Abnormal Bleeding Around the Time of Menopause

One of the most common conditions that affect women all over the world  is abnormal bleeding that occurs as women approach the end of their reproductive years. Such bleeding impacts daily activities and the quality of life. Exclusions of pregnancy and malignancy as sources for abnormal bleeding in this age group must also be considered.

Abnormal uterine bleeding can be associated with problems of ovulation – no regular shedding of eggs. These types of disorders are most commonly associated with heavy, irregular uterine bleeding. The  bleeding that  occurs in this  setting is because of the effects of chronic unopposed hormone (estrogen) on the lining of the womb -the endometrium.

As women approach menopause, the incidence of anovulatory uterine bleeding increases. Although bleeding changes in women in this age group are largely related to normal menopausal transition, it is important to rule out endometrial hyperplasia and cancer.

You are in the perimenopause as from the commencement of the onset of cycle irregularity and finishes 1 year after the last menses.

The mean age of menopause in women in the US is 51.4 years. Smokers begin menopause 1.74 years earlier than nonsmokers. The average duration of the menopausal transition is 4 years, and is most often associated with menstrual irregularity.

In perimenopausal women, the abnormal bleeding is caused by naturally declining ovarian function. The cycles during menopause can fluctuate between predictable ovulatory bleeding and erratic bleeding which can be especially frustrating for the patient.

Pregnancy must be excluded during the evaluation. Pregnancies, although rare, may still occur until 1 full year without menses.

Therefore, for women without contraindications, hormonal contraception, rather than hormone therapy, should be used for pregnancy prevention, menstrual control, and alleviation of perimenopausal symptoms in women at risk. Premenopausal use of hormone therapy will not provide menstrual regularity or contraception.

The choice of treatment of is guided by the goals of therapy, which may be to stop acute bleeding, avoid future irregular or heavy bleeding, simultaneously provide contraception, and prevent complications, such as anemia, unnecessary surgical intervention, and diminished quality of life.

Because abnormal bleeding  is an endocrinologic abnormality, the underlying disorder should be treated medically rather than surgically. Surgical therapy is  indicated only after  medical therapy has failed  is contraindicated, is not tolerated by the patient, or the patient has concomitant significant intracavity lesions.

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