated promptly (with surgery or medicine) because it increases the risk of endometrial cancer.

  The Mayo Clinic identifies endometrial cancer as the most common cancer of the uterus. Obesity is the biggest risk factor, raising the risk of developing it three to 10 times higher than in someone of healthy weight. A white or watery pink discharge may precede bleeding, lasting from a few weeks to a few months. Women should bring this discharge to the attention of their doctor right away. Bleeding usually occurs in the earliest stages of the cancer, when the cure rate is highest.