Referral To A Consultant
If your GP thinks a medical condition might have caused your periods to stop, they may refer you to a consultant who specialises in the condition.
Depending on what your GP suspects is causing the problem, you may be referred to:
- a gynaecologist a specialist in treating conditions that affect the female reproductive system
- an endocrinologist a specialist in treating hormonal conditions
You may have a full gynaecological examination and various tests, including:
- blood tests to see whether you have abnormal levels of certain hormones
- an ultrasound scan, CT scan or MRI scan to identify any problems with your reproductive system or the pituitary gland in your brain
Treating Post Menopause Bleeding
If you have postmenopausal bleeding it is important to have it investigated.
You will most likely be referred to a gynaecologist who may:
- ask you questions about the history of your health
- examine you
- do a blood test
- look at the inside of your vagina and cervix using special tongs . At the same time, they may take a tiny sample of your cervix for testing .
The kind of treatment you have will depend on what is causing the bleeding.
- Atrophic vaginitis and thinning of the endometrium are usually treated with drugs that work like the hormone oestrogen. These can come as a tablet, vaginal gel or creams, skin patches, or a soft flexible ring which is put inside your vagina and slowly releases the medication.
- Polyps are usually removed with surgery. Depending on their size and location, they may be removed in a day clinic using a local anaesthetic or you may need to go to hospital to have a general anaesthetic.
- Thickening of the endometrium is usually treated with medications that work like the hormone progesterone and/or surgery to remove the thickening.
Before treatment there are a number of tests and investigations your gynaecologist may recommend.
All treatments should be discussed with you so that you know why a particular treatment or test is being done over another.
What Causes Bleeding After Menopause
Bleeding after menopause is rarely cause for concern. It does need to be investigated, however, because in very few cases it will be an indicator of something more serious.
In about 90 per cent of cases, a particular cause for bleeding after menopause will not be found. This is not a cause for alarm, if there is a serious problem it will be identified through investigations. Most of the time, postmenopausal bleeding is caused by:
- inflammation and thinning of the lining of your vagina
- thinning of the lining of your uterus
- growths in the cervix or uterus which are usually not cancerous
- thickened endometrium often because of hormone replacement therapy
- abnormalities in the cervix or uterus.
These are generally not serious problems and can be cured relatively easily.
However, about 10 per cent of the time, post-menopausal bleeding is linked to cancer of the cervix or uterus and so it is very important to have it investigated.
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Investigation Of Postmenopausal Bleeding
The primary goal in investigation is to exclude malignancy, and secondarily to elucidate a treatable non-malignant cause . In particular, patients with diabetes, obesity, history of PCOS, or a family history of endometrial cancer are at greater risk of malignancy . Patients taking non-conventional MHT, such as troches and transdermal progestogen are at risk of endometrial hyperplasia and cancer .
A detailed history should be taken. When does the bleeding occur? Is it post-coital? What medications is the patient taking? Is the patient taking tamoxifen? Is the patient taking so-called bioidentical hormones? Has the patient missed MHT doses? When was the last Pap smear?
Physical examination should include inspection of the vulva, vagina and the cervix for visual evidence of lesions or bleeding, taking note of any signs of atrophy. Bleeding from the perineum, urethra and anus is also a possibility. A Pap smear should be done.
Tamoxifen therapy is associated with stimulation of the endometrium and an increased risk of endometrial cancer . Tamoxifen therapy invariably produces a thickened endometrium which is not always indicative of neoplasia. Therefore TVUS is not useful for the investigation of PMB in a woman on tamoxifen therapy and examination of the uterine cavity by hysteroscopy is recommended .
How Long Does Implantation Bleeding Last On Your Period
Your normal period may last from three days to a week, but implantation bleeding usually occurs for less than two days. Some women may only see the spotting or light discharge on one day or for a few hours. 3. Color Implantation bleeding is normally a pinkish or brown colored discharge rather than the sharp, red color of a normal menstrual period.
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Am I Pregnant : : Unprotected Intercourse
So for the last year or so ive been on the depo provera birth control. I have not gotten my last injection due on the 16th of march. And was very lightly bleeding for about a week during that time for the next shot then it stopped for a few days and then started bleeding heavy for the next five days. Finally stopped on april 3. Keep in mind My periods have never been normal. I had unprotected sex on the 8th and 12th and now am lightly spotting. Can i be pregnant?
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Q When Should I Call A Doctor About My Perimenopausal Symptoms
If you have not had a period for 12 months and then experience vaginal bleeding, contact your doctor. It is not normal for bleeding to recur after this period of time. Read our article about when you should see your OBGYN.
Remember, perimenopause and menopause are natural and normal transitions, but they can be stressful. Many symptoms can be managed which can help you regain a sense of control, well-being, and confidence to thrive in your next stage of life.
We want you to feel supported, heard, and cared for as you go through this change.
Sometimes, the biggest help is simply confirmation that what youre experiencing is normal!
Dr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Womens Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.
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Doing Too Much Exercise
The stress that intense physical activity places on your body can affect the hormones responsible for your periods. Losing too much body fat through intense exercise can also stop you ovulating.
You’ll be advised to reduce your level of activity if excessive exercise has caused your periods to stop.
If you’re a professional athlete, you may benefit from seeing a doctor who specialises in sports medicine. They’ll be able to give you advice about how to maintain your performance without disrupting your periods.
Can I Treat Irregular Periods
For beginners, women should strive to start making lifestyle changes to promote optimal endocrine system health. An optimized diet and exercise along with wholesome habits can help women improve their overall health and cope with the changes they are experiencing. There are also alternative medicines available that can further boost the body’s efforts.
Click on the link to learn more about these natural and effective irregular period treatments, many of which can also be used to alleviate other bothersome menopause symptoms for optimal health far into one’s twilight years.
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Missed Periods Intermittent Spotting Heavy Bleeding And Flooding
Changes in periods vary widely as hormones adjust. As mentioned in other parts of this site this is a time to really tune into your body and trust your instincts. As you can see from this list it’s hard to define what perimenopause periods are like:
Periods can disappear for a year and then return.
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The Best Friends Guide: Anxiety – A Practical Toolkit For Moving Beyond Anxiety at Menopause – 12
Thanks Girls another great book ! Well done My Second Spring, the advice is practical, down to earth and Im already working on my toolkit. Thank you so much
Can Perimenopause Cause Heavy Bleeding
From your early 40s and into your 50s, during perimenopause, you may find that your periods change and become erratic as your ovaries slow down and oestrogen levels start to fluctuate. It can be very common for your cycle to become highly unpredictable and periods to be heavier and longer.
There are a whole range of menstrual issues in perimenopause that are normal but if it impacts your life, consult your doctor for treatment and to exclude iron deficiency, anemias and check there isnt an underlying cause other than menopause.
There are also a number of other conditions of the womb that can cause heavy bleeding including fibroids , a pelvic infection, polyps and, rarely, cancer, so its really important that you see a doctor.
I would advise keeping a diary of whats happening and when, how long the bleeding lasts and how it is affecting you on a daily basis, as that can be useful for your doctor to see, says Dr Armstrong.
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Thank You Second Springers For Commenting
Have a read of the very useful comments and discussions below to gain an understanding of the variety of women’s’ experiences of periods around the time of perimenopause. Many thanks to these fabulous Second Spring women for taking the time to comment and share their experiences. We all learn so much from each other. This menopause conversation needs to be louder and clearer to stop women from suffering in silence and feeling very isolated.
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Menopause Symptoms Can Feel Like Pms
Some women develop symptoms of Premenstrual Syndrome for the first time or have more acute levels of their normal PMS. These symptoms can be physical, psychological, or emotional. Most of us will have had some level of PMS during the second half of the monthly cycle over the years. Symptoms may have been getting stronger during your 30s and 40s, approaching menopause. Most common symptoms are irritability, aggression, tearfulness, mood swings, breast pain and fluid retention.
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When Should You See A Doctor For Heavy Bleeding
You should call the attention of your doctor when you notice one or some of the following symptoms:
- Extremely heavy menstrual bleeding from the vagina which soaks one tampon at least within the space of two hours.
- Irregular vaginal bleeding. Always take note of when you begin to notice bleeding in between periods.
Not Sure What To Do Next
If you are still concerned about bleeding after menopause, use healthdirects online Symptom Checker to get advice on when to seek medical attention.
The Symptom Checker guides you to the next appropriate healthcare steps, whether its self care, talking to a health professional, going to a hospital or calling triple zero .
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Let It Bleed: Causes Of Heavy Periods
In the developed world, girls now get their periods earlier, and women spend less time being pregnant and breast feeding on demand. This means that the average women can now expect to have more than 400 menstrual cycles in their lifetime . Even the use of most hormonal contraceptives will yield a monthly bleed. So its no wonder that women are so concerned when their cycles seem to be longer and heavier than usual.
To address the most-pressing question, When should I be concerned? What is the medical definition of too much bleeding?, there is a medical definition of too-heavy periods. If a woman is bleeding 80cc or more, that is excessive bleeding. Trying to measure exactly the amount of bleeding is difficult even in a research setting, much less in a home bathroom! Some general indications of excessive bleeding can include:
- Saturating a maxipad or super tampon every 60-90 minutes for several hours
- Passage of large clots
- Significant bleeding for more than seven days
Probably the most important factor would be if your bleeding is heavy enough to interfere with your normal activities.
There are two major reasons for very prolonged/heavy periods: hormonal and what I call structural. Here at WebMD we get questions about prolonged and heavy bleeding just about every day, so it seems like a good time to share information about some of the causes of too-heavy periods and other types of abnormally heavy vaginal bleeding.
Diagnosis And Treatment For Abnormal Bleeding
Treatment of menorrhagia is possible once your doctor is aware of the condition.
Your doctor will most definitely ask of your medical history if you are an adult. This is most likely because if it were an adolescent, his or her first guess would be anovulation due to her age.
He or she may recommend you for some test procedures after he or she must have told you to keep tabs on your menstrual cycle. These tabs or notes will now help the doctor during diagnosis.
Some test which might help to diagnose menorrhagia include:
- Ultrasound or laparoscopy. These tests due to its imaging abilities help to show the image of your uterus, pelvis and ovaries using sound waves/ direct visualization and so can help detect abnormalities if spotted.
- Pap smear/test. This test works with the collection of cells from your cervix. These cells are tested to look out for inflammation or an infection around the cervix which may be cancerous and so lead to heavy bleeding when you menstruate or irregularly.
- Blood tests. Your doctor takes your blood sample and checks if there is a case of iron deficiency in your blood due to Anemia and some other problems like blood-clotting anomalies and thyroid disorder .
- Endometrial biopsy. A tissue sample of your uterine wall might be taken to a pathologist by your doctor in order to know why it keeps shedding blood.
- Further tests such as hysteroscopy, sonohysterography, etc. depending on what the previous set of tests would show.
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How Is Postmenopausal Bleeding Treated
Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments.
- Antibiotics can treat most infections of the cervix or uterus.
- Estrogen may help bleeding due to vaginal dryness. You can apply estrogen directly to your vagina as a cream, ring or insertable tablet. Systemic estrogen therapy may come as a pill or patch. When estrogen therapy is systemic, it means the hormone travels throughout the body.
- Progestin is a synthetic form of the hormone progesterone. It can treat endometrial hyperplasia by triggering the uterus to shed its lining. You may receive progestin as a pill, shot, cream or intrauterine device .
When To See Your Doctor
You may see a variety of shades and textures with your periods, even if youre healthy. If your period is lasting longer than seven days or is very heavy soaking through a pad or tampon every hour or two make an appointment with your doctor to rule out certain medical conditions.
Other reasons to make an appointment:
- if your cycles are irregular, changing dramatically in length from one month to the next
- if your cycles are shorter than 24 or longer than 38 days in length
- if you havent had a period in three months or longer
- if you have considerable pain or other unusual symptoms that accompany your bleeding
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When To See Your Gp
See your GP if you’re not pregnant you’ve had a negative pregnancy test and you’ve missed more than 3 periods in a row.
If you’re sexually active and you have not taken a pregnancy test, your GP may advise you to take one.
They may also ask you about:
- your medical history
- any emotional issues you’re having
- any recent changes in your weight
- the amount of exercise you do
Your GP may recommend waiting to see whether your periods return on their own. In some cases you may need treatment for your periods to return.
You should also see your GP if your periods stop before you’re 45 or if you’re still bleeding when you’re over 55.
Causes Of Abnormal Uterine Bleeding
While in many cases it is not possible to determine the exact cause, there are a number of reasons a woman may experience abnormal uterine bleeding. Some of the known causes of abnormal uterine bleeding include:
- spontaneous miscarriage in pregnancy
- ectopic pregnancy lodgement of the fertilised egg in the slender fallopian tube instead of the uterine lining
- hormonal disorders conditions such as hypothyroidism , polycystic ovarian syndrome and hyperprolactinemia can disrupt the menstrual cycle
- ovulatory dysfunction this is when the ovary does not release an egg each month. Most commonly, this occurs at either end of a woman’s reproductive years, either during puberty or at menopause
- endometriosis the cells lining the uterus can travel to, attach and grow elsewhere in the body, most commonly within the peritoneal cavity
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