Bleeding Before And After Menopause

What is perimenopause?

The period of a woman’s life that preceeds menopause. This usually extends from age 45 years to 55 years.

What is menopause?

When a woman’s ovaries stop releasing eggs and stop producing estrogen and progesterone which results in their inability to become pregnant.

What are some of the common changes that occur in the menstrual cycle during perimenopause?

During a normal menstrual cycle, the levels of the hormones estrogen and progesterone increase and decrease in a regular pattern. Ovulation occurs in the middle of the cycle, and menstruation occurs about 2 weeks later. During perimenopause, hormone levels may not follow this regular pattern. As a result, you may have irregular bleeding or spotting. Some months, your period may be longer and heavier. Other months, it may be shorter and lighter. The number of days between periods may increase or decrease. You may begin to skip periods.


How can I tell if bleeding is abnormal?

Any bleeding after menopause is abnormal and should be reported to your health care professional. Although the menstrual period may become irregular during perimenopause, you should be alert for abnormal bleeding, which can signal a problem not related to perimenopause. A good rule to follow is to tell your health care professional if you notice any of the following changes in your monthly cycle:

  • Very heavy bleeding
  • Bleeding that lasts longer than normal
  • Bleeding that occurs more often than every 3 weeks
  • Bleeding that occurs after sex or between periods

What are some of the common causes of abnormal bleeding?

  • Polyps—Uterine polyps occur when there is an overgrowth of cells in the lining of the uterus (endometrium) which leads to polyps being formed. They are also known as endometrial polyps. These polyps are usually noncancerous (benign).
  • Endometrial atrophy—Thinning of the vaginal wall can occur after menopause. This condition is called endometrial atrophy. You may experience abnormal bleeding after the thinning process starts.
  • Endometrial hyperplasia—In this condition, the lining of the uterus thickens. It can cause irregular or heavy bleeding. Endometrial hyperplasia most often is caused by excess estrogen without enough progesterone. In some cases, the cells of the lining become abnormal. This condition, called atypical hyperplasia, can lead to cancer of the uterus. When endometrial hyperplasia is diagnosed and treated early, endometrial cancer often can be prevented. Bleeding is the most common sign of endometrial cancer in women after menopause (Source: ACOG.ORG).

How is abnormal bleeding diagnosed?

To diagnose the cause of abnormal perimenopausal bleeding or bleeding after menopause, your health care professional will review your personal and family health history. You will have a physical exam. You also may have one or more of the following tests:

  • Endometrial biopsy—Procedure when a small amount of the tissue lining the uterus is removed and examined under a microscope.
  • Pelvic ultrasound—Sound waves are used to create a picture of the pelvic organs with a device placed on the abdomen or in the vagina.
  • Sonohysterography—This examination is when sterile fluid is inserted into the uterus using a tube.
  • Hysteroscopy—Using a device called a hysteroscope, it is inserted into the uterus through the cervix to observe the inside of the uterus or perform surgery.
  • Dilation and curettage (D&C)—When the cervix is opened (or dilated) and tissue is lightly scraped (curettage) or suctioned from the inside of the uterus.

What treatment is available for abnormal bleeding?

Treatment for abnormal perimenopausal bleeding or bleeding after menopause depends on its cause.



Medications used to help control abnormal bleeding include:

  • Antibiotics
  • Tranexamic acid
  • Hormonal birth control methods
  • Nonsteroidal anti-inflammatory drugs
  • Gonadotropin-releasing hormone (GnRH) agonists


If the medication doesn’t help, a surgical procedure may be needed.

  • Endometrial Ablation
  • Uterine Artery Embolization
  • Hysterectomy (if not performed yet)

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