Bloody Cycles

The transition to menopause is thought to consist of increasingly prolonged intervals between menstrual flow. The recently published SWAN study, however, suggests that early in that transition, the frequency of heavier and longer cycles may be far more common.

... We found that the large majority of women in SWAN, over 50% of whom were not white, reported menses duration of 10+ days, spotting of 6+ days and/or 3+ days of heavy bleeding during the MT. The likelihood of experiencing these menstrual bleeding events varied by race/ethnicity, BMI and reported uterine fibroids. These data confirm that two types of bleeding, longer menses with more days of spotting and heavier menses, occur in most women during the MT. These data provide clinicians and women with important normative data regarding the expected frequency of these bleeding changes during the menopausal transition, data that may facilitate decision-making in clinical practice. Such information, particularly when coupled with the emerging information about duration of the stages of the menopausal transition, will be of great value to women in this life-stage who wish to be active participants in their own health care. Such normative data can greatly alleviate concerns about midlife changes in ones bleeding patterns and facilitate coping with what, in most cases, will probably be a time-limited experience. Further research on the correlation between such bleeding and documented pathology is warranted to better support recommendations for watchful waiting versus clinical intervention.

Changes may be marked by differences in estrogen and progesterone production, signifying either greater or fewer ovulatory episodes. These changes may also signify underlying pathology such as uterine fibroids, adenomyosis, polyps or even hyperplasia. The last is especially troubling as prolonged estrogen stimulation without the periodic interjection of progesterone may lead not only to unscheduled bleeding but in a few cases, cancer.

A transvaginal sonogram is a simple test to gauge the thickness of the endometrial lining and should be considered as an integral part of the workup for abnormal bleeding. For more information, or to schedule an appointment, you can call my office at North Shore LIJ: (718) 925-6277.