Let’s talk about menopause and abnormal bleeding, a topic often brought up in a Gynecologist’s office. What is it? When does it happen? What the heck is happening to my body, and what do I do about it?
Most women have heard tales of infamous “hot flashes” from mothers and grandmothers by the time they reach their 40s. These are no joke, but they’re not the whole story of menopause. You don’t just wake up one day in a red-hot sweat having concluded your last period and realize, “Hey, I’m in menopause.” The average age of menopause diagnosis is around 51 years old. The full transition into menopause, however, actually occurs over many years. A clinical diagnosis of menopause is only made 12 months after your last menstrual cycle. At this point, we know that the ovaries have slowed hormone production to the point where they can no longer make a follicle – the structure that releases an egg – and thereby trigger a menstrual period. Before that, a woman can experience YEARS of fluctuations in her hormonal milieu. This is called perimenopause.
It is during this transition period when women often visit their gynecologist without a good understanding of how to deal with their symptoms. For example, menstrual periods can become very irregular. This is the first sign of a change and is completely normal. A woman may have typical bleeding one month, no bleeding for three months, and then the heaviest period she’s ever seen might occur seemingly out of nowhere. These irregular cycles, though very frustrating, are usually a helpful clue that the ovaries are doing less for you than they used to. This isn’t something mothers and grandmothers talk about much, and it’s definitely not as public as hot flashes.
So as you undergo perimenopause, how can you decipher what’s normal and what’s not? During this time period, take note if your bleeding can be described by any of the following: if it occurs more often than every 3 weeks, lasts longer than 10 days, is extremely heavy, or occurs after a 6 month lapse in bleeding. Those are all reasons to see your physician. You should also be sure to see your doctor if you are experiencing irregular bleeding and have a family history of uterine cancer.
Even if those situations don’t apply, this is still a really good time for a woman to schedule a visit with her doctor in order to help ease the transition into menopause over the next few years. As the ovaries slowly stop production of estradiol, many aspects of a woman’s overall health are impacted. These include cognitive ability, sleep cycles, and the overall health of bones, heart, and the colon just to name a few. Sexual function, libido, and vaginal health are also strongly tied to the production of estradiol by the ovaries. Symptoms related to any or all of these systems can be a part of your body’s path to menopause.
So if you and your physician determine you’re on your way to the no-more-periods period, what can you do about it? During the perimenopausal years, it is still safe for most women to take oral contraceptive pills. Your physician may even recommend them to provide contraception (yes, you can still get pregnant!), decrease risk of ovarian cancers, increase bone density, and keep menstrual cycles lighter and more regular. All of these benefits can make your years leading up to menopause healthier and happier. I also discuss lifestyle changes with my perimenopausal patients – things YOU can do without a prescription to make menopause a little easier. For example, every woman should take in adequate calcium and vitamin D (1,200 mg of Ca2+ and 600 IU of VitD per day), engage in regular exercise to reach and maintain a BMI under 30, and avoid smoking. For some women, even getting a little extra estrogen from soy products in your diet can be helpful.
Irregular bleeding caused by your ovaries winding down to retirement doesn’t need to be a hushed-up, stressful situation. It can be viewed as a helpful message from your body, clueing you in to what’s next. Take the opportunity to get healthy, see your gynecologist, and prepare for menopause itself… because, as my mother just told me, “That deserves its own article.”
by Kelly McGuire, DO
Medical Associates Clinic
Dr. McGuire practices with the Medical Associates Department of OB-Gyn, in collaboration with Joseph Berger, MD, Tara L. Holste, DO, Lisa A. Kramer, MD, Trupti S. Mehta, MD, Laura Neal, MD, and Erika O’Donnell, MD. They provide a complete range of specialized care for women. Call 563-584-4435 to schedule an appointment.