Menopause and Unexpected Periods: Your Symptoms

Menstruation after menopause?

Hello Dr.
Tsao,
Last July, after my menstrual period, I did not have my period for a whole year until this July.
The doctor said this indicated menopause, but this month (September), I suddenly got my period again, which lasted about 3-4 days with a small amount of blood and mucus.
This means there was a 14-month gap since my last period.
Concerned about potential issues, I went to a gynecology clinic for an examination.
The results showed that the endometrial thickness was normal and the ovaries were functioning normally, based on a transvaginal ultrasound.
The Pap smear was also normal, and the doctor said everything was fine, suggesting that the return of my period might be due to consuming more estrogen-rich foods.
I was advised to return for a check-up in six months.

In the past few years, I have not consumed royal jelly, soy isoflavone capsules, or yam, which are foods rich in estrogen.
Before menopause (during my irregular periods), I underwent hormone replacement therapy (with Premarin) for 2.5 years and stopped the medication three months ago.

I would like to ask you:
1.
Since the endometrial thickness is normal, should I be concerned about endometrial cancer?
2.
Could the return of my period after menopause be related to stopping Premarin?
Thank you for taking the time to respond amidst your busy schedule.

Miss Zhang, 50~59 year old female. Ask Date: 2018/09/28

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, your examination results are fine.
My recommendation is to observe for the time being.
If there is no bleeding, there is no need to worry.
However, if bleeding occurs again after some time, I suggest undergoing further endometrial evaluation.
If there are still concerns, you may consult your regular obstetrician-gynecologist.
Wishing you good health.

Reply Date: 2018/09/28

More Info

Menopause is a significant transition in a woman's life, marking the end of her reproductive years. It is characterized by the cessation of menstruation for 12 consecutive months, typically occurring between the ages of 45 and 55. However, the experience of menopause can vary widely among women, and unexpected menstrual bleeding after a period of amenorrhea (absence of menstruation) can be concerning.

From your description, it appears that you have not had a menstrual period for 14 months, which aligns with the definition of menopause. However, the sudden return of menstrual bleeding after such a long absence raises important questions. Let's address your concerns:
1. Normal Endometrial Thickness and Cancer Risk: The fact that your endometrial thickness is normal is reassuring. In postmenopausal women, a thickened endometrium can be a potential indicator of endometrial hyperplasia or cancer, particularly if accompanied by abnormal bleeding. Since your ultrasound showed normal thickness and your Pap smear was also normal, the likelihood of endometrial cancer is significantly reduced. However, it is essential to continue monitoring your symptoms and follow up with your healthcare provider as recommended.

2. Relationship Between Hormonal Therapy and Menstrual Return: Hormonal therapy, such as the use of medications like "伴樂娜" (likely referring to a form of hormone replacement therapy), can influence menstrual patterns. When you stop hormone therapy, your body may take some time to adjust, and this can lead to unexpected bleeding. The return of your menstrual cycle after stopping hormone therapy does not necessarily mean that you are no longer in menopause, but rather that your body is responding to the changes in hormone levels. It is not uncommon for women to experience irregular bleeding during the transition phase of menopause, even after a period of amenorrhea.

In addition to these points, it is important to consider other factors that may contribute to unexpected bleeding, such as:
- Hormonal Fluctuations: Even after menopause, some women may experience fluctuations in hormone levels that can lead to sporadic bleeding.

- Uterine Polyps or Fibroids: These benign growths can sometimes cause bleeding and may need to be evaluated if they are suspected.

- Other Medical Conditions: Conditions such as thyroid disorders or clotting disorders can also affect menstrual patterns.

Given your history and the recent changes, it is advisable to maintain regular follow-ups with your gynecologist. They may recommend periodic ultrasounds or other evaluations to monitor your endometrial health, especially if you experience further bleeding or any other concerning symptoms.

In conclusion, while your current situation does not appear to indicate a serious problem based on the information provided, it is essential to stay vigilant and communicate openly with your healthcare provider about any changes or concerns you may have. They can provide personalized advice and ensure that you receive the appropriate care during this transitional phase of your life.

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