Q: I have been in full menopause for three full years. I will be 45 in February. Yesterday I awoke with what appeared to be a light period. What could be going on? I have had all the same symptoms as usual, hot flashes, and night sweats. Nothing has changed in my diet and there have been no medication changes. Everything is exactly the same. Today it seems I have progressed as a typical cycle would. I do not know if this requires a call to the GYN or if it just one of those fluky things.
I have three kids, 22, 19 and 13 if that has any bearing on the situation. My two aunts both went through menopause in their late 30s. My mom was 55 and her mom 50.
A: The interior portion of the uterus has two layers known as the endometrium and the myometrium. Prior to menopause and in women who menstruate, the endometrium thickens monthly in preparation for pregnancy. If she doesn’t become pregnant, the thickened lining is shed during a normal cycle. Once a women completes menopause, this pattern stops, so uterine bleeding three years post menopause is abnormal. During the transition to menopause, estrogen secretions within the body continue, while progesterone secretions decline. These hormonal changes can cause the endometrium to produce excess amounts of tissue, increasing the possibility that polyps or thickening of the lining of the uterus can develop, causing an abnormal bleed.
Menopausal women who take hormone replacement therapy (HRT) may experience the symptoms you describe. You do not indicate if you are on HRT, so I cannot venture a guess as to whether this is your answer; however, you should make an appointment with your gynecologist because after three years, abnormal uterine bleeding should be investigated. You could have developed a polyp, fibroid, uterine infection, endometrial hyperplasia or another condition. If you are on an anti-coagulant or have had radiation therapy, this could also be a possible cause.
Your physician will likely perform a pelvic examination; he or she may take a Pap smear, order lab work, and may even schedule you for an endometrial biopsy, transvaginal ultrasound, or other testing . The biopsy will rule out endometrial cancer, while the ultrasound can provide a clear view of the uterus.This testing is not to imply there is anything wrong but your gynecologist will likely begin simply once you provide a history of what is going on with your body and will progress with more sophisticated testing until an answer is found.
Menopause is a natural biological process. While it can begin during a woman’s 40s and 50s, the average age in this country is 51, so you began the process earlier than most. Visit your specialist and get to the bottom of the issue so you can get on with what must be a busy life with three children. Good luck.
Other readers who would like related information can order Dr. Gott’s Health report “Menopause” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.