Abnormal Bleeding: Symptoms, Causes, and Concerns for Women Over 40 - Obstetrics and Gynecology

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Abnormal bleeding


I am 48 years old, unmarried, and my menstrual cycle has been approximately 22-25 days in recent years.
I usually experience bleeding for 3-5 days during the ovulation period, which occurs around days 10-15.
I started my period on February 17 (with a few days of light bleeding beforehand), and today it has been almost a month without stopping.
The flow is not heavy, and it typically stops by the evening.
I occasionally feel a dull, stabbing pain in my right abdomen.
I would like to know if this is considered irregular menstruation or possibly a symptom of menopause.
Additionally, I am concerned about the continuous bleeding and fear it might be cancer.
I would appreciate your assistance, thank you.

Xiao Qin, 40~49 year old female. Ask Date: 2022/03/14

Dr. Huang Yuande reply Obstetrics and Gynecology


As one approaches menopause, ovarian secretion becomes unstable, and hormonal changes may lead to irregular menstruation.
If this persists for too long, it is necessary to consult a physician to check for: 1.
Any tumor lesions.
2.
Hormonal function tests.
Treatment will then be based on the results.

Reply Date: 2022/03/14

More Info


Abnormal bleeding in women, especially those over 40, can be a source of significant concern and anxiety. Your description of experiencing prolonged bleeding for nearly a month, along with the history of irregular menstrual cycles, raises important questions about potential underlying causes.
Firstly, it is essential to understand that as women approach menopause, which typically occurs between the ages of 45 and 55, hormonal fluctuations can lead to irregular menstrual cycles and abnormal bleeding. This transitional phase, known as perimenopause, can cause changes in the frequency, duration, and volume of menstrual bleeding. The fact that your cycles have been shorter (22-25 days) and that you experience bleeding during ovulation (around days 10-15) is not uncommon. Ovulation bleeding, or mid-cycle spotting, can occur due to hormonal changes when the ovary releases an egg.

However, the persistence of bleeding for nearly a month is concerning and warrants further investigation. While it is possible that this could be related to hormonal imbalances associated with perimenopause, other potential causes must be ruled out. These can include:
1. Uterine Fibroids: Non-cancerous growths in the uterus can cause heavy or prolonged bleeding. They are common in women in their 40s and can lead to symptoms such as pelvic pressure and pain.

2. Endometrial Hyperplasia: This condition involves the thickening of the uterine lining, often due to excess estrogen without sufficient progesterone. It can lead to irregular bleeding and, in some cases, may progress to endometrial cancer.

3. Polyps: These are growths on the lining of the uterus that can cause abnormal bleeding. They are usually benign but can lead to symptoms similar to those of fibroids.

4. Hormonal Imbalances: Conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders can lead to irregular menstrual cycles and abnormal bleeding.

5. Cancer: While it is understandable to be concerned about cancer, especially with prolonged bleeding, it is essential to remember that many benign conditions can cause similar symptoms. However, any persistent abnormal bleeding should be evaluated to rule out malignancy.

Given your symptoms, including the right abdominal discomfort, it is crucial to consult with a healthcare provider for a thorough evaluation. This may include:
- Pelvic Examination: A physical examination to assess for any abnormalities.

- Ultrasound: Imaging studies to visualize the uterus and ovaries for fibroids, polyps, or other abnormalities.

- Endometrial Biopsy: If indicated, this procedure can help determine if there are any precancerous changes in the uterine lining.

- Blood Tests: Hormonal assessments to evaluate for conditions like thyroid dysfunction or other hormonal imbalances.

In the meantime, keeping a detailed record of your menstrual cycles, including the duration and volume of bleeding, as well as any associated symptoms (like pain or discomfort), can be helpful for your healthcare provider in making an accurate diagnosis.

In summary, while hormonal changes related to perimenopause can explain some of your symptoms, the persistence of bleeding for nearly a month is concerning and should be evaluated by a healthcare professional. Early diagnosis and treatment are essential for managing any underlying conditions effectively and alleviating your concerns.

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