Abnormal Bleeding & Spotting During Menopause

The calendar, once so useful for predicting and planning around your period, becomes useless in menopause. Periods tend toward the erratic and the stages of bleeding are never uniform among women. One woman may experience fewer cycles over time, each shorter and lighter until they stop. Another may experience heavy and scary bleeding, leading her to think, what is abnormal bleeding and spotting during menopause?

• Abnormal bleeding is hard to gauge during menopause

Normal

• About 90 percent of women will experience changes in bleeding during menopause, write Pat Wingert and Barbara Kantrowitz in "The Menopause Book." It is considered normal to skip periods, experience heavier or lighter flows, and have a period that lasts less than two days and more than four. Duration, too, may shrink from 21 to 23 days and then expand to longer and longer intervals until it stops permanently.

Abnormal

• Women should see a doctor if experiencing gushing and heavy bleeding, especially when accompanied by clots; bleeding that lasts more than seven consecutive days; cycles that begin less than 21 days apart; and any bleeding or spotting between periods or bleeding during or after sex. Heavy bleeding is defined as needing to change the maximum absorbency tampon or pad every two hours. A woman experiencing any bleeding one year after ceasing menses should be seen by a doctor.

Causes

• Hormones are a primary cause of abnormal bleeding. Menopausal women may continue to produce estrogen streams but not progesterone, which causes the uterine lining to become more overgrown than normal. Or decreases in estrogen can cause thinning of the vagina and uterus lining. Hormone therapy and oral contraceptives can induce "withdrawal bleeding." Other abnormal bleeding causes are infection, thyroid and liver problems, polyps, cysts or fibroids, use of certain medications and gynecological cancer.

Diagnosis

• A doctor will ask how often periods are occurring, the color and duration of flow and if there are any clots. The doctor may run blood tests and will perform a physical exam. Other tests that may be needed:

  An endometrial biopsy: A catheter is used to collect a small amount of tissue from the uterus.

  A sonohysterography: Fluid is injected into the uterus and a picture of the uterus is viewed.

Treatment

• Hormone therapy may be given to control bleeding, but it could take months to notice a difference. If polyps and cysts are causing the bleeding, doctors will surgically removed them. For cancer, treatment options should be discussed with the doctor. If bleeding happens only with sex, talk to the doctor about short-term use of a local hormone therapy and lubricants and personal moisturizers.