Abnormal Bleeding: Insights for Women Approaching Menopause

Abnormal bleeding

I am 51 years old.
Last September and this May, I experienced menstruation that started again 9 days after the previous cycle ended (the second cycle lasted about 8-9 days, with bright red color and normal flow).
The endometrial thickness was approximately 0.6 cm.
Since 2015, I have had similar issues, and gynecologists have prescribed progesterone to regulate my cycle, which typically works for about six months before the irregularities return.
Recently, I went to a major hospital for an examination, and the doctor ordered blood tests for hormone levels (the doctor believed I was nearing menopause and that blood tests were not necessary during menstruation).
Can the results obtained from this test be considered reliable? My results were FSH = 19.4 and E2 = 38.
Does the doctor think these values indicate that I am not close to menopause? Additionally, I have annual Pap smears and regular ultrasounds.

Ailis, 50~59 year old female. Ask Date: 2019/06/23

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the results of your blood test indicate that you have not yet reached menopause.
There are many factors that can affect your menstrual cycle or cause bleeding outside of your period, such as age, environment, lifestyle, stress, emotional instability, weight changes, medications, emergency contraception, diet, polycystic ovary syndrome, uterine or cervical lesions, infections, ovulation, pregnancy, and breastfeeding, among others.
It is advisable to consult a gynecologist if your symptoms persist or worsen to determine if there is a hormonal imbalance or other underlying causes that require treatment.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2019/06/23

More Info

Abnormal bleeding can be a significant concern for women, especially as they approach menopause. At 51 years old, you are indeed in a transitional phase where hormonal fluctuations can lead to irregular menstrual cycles and unexpected bleeding. Your experience of having menstrual-like bleeding shortly after your period, along with the history of similar occurrences, is not uncommon during this time.

The hormonal tests you underwent, specifically measuring Follicle Stimulating Hormone (FSH) and Estradiol (E2), are crucial in assessing your reproductive hormonal status. FSH levels above 30 mIU/mL typically indicate that a woman is in menopause, while lower levels suggest that ovarian function may still be present. Your FSH level of 19.4 mIU/mL indicates that you are likely in perimenopause, the transitional phase leading up to menopause, rather than being fully menopausal. Estradiol levels, which reflect the amount of estrogen in your body, are also important. Your E2 level of 38 pg/mL is on the lower side, which is consistent with the hormonal changes occurring as you approach menopause.

The irregular bleeding you described, particularly the occurrence of a menstrual-like flow shortly after your period, can be attributed to several factors. One common cause is hormonal imbalance, which can lead to anovulatory cycles where the ovaries do not release an egg, resulting in unpredictable bleeding patterns. The use of progesterone (like the luteal phase support you mentioned) can help regulate the menstrual cycle temporarily, but as you have experienced, these effects may not be long-lasting.

Another potential cause of abnormal bleeding in women approaching menopause is the thickening of the endometrial lining (the lining of the uterus), which can occur due to unopposed estrogen. This thickening can lead to heavier or irregular bleeding. Regular monitoring through ultrasound, as you have been doing, is essential to assess the thickness of the endometrial lining and rule out any pathological conditions such as polyps or hyperplasia.

It is also important to consider other factors that could contribute to abnormal bleeding, including lifestyle changes, stress, weight fluctuations, and certain medications. Stress, in particular, can have a significant impact on hormonal balance and menstrual regularity.

Given your history and current symptoms, it is advisable to continue working closely with your healthcare provider. Regular follow-ups, including hormonal assessments and imaging studies, are crucial in monitoring your condition. If the abnormal bleeding persists or worsens, further evaluation may be warranted, including a biopsy of the endometrial lining to rule out any serious conditions.

In summary, while your hormonal levels suggest you are in perimenopause, the irregular bleeding you are experiencing is not uncommon during this transitional phase. It is essential to maintain open communication with your healthcare provider, adhere to regular check-ups, and report any new or concerning symptoms. This proactive approach will help ensure that any underlying issues are addressed promptly and effectively.

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