Menopause is defined as the absence of a menstrual period for one year. Menopause starts at around age 51, according to the American Congress of Obstetricians and Gynecologists. Perimenopause refers to the years leading up to menopause when periods often become less predictable. While any bleeding that occurs after menopause is considered abnormal, during perimenopause it is often harder to define what is considered abnormal.
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During perimenopause, it is common for women to experience shorter or lighter periods some months and longer heavier periods other months. However, physicians often consider bleeding abnormal after perimenopause if it lasts longer than a woman’s average menstrual cycle, occurs more often than every three weeks or if bleeding occurs after sex or in between periods. Another sign of abnormal bleeding is heavy bleeding that causes a woman to soak through a superabsorbent pad in less than a couple of hours.
Abnormal bleeding during perimenopause can have a number of causes. Many women develop noncancerous growths known as polyps along the lining of the uterus and cervix that may cause irregular bleeding. Women may experience abnormal bleeding if they have a condition known as endometrial hyperplasia, a condition in which the uterus thickens, causing irregular or heavy bleeding. Another possible cause of abnormal bleeding during perimenopause is endometrial cancer. The American Congress of Obstetricians and Gynecologists explains that endometrial cancer, or uterine cancer, is the most common type of cancer of the reproductive system in the United States.
In order for physicians to diagnose the cause of abnormal bleeding, they will perform a physical exam as well as collect a thorough health history. A physician will collect a small sample of tissue from the uterus in order to view the tissue under a microscope to look for abnormal cells. Women may also have a sonogram or transvaginal ultrasound in order to look for any unusual growths or lesions on the reproductive organs. A physician may need to perform a dilation and curettage, or D and C, to open the cervix and scrape cells from the uterine wall to examine more closely.
Treatment often depends on the underlying cause of the abnormal bleeding. Women who no longer wish to have children can often treat the bleeding by having the reproductive organs removed. Women with endometrial hyperplasia or polyps can often benefit from hormone therapy, such as birth control pills.
It is often hard for a woman in perimenopause to determine what is normal and what isn’t because hormones tend to fluctuate during this time. If a woman suspects something may be wrong it is important to discuss these concerns with their practitioner because early diagnosis of many illnesses can often affect the prognosis.