Abnormal Menstrual Patterns: Causes and Concerns for Women Over 50

Menstrual irregularities

Hello Doctor: I am a 50-year-old who underwent laparoscopic uterine artery embolization for uterine fibroids two years ago, without removing the fibroids or the uterus.
My menstrual cycles have been normal until September, when I experienced very light bleeding, almost none.
In October, my period started with heavy flow for the first three days, then gradually decreased, lasting for sixteen days without finishing, occasionally with small blood clots.
I have never experienced this before.
What could be the reason, Doctor? Thank you!

Fan Fan, 50~59 year old female. Ask Date: 2002/10/05

Dr. Chen Changfu reply Obstetrics and Gynecology

Hello! Based on your age and the description of your abnormal menstrual bleeding, it is likely that this is due to age-related ovarian dysfunction resulting in uterine bleeding, known as dysfunctional uterine bleeding (DUB), which is a common cause of menstrual irregularities during menopause.
However, you have a history of uterine fibroid treatment and did not mention any follow-up examinations after treatment.
Given your description of abnormal menstrual bleeding, it is confirmed as abnormal uterine bleeding.
There are many potential causes for abnormal uterine bleeding, so I recommend that you promptly visit a gynecologist for an examination to determine the underlying cause.

Dr.
Chen Chang-Fu, Department of Obstetrics and Gynecology, Qishan Hospital, Department of Health, Executive Yuan, October 14, 2002.

Reply Date: 2002/10/05

More Info

Abnormal menstrual patterns in women over 50 can be concerning, especially when they have a history of conditions like uterine fibroids. At this age, women are often approaching or experiencing perimenopause, a transitional phase leading up to menopause, which can significantly affect menstrual cycles.
In your case, the irregularities you are experiencing—such as very light periods followed by prolonged bleeding with occasional blood clots—could be attributed to several factors. One of the most common causes of abnormal uterine bleeding in women of your age is dysfunctional uterine bleeding (DUB), which is often related to hormonal imbalances. As women approach menopause, the ovaries gradually produce less estrogen and progesterone, leading to changes in the menstrual cycle. This can result in lighter periods, heavier periods, or even missed periods altogether.

The presence of uterine fibroids, which you mentioned having, can also contribute to abnormal bleeding. Fibroids are benign tumors that can grow in the uterus and may cause heavy menstrual bleeding, prolonged periods, or bleeding between periods. Even if you had a procedure to block blood flow to the fibroids, they can still affect your menstrual patterns, especially if they are still present.

Another consideration is the possibility of endometrial hyperplasia, which is a thickening of the uterine lining that can occur due to prolonged estrogen exposure without adequate progesterone. This condition can lead to irregular bleeding and is more common in women who are perimenopausal or postmenopausal.
Stress and lifestyle factors can also play a role in menstrual irregularities. High levels of stress can impact hormonal balance, potentially leading to changes in your cycle. Additionally, factors such as weight changes, diet, and exercise can influence menstrual patterns.

Given your symptoms and history, it is crucial to consult with a healthcare provider for a thorough evaluation. They may recommend a pelvic ultrasound to assess the size and condition of the fibroids and the endometrial lining. A biopsy might also be necessary to rule out any precancerous changes in the endometrium, especially since you are experiencing prolonged bleeding.

In conclusion, while hormonal changes associated with perimenopause are a likely cause of your symptoms, the presence of fibroids and other potential factors must be evaluated. It is essential to seek medical advice to determine the underlying cause of your abnormal menstrual patterns and to discuss appropriate management options. Regular check-ups and monitoring are vital to ensure your reproductive health during this transitional phase.

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