Menopause: Thick Endometrium and Irregular Bleeding Concerns

Menopausal issues

On November 3, my menstrual period came normally.
From December 2 to December 8, I experienced spotting, which was not the usual menstrual flow.
I visited a doctor on December 7, and the doctor mentioned that my endometrium was very thick and prescribed medication to induce menstruation.
However, after finishing the medication on December 10, it has been a week and my period still hasn't started.
Am I going through menopause? Can the endometrium still be thick during menopause? Thank you, doctor.

Jia You, 50~59 year old female. Ask Date: 2021/12/16

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the factors that can affect the menstrual cycle or cause intermenstrual bleeding are numerous, including 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.
If your regular menstruation has not yet occurred, it is advisable to consult a gynecologist to check for hormonal imbalances or other causes and to monitor the endometrium.
Thank you! Wishing you peace and health, Dr.
Chang.

Reply Date: 2021/12/16

More Info

Understanding menopause and its associated symptoms can be quite complex, especially when it comes to irregular bleeding and changes in the endometrial lining. Based on your description, it seems you are experiencing some concerning symptoms that warrant further exploration.

Firstly, it’s important to understand that menopause typically occurs between the ages of 45 and 55, marking the end of a woman's reproductive years. During this transition, known as perimenopause, hormonal fluctuations can lead to irregular menstrual cycles, changes in bleeding patterns, and variations in the thickness of the endometrial lining.

In your case, you mentioned that your menstrual cycle was normal in November but then experienced spotting from December 2nd to December 8th, which is not typical for your cycle. The fact that your doctor noted a thick endometrium during your examination is significant. A thickened endometrium can occur for several reasons, including hormonal imbalances, particularly an excess of estrogen relative to progesterone. This can lead to abnormal uterine bleeding, which may manifest as spotting or heavy bleeding.

The medication prescribed by your doctor was likely aimed at inducing a menstrual period to help shed the thickened endometrial lining. However, since you have not had a period after completing the medication, this could indicate a few possibilities:
1. Hormonal Imbalance: As you approach menopause, your body may not be producing enough progesterone to counterbalance the effects of estrogen, leading to a thickened endometrium and irregular bleeding.

2. Anovulation: During perimenopause, it is common for ovulation to become irregular or cease altogether. If you are not ovulating, your body may not produce the necessary hormones to trigger a menstrual period, resulting in a thickened endometrium.

3. Other Underlying Conditions: Conditions such as polyps, fibroids, or even endometrial hyperplasia can cause a thickened endometrium and abnormal bleeding. These conditions may require further evaluation through imaging studies or a biopsy.

Regarding your question about whether menopause can still involve a thick endometrium, the answer is yes. Even during menopause, it is possible to have a thickened endometrial lining due to unopposed estrogen stimulation, especially if there are factors such as obesity or hormone replacement therapy involved.

It is crucial to follow up with your healthcare provider, especially since you have not had a menstrual period after taking the prescribed medication. They may recommend further diagnostic tests, such as an ultrasound or endometrial biopsy, to assess the thickness of the endometrium and rule out any serious conditions.

In summary, while irregular bleeding and a thickened endometrium can be common during the transition to menopause, it is essential to monitor these symptoms closely. Your healthcare provider can help determine the underlying cause and appropriate treatment options to manage your symptoms effectively. If you have any further concerns or if your symptoms worsen, do not hesitate to seek medical attention promptly.

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