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Q: I’m going through menopause and haven’t had a period for a year-and-a-half. This month, I am bleeding rather heavily. What is this?

The body changes as you go through menopause.  During that time, your ovaries stop producing estrogen and progesterone, the hormones vital for fertility.  In menopause, your periods come and go as they please.   You may have a menstrual cycle one month and then don’t have another period until three or four months later.  Some may experience periods regularly, but they don’t last as long. In order to be officially menopausal, your periods must have stop for at least one year.  Even when you are menopausal, you can still be experience bleeding due to other reasons. The type of bleeding you’re experiencing, such as heavy bleeding, bleeding that last more often than normal or occurs every three weeks, or bleeding that occurs during sex, may indicate other issues besides menopause.

So what are some potential causes?

The first potential cause is endometrial polyps, or fibroids, which are tissue growths that develop in your uterus (aka womb). In most cases, these tissues are benign but it is still important to have them evaluated.

Another common cause of abnormal bleeding is the thinning of the lining of your uterus.  When the levels of estrogen are low in the body, the lining of your uterus starts to thin because it no longer needs to prepare for pregnancy.  Hence the tissues shed and you experience bleeding.

We also cannot forget the possibility of an underlying cancer. This is not the most common reason for abnormal bleeding, but the potential is there.

Lastly, use of certain medications like blood thinners and even infection can cause abnormal bleeding.

It is extremely important that you talk to your primary care provider or OB-Gyn doctor about abnormal bleeding. When doing so, make sure to describe to them in detail how long and the amount of bleeding you observe, what brings the bleeding on (eg, sex), and if there are other symptoms that occur with the bleeding (eg, pain, fever, vaginal odors).  Besides doing a physical exam to examine you, there are many imaging techniques available to look at your uterus and ovaries.  If the tests show that there are some growths, surgery may be needed to remove them.  On the other hand, a thinned uterine lining and infection can be best treated with medication.

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