MenopauseMenu guest blog post by Ann Bridges, MD FACOG of The Polyclinic’s OB/GYN department.
Menopause is defined as not having a menstrual period for 12 months. The average age that this occurs is 51-52; however, most women experience some years of irregular and crazy cycles before periods finally stop.
Perimenopause starts when the periods become irregular. Early in this process the cycles may be off by a week or so, with the occasional skipped cycle. The cycle length is also typically shorter than 28 days. Later on the periods become more irregular, and many women start skipping more cycles or having prolonged and sometimes heavier flow.
PMS symptoms can also be more pronounced including breast tenderness, increase in migraine headaches, and mood changes. Some women will also start to notice the occasional hot flash or night sweats off and on. Hormones are fluctuating a lot during this transition and ovulation becomes less likely, but not impossible. Contraception is still needed during this time period!
Abnormal bleeding can occur during perimenopause and although it can be related to the hormonal chaos that is happening, there are other causes that may need to be investigated including polyps, fibroids, cancer, precancer changes, and other problems. In women with prolonged or heavy bleeding investigation may be needed including biopsy of the uterine lining, pelvic ultrasound to look for structural problems, or hysteroscopy which is a short procedure to look inside the uterine cavity.
There are several options for treating heavy or irregular periods around menopause depending on patient preference, reasons for bleeding, and other risk factors:
- Birth control pills can often regulate the cycle and decrease bleeding.
- Progesterone IUDs like Mirena or Kyleena can reduce bleeding but don’t regulate the periods; however, some women will have no period or just a little spotting with these IUDs which is usually seen as a positive.
- Taking nonsteroidal anti-inflammatory medications like Ibuprofen can also reduce menstrual bleeding.
- Other options might include uterine cavity ablation (a minimally invasive procedure) or uterine artery embolization, a procedure to block the arteries which feed the uterus.
Irregular periods are a normal part of perimenopause and though they can be annoying, there are many options available to ease this transition.
Dr. Ann Bridges