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.