Menstrual Changes and Polyps in Women Over 40

Menstruation, polyps

Hello Doctor, I am 48 years old and have had two natural deliveries.
My menstruation did not come in September this year, and in October and November, my periods lasted more than seven to eight days.
From November 16 to today, November 24, it has been nine days, and I am experiencing light brown spotting.
I am quite concerned.
I have a uterine polyp that is about 2 cm, which was discovered two years ago.
I previously underwent a hysteroscopy at National Taiwan University Hospital, and the doctor advised that it should just be monitored without any intervention.
Additionally, I have been experiencing some mild lower abdominal discomfort, similar to menstrual cramps.
I have had transvaginal ultrasounds over the past two years, with the last one in May of this year, and the polyp has not grown.
However, I am uncertain whether I need to take more proactive measures regarding it at my age.
If my menstrual period lasts nine to ten days and then tapers off to just some spotting, should I seek medical evaluation or wait for it to resolve on its own? After all, I have read on many websites that a period lasting about seven days is typical.
My previous cycles were usually five to seven days, but they have suddenly extended over the past two months, which has caused me some worry.
Thank you, Doctor, for clarifying my concerns.

linlin, 40~49 year old female. Ask Date: 2018/11/24

Dr. Huang Jianzhong reply Obstetrics and Gynecology

A 48-year-old woman, who has had two natural deliveries, has not had her period since September.
In October and November, her menstrual bleeding lasted over seven to eight days.
From November 16 to today, November 24, it has been nine days, with light brown spotting.
She is quite concerned as she has a 2 cm polyp in her uterus, discovered two years ago.
She previously underwent a hysteroscopy at National Taiwan University Hospital, where the doctor advised to just monitor it without any intervention.
Currently, she is experiencing some mild lower abdominal discomfort, similar to menstrual cramps.
Over the past two years, she has had transvaginal ultrasounds, the most recent one in May, which showed that the polyp has not grown.
She is uncertain whether, given her age, she should take more proactive measures regarding the polyp.
With her menstrual period lasting nine to ten days and now reducing to just a little spotting, she wonders if she should seek medical evaluation or just wait for it to resolve on its own.

Response: It is generally acceptable to wait for it to resolve on its own, as many sources indicate that a menstrual period lasting about seven days is typical.
Previously, her periods lasted five to seven days, and the recent extension has caused her some concern.

Reply Date: 2018/11/24

More Info

Understanding menstrual changes and the presence of polyps in women over 40 can be quite complex, especially as women approach perimenopause and menopause. At 48 years old, you are in a transitional phase where hormonal fluctuations can lead to irregularities in your menstrual cycle, including changes in flow duration and intensity.

Firstly, it is important to recognize that menstrual cycles can vary significantly during this time. The average menstrual cycle length is typically around 28 days, but it can range from 21 to 35 days. As women approach menopause, cycles may become longer or shorter, and the flow may become heavier or lighter. In your case, experiencing prolonged menstrual bleeding for nine days, especially with a change in color to a light brown, can be concerning but is not uncommon during this transitional phase.

The presence of a 2 cm polyp in your uterus adds another layer of complexity. Uterine polyps are growths on the inner lining of the uterus (endometrium) and can be benign. They can sometimes cause irregular bleeding, especially if they are located in a position that interferes with the normal shedding of the endometrial lining. Since your polyp has been stable for two years and has not increased in size, it may not require immediate intervention, but regular monitoring is essential.
The discomfort you are experiencing in your lower abdomen, similar to menstrual cramps, could be related to the polyp or the hormonal changes you are undergoing. It is crucial to differentiate between normal menstrual discomfort and pain that may indicate a more serious condition. If the pain becomes severe or is accompanied by other symptoms such as fever, significant changes in bleeding patterns, or any unusual discharge, it would be advisable to seek medical attention promptly.

Regarding your concern about whether to seek treatment for the polyp, it is generally recommended to consider the following factors:
1. Symptoms: If the polyp is causing significant symptoms, such as heavy bleeding or pain, removal may be warranted.

2. Size and Growth: If the polyp grows or changes in appearance, further evaluation may be necessary.

3. Age and Risk Factors: As you are over 40, any abnormal bleeding should be evaluated to rule out more serious conditions, including endometrial cancer, especially if you have a family history of gynecological cancers.

In terms of your menstrual cycle, if your bleeding continues to be prolonged or if you have any concerns about the nature of your bleeding, it is advisable to consult with your healthcare provider. They may recommend further evaluation, such as a transvaginal ultrasound or a hysteroscopy, to assess the polyp and the endometrial lining more closely.

In summary, while changes in menstrual patterns and the presence of a polyp can be concerning, they are not uncommon in women approaching menopause. Regular monitoring and open communication with your healthcare provider are key to managing your health during this transitional period. If you experience any significant changes or worsening symptoms, do not hesitate to seek medical advice.

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