Menopause is a time of radical restructuring of the entire female body. Long periods can occur during any period of menopause and signal serious problems. However, long periods during menopause are a very ambiguous concept. Already by the age of menopause, a woman should clearly know how many days and in what quantities she has her periods, because the individual characteristics of the body play a large role in this matter. For some, one number of periods is considered the norm of life, but for others, it is something out of the ordinary.
Changes in the menstrual cycle during menopause
Age-related hormonal changes are primarily reflected in the course of the menstrual cycle and are the first symptoms of impending menopause.
During menopause, it is customary to distinguish subsequent periods.
Premenopause
It begins after 45 years and lasts from several months to 5 years. Menstruation continues at this time, but becomes irregular, and the intervals between them increase. This is due to changes in the functioning of the endocrine system against the background of biological aging of the female body, namely, a decrease in the number of ovulations. But some ladies are still able to get pregnant during this period, so you should not neglect contraception.
Menopause
At this time, the amount of female sex hormones-estrogens is so small that those proliferative changes in the endometrium do not occur, which lead to its rejection and do not cause normal menstruation. Therefore, during this period, menstruation stops completely. This can happen suddenly, completely and irrevocably. Or it can occur gradually, when from cycle to cycle menstruation becomes less and less frequent.
When a woman over 45 years of age does not have periods for 12 months, this means that menopause is moving into the next period - postmenopausal.
Postmenopause lasts until the woman's death.
Note!
Any bleeding after menopause is considered pathological and dangerous! Because its appearance is no longer associated with age-related changes and hormonal changes. Very often, blood from the genital tract in postmenopause is a symptom of a hyperplastic process in the endometrium (the endometrium becomes “lush” under the influence of hormones), and this is the risk of developing uterine cancer in a woman during this period of life.
Normal discharge
In a healthy girl of reproductive age, a small amount of leucorrhoea is considered normal and does not require a visit to the doctor. Their presence is explained by the active activity of the endocrine system. After menopause, the functioning of sex hormones is suppressed, the uterus ceases to produce a sufficient amount of mucus (hence the appearance of one of the clear signs of postmenopause - dryness in the intimate area). However, this does not mean that the secretion process stops completely. Normal discharge in the postmenopausal period is practically no different from physiological leucorrhoea and has the following features:
- transparent or whitish tint;
- viscous consistency;
- sourish (not repulsive) odor.
If leucorrhoea does not bother the patient with its abundance and irritation of the genitals, there is no reason to visit a doctor.
How does bleeding occur during menopause?
Bleeding during menopause can occur in the following ways:
- occurs irregularly, after a delay in menstruation and continues for a long time, called menometrorrhagia;
- menorrhagia – bleeding is also prolonged, but unlike the first option – regular and profuse;
- the appearance of bleeding between cycles, so-called metrorrhagia;
- Heavy menstruation occurs regularly, but the interval between them is less than 21 days - polymenorrhea.
On a note!
Menorrhagia is heavy menstrual bleeding and is classically defined as a loss of >80 ml/cycle. Menorrhagia affects ≥ 9% of all women, increasing to 20% during perimenopause.
In premenopause, practitioners more often have to observe the first scenario, and in postmenopause, metrorrhagia is more common.
How to stop metrorrhagia at home
Folk remedies provide auxiliary support for the body in order to prevent the development of inflammation during severe bleeding from the vagina, and increase local immunity.
Women are recommended to take herbal infusions : viburnum, St. John's wort, nettle . Decoctions are used to eliminate metrorrhagia, normalize blood circulation and blood pressure.
When bleeding opens, the uterine mucosa becomes unprotected against infections and the penetration of bacteria into the bloodstream. Women during menopause should undergo a course of antibiotic treatment to avoid blood poisoning and the occurrence of purulent foci in the brain and liver.
Before the ambulance arrives, you need to lie on your side, taking a horizontal position and tucking your legs under you. You need to put a napkin with an ice cube or a cold heating pad on your stomach and take a pain reliever. If there are no visible causes of discharge, then doctors will first prescribe a hemostatic drug.
What is the cause of bleeding during menopause?
Uterine bleeding during menopause is perhaps the most common pathology that puts a woman of Balzac’s age in a hospital bed. And also, it is heavy bleeding during menopause that determines the indications for hysterectomy in more than half of women.
Despite the variety of causes of uterine bleeding in peri- and postmenopausal women, they are divided into the following groups:
- organic bleeding that is associated with pathology of the female organs;
- inorganic, which at the beginning of menopause are explained by the lack of ovulation, and after menopause - by endometrial atrophy;
- occurring while taking hormonal drugs (HRT) during menopause on the days of expected menstruation, or when using certain other medications;
- menopausal bleeding caused by diseases of the liver, cardiovascular system or pathology of the endocrine glands.
- Separately, dysfunctional uterine bleeding of the menopause is distinguished, which occurs when there is no pathology of the female organs, but there are changes in the endometrium against the background of impaired hormonal function of the ovaries.
Attention!
In women with a more or less preserved menstrual cycle in premenopause, pregnancy can cause bleeding, which indicates its unfavorable course.
Bleeding in premenopause and menopause
During this transition period for a woman, it is difficult to distinguish the acyclic nature of bleeding caused by age-related anovulation from irregular periods. What is the difference between bleeding during menopause and menstruation?
So, signs of abnormal uterine bleeding:
- blood is released profusely, sometimes with clots;
- duration of bleeding more than 8 days;
- the volume of blood loss exceeds 80-100 ml of blood;
- frequently recurring (interval less than 24 days);
- the blood flowing from the uterus is always bright red and liquid;
- against the background of blood loss, the woman’s well-being suffers (weakness, dizziness, a tendency to faint, pale skin, blood pressure and hemoglobin levels decrease).
Blood loss in premenopause can be caused by:
- submucosal nodes on the uterus;
- formations in the ovaries;
- endometrial polyp;
- thickening of the endometrium;
- adenomyosis;
- intrauterine device;
- hormonal contraceptives, or drugs used for hormone replacement therapy.
Bleeding in postmenopause
Important!
Practitioners recommend first ruling out uterine (endometrial) cancer if any uterine bleeding occurs after menopause. A woman who discovers blood in herself after a long absence of menstruation should immediately inform her doctor.
The most common causes that can cause bleeding after menopause:
- cancer of the uterus;
- cervical cancer;
- atypical endometrial hyperplasia;
- recurrent endometrial polyps;
- atrophic conditions of the vagina;
- vaginal tumors.
Treatment Options
Treatment of pathological discharge directly depends on the cause that contributed to its development:
- infectious and inflammatory diseases are successfully treated with antibacterial and antifungal agents, vitamins and a special dietary regimen ;
- endocrine pathologies are eliminated using a conservative or surgical method (prescribing hormonal drugs or performing surgery);
- Therapeutic measures for the treatment of sexually transmitted infections include antiseptic douching , anti-inflammatory medications , a long course of antibiotics and restorative complexes .
Treatment of endometrial and uterine cancer includes surgery, radiation, hormonal and chemotherapy treatments . As a last resort, doctors resort to complete extirpation of the organ and its appendages .
How to diagnose menopausal bleeding?
Discharge of blood from the vagina not associated with menstruation is always an anomaly that can occur in the absence of recognizable pelvic pathology or general disease and reflects a disruption of the normal pattern in the endometrial uterine layer. In many cases, blood loss is unpredictable. It may be excessive or mild, and may be long-lasting, frequent, or occasional.
1-2% of women eventually develop endometrial cancer.
Discharge of blood from the genital tract is a symptom of many female diseases, so diagnosis must be comprehensive:
In addition to the woman’s complaints of blood from the vagina, the doctor evaluates the amount of blood loss, duration and frequency of bleeding.
- It is mandatory to study clinical and biochemical blood tests, as well as its coagulation system.
- Determination of blood hCG (pregnancy hormone), which is especially important at the beginning of menopause, when a woman still has the opportunity to become pregnant.
- Determination of tumor markers CA-125 in ovarian tumors.
- Oncocytology of cervical smear.
- Ultrasound diagnostics of the pelvis allows you to identify nodes on the uterus, areas of adenomyosis, formations in the ovaries, makes it possible to assess the condition of the endometrium, confirm or exclude endometriotic polyps.
- If necessary, an MRI of the pelvis is performed.
To identify intrauterine pathology, diagnostic curettage of the uterine cavity is used, followed by histological examination of the scraping.
When the bleeding has stopped, hysteroscopy can be used to visually assess the walls of the uterus and take endometrial tissue for a biopsy.
Treatment
The most important thing in the treatment of postmenopausal bleeding is to determine the root cause of this condition. Treatment for this condition should be targeted based on the cause.
Oncological or suspected diseases should be treated by oncologists. Confirmed endometrial cancer or sarcoma involves removal of the uterus and pelvic lymph nodes. Chemotherapy or radiation treatment is added according to the situation.
After such radical treatment, patients should be observed for a long time by an oncologist or gynecologist and undergo an annual examination.
Non-oncological diseases of the cervix are subject to treatment in the cervical pathology office - this includes anti-inflammatory treatment, destruction of lesions on the cervix, and wound healing therapy.
For histologically confirmed endometrial hyperplasia, hormonal therapy is necessarily included - gestagens of various types - norkolut, gestodene, levonorgestrel, and so on. In young women, it is preferable to introduce an intrauterine therapeutic system or “spiral” “Mirena”.
If there is recurrent or recurrent endometrial hyperplasia, the issue of removing the uterus is considered. An alternative to such a radical operation can be the so-called endometrial ablation - irreversible destruction of the endometrium by radio waves or laser.
If you have recurring problems with uterine bleeding, you should reconsider your lifestyle - discuss your medication schedule with your doctor, give up physical procedures, lose weight and reconsider your diet.
