Perimenopausal Menstrual Irregularities
As women approach menopause, there are many changes that can happen in the body including changes in the menstrual cycle. Most women experience several years of changes in the cycle before they completely stop. This transition into the period stopping is called perimenopause. And menopause is retrospectively defined as 12 months without a period. The average age for menopause is 51 years old but this varies for each woman and is influenced by several factors including genetics, smoking, weight, activity level, and previous surgeries. There is no reliable testing that can accurately predict when a woman will become menopausal but on average, perimenopausal changes begin 4 years before the period completely stops.
During perimenopause, because of changes in hormones, periods may become erratic, such as:
- Coming more or less often
- Bleeding that lasts for fewer or more days
- Flow that fluctuates from heavy to light
- Skipping periods
Even though these changes can be normal, there are times when medical evaluation is recommended, such as:
- Vaginal bleeding more often than every 3 weeks
- Excessive bleeding (e.g. changing heavy pad or tampon more than every hour or passing large clots)
- Prolonged bleeding (e.g. >10 days)
- Spotting between periods
Medical evaluation for irregular bleeding can include blood work, a pelvic ultrasound, a biopsy of the tissue inside the uterus (ie: an endometrial biopsy) and/or using a camera to look inside the uterus (ie: a hysteroscopy). All of this can conveniently be performed in our office when deemed necessary.
Depending on the severity of the menstrual changes and the results of the evaluation, treatment may be optional or recommended. Treatment options vary widely but may include: birth control pills, IUDs, non-hormonal medications to slow menstrual bleeding, endometrial ablation, or hysterectomy.
At Healthcare For Women and our Hormone Menopause Resource Center, we have a special interest in promoting hormonal wellness and healthy aging. Perimenopause can be a challenging and confusing time and we want to educate our patients on their bodies – what are normal expectations and when there should be a reason for concern.
Please contact us to learn more, ask questions about Perimenopausal Menstrual Irregularities and work together to make this transition easier.
Written By Dr. Bridgett Casadaban