Abnormal Uterine Bleeding Playbook: Make A Game Plan

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The only lining I used to obsess over was that on the inside of my blazers. Now that I’m dealing with perimenopause and menopause, my obsession has turned to a much more important lining …the lining of my uterus.

When we have a normal menstrual cycle, the lining of the uterine cavity usually sloughs off every 28 days. In menopausal women, the lining usually thins out and no longer sloughs off.

As women’s moods can fluctuate during the menstrual cycle, the period also can become a Drama Queen during perimenopause (the 6-10 years before menopause). She can come and go as she pleases. Sometimes she’ll make a surprise appearance, sometimes she’ll stay beyond her welcome, and sometimes she’ll just be spotty. When you haven’t seen her for 12 consecutive months, you can now past go and collect $200! Yes, you are now in menopause. Wouldn’t it be more fun if it was a board game? Sigh.

What is abnormal bleeding?

Many women experience random bleeding during their perimenopausal and menopausal journey. Although menstrual irregularity is normal during perimenopause, unusual bleeding could be a sign of a problem. Unusual bleeding can be attributed to a variety of factors, including: thyroid problems, hormonal imbalance, thinning (atrophy) of the endometrial or vaginal tissues, uterine polyps, fibroids and cancer – just to name a few. Three of the most common causes, according to the American College of Obstetricians and Gynecologists (ACOG), are:

  • Polyps – Polyps are growths of tissue that are usually noncancerous. On the uterine wall or endometrial surface, they can cause irregular or heavy bleeding. On the cervix, they can cause bleeding after sex.
  • Endometrial atrophy – Due to low estrogen levels after menopause, the endometrium may thin out, causing abnormal bleeding.
  • Endometrial hyperplasia – This is the opposite of atrophy, as the uterine lining thickens due to excess estrogen (without enough progesterone). If the cells of the uterine lining become abnormal (atypical hyperplasia), this can lead to uterine cancer. However, endometrial cancer can be prevented with early diagnosis and treatment. ACOG notes that bleeding is the most common sign of endometrial cancer in postmenopausal women.

What should you do if you experience abnormal bleeding?

If you suddenly experience out-of-the-ordinary bleeding, it’s very important to be evaluated by your gynecologist/menopause specialist. Think of him/her as your coach to help you tackle your opponent.

So how can you tell if your bleeding is abnormal? According to ACOG, any bleeding after menopause is abnormal. During perimenopause and menopause, alert your doctor if you experience any of the following:

  • very heavy bleeding
  • bleeding that lasts longer than normal
  • bleeding that occurs more often than every 3 weeks
  • bleeding that occurs after sex or between periods

I’ve got abnormal bleeding – now what?

In addition to a physical examination, ultrasound and endometrial biopsy are two ways your doctor can examine endometrial bleeding. Here’s the possible team lineup from ACOG:

  • Dilation and curettage (D&C) – The cervix opening is enlarged and tissue is scraped or suctioned off the uterus then sent to a lab for testing. (Note that your vagina will be benched from the playing field for a few weeks after the procedure.)
  • Endometrial biopsy – A thin tube is used to extract a small amount of tissue from the uterine lining; the sample is then sent to a lab for testing.
  • Hysteroscopy – A hysteroscope (a thin, lighted tube with a camera at the end) is inserted into the cervix, providing a view of the inside of the uterus.

I featured my own experience with bleeding in Menopause Mondays: D&C – Hysteroscopy – Polypectomy. I also featured Molly’s story as I wanted to stress the importance of having ALL out-of-the-ordinary bleeding evaluated by your doctor.

I received my test results – what’s the game plan?

Treatment, of course, depends on your diagnosis. ACOG outlines several options:

  • Polyps may require surgery.
  • Endometrial atrophy can be treated with medication.
  • Endometrial hyperplasia can be treated with progestin therapy, which causes shedding of the endometrium. However, you’ll need regular endometrial biopsies as this condition puts you at increased risk for endometrial cancer.
  • Endometrial cancer usually requires a hysterectomy (removal of the uterus) and removal of nearby lymph nodes. (I’d like to point out that, while many women get hysterical over the thought of a hysterectomy, in this case it’s the best option and certainly not the end of the world for women past childbearing age.)

As you go through perimenopause and menopause, don’t forget to “tick” off your symptoms in a menopause symptom chart. If something doesn’t feel right, don’t pretend it’s not happening. Your doctor or your menopause specialist is always a phone call away. It may be nothing. But if it’s not, you just might be able to give this unwanted “guest” (and any of her unsavory teammates) the heave-ho.

Suffering in silence is OUT! Reaching out is IN!

After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

  • Lori Jo Vest

    You may also be able to stave off the uterine bleeding with a Mirena IUD (depending on what’s causing it, of course!) The Mirena releases small amounts of hormones directly into the uterus. Mine has done wonders and I don’t have to cut back my activities anymore.

    • Ellen Dolgen

      Thanks for sharing, Lori!

  • Deb

    Such a welll researched, well written article!

    • Ellen Dolgen

      Thanks, Deb!

  • Very interesting piece. I have learned a lot!

    • Ellen Dolgen

      I am so happy you found the blog helpful, Rena!

  • Linda

    Hi Ellen:) great info! Totally understand what your saying regarding hysterectomy… So many women suffer and think it’s to drastic a surgery…? When really, the thing that is drastic is bleeding heavy for 10 days, painful cramping . Been there and don’t regret having a partial hysterectomy. Like alot of women, i had chronic endometriosis. It was a miracle i was able to get pregnant. At the age of 35 i couldn’t Handel the pain and bleeding anymore. The decision was to keep my ovaries. After the surgery my husband said, he felt like he had a hysterectomy too:) LOL! No more misery!
    My hope for women is to do what’s best for you… Taking care of yourself is necessary. Especially when menopause hits. Now at the age of 53, I’m so blessed to have this blog with Loving support during menopause:)

    • Ellen Dolgen

      I love what your husband said, Linda! Women truly are the glue that holds the family together…when we are not feeling well — it affects everyone in the house! You are so right…..women need to do what is best for them. There is no one – size – fits – all. My Motto is: Suffering in silence is OUT! Reaching out is IN! I am thrilled that you find Menopause Mondays a helpful blog! Thanks so much for taking the time to comment! We learn from each other.

  • Susan

    Ellen, thank you so much for this information. It was very timely as I am having this procedure done next week. Reading your personal story really helped to alleviate my fears – and the way you wrote it made me laugh. I am going to share what you wrote with my daughters so they will understand. My doctor explained it well, but having the information from someone who has actually had the procedure helps. I have also shared the Shmirshky book with several friends over the past few years. Thank you for what you are doing!!! I look forward to the newsletter each week – lots of good information.

    • Ellen Dolgen

      Thanks for taking the time to write such sweet words, Susan. It makes me so happy that I have helped to alleviate your fears! Keep me posted on you! Good Luck!

  • Linda

    I was diagnosed by my gyno with endometrial hyperplasia after a month of flooding. I was then diagnosed with low thyroiid, a serious Vit. d deficiency and low progesterone by a second doctor that specializes in bioidentical hormones. After three months on bioidentical progesterone, iodine, magnesium and high dose Vit D, the bleeding is under control, thank goodness. Your article states that progestin treatment raises your risk of endometrial cancer…what about bioidentical progesterone?

    • Ellen Dolgen

      Linda,
      Sounds like you found a great doctor that has got your hormones balanced and the bleeding eliminated. Good for you for taking such good care of yourself! Progesterone, a natural human hormone made by the ovaries which has multiple roles in balancing the effects of estrogen upon the human body. Progestin is a synthetic form of the hormone progesterone which mimics the benefits of progesterone.. You have asked a very good question that would be best answered by your hormone specialist. Thanks for sharing your journey!

  • Had the biopsy and d&c several times but last results were that nothing lives there. Which was kind of freaky, actually. 😉

    • Ellen Dolgen

      Carol, I can understand how the use of these words would feel strange. I wonder who comes with these words????

  • Helen

    Bravo for publishing this. I went into see gyno after extended period of 13 days, we opted for aggressive approach and proceeded to hysteroscopy. I was 42 . They found endocarcinoma, very early stage. I had experimental treatment with progestin which helped the cancer recede somewhat, then ended up with full hsyto+ oophrectomy. I am fine and cancer free today. No history of cancer, don’t smoke etc in my family. I urge your readers to please see their doctor if they have any abnormal bleeding. Especially when the bleeding doesn’t look like your normal period and you are 40+. sorry for TMI. it probably saved my life.

    • Ellen Dolgen

      Helen, I am so happy that you are fine and cancer free today! You have a vital message and important message to share, thanks for taking the time to do that!

    • Dani

      This is a great article and such important information to share. I also ended up with endometrial cancer at age 43 – before menopause and with no history of cancer in my family. Like Helen, my periods were lasting for weeks and I had severe abdominal pain. I too ended up with a hysterectomy, and then an oophectomy in a separate surgery. The point if all of this sharing is to let people know that they should listen to their bodies and should never assume all is normal. If something feels wrong then it probably is! Thank you for this site!

      • Ellen Dolgen

        Thank YOU, Dani! Your story truly helps to get that message out lout and clear!

  • Dianne

    I am just realizing I have all the symptoms of perimenopause. My question is what is a menopause specialist and how do I find one? I have an appt with a new gynecologist because my old one certainly wasn’t interested in women who weren’t going to have any more babies. But how do I find a menopause specialist? I live in NYC.