Unexpected Menstrual Bleeding After Years of Amenorrhea: What to Know

Experiencing menstruation again after years of menopause?

Hello Dr.
Tsai: I had endometriosis when I was younger and had my left ovary removed.
After giving birth to my second child, my menstruation stopped, and my doctor assessed that I had entered menopause.
During this period, I took medication, but due to side effects, I stopped taking it for about 7-8 years.
Two weeks ago, after being intimate with my husband, I noticed yellow discharge the next day.
However, due to a busy work schedule, I couldn't visit the hospital in time.
Last week, I experienced sudden bleeding that resembled menstruation (with similar blood volume and symptoms), and the discharge was clear.
This situation has persisted for a week.
I would like to ask if it is possible to suddenly have menstruation after 7-8 years of menopause? Could taking some health supplements (like royal jelly) trigger menstruation? Or could it be due to some disease causing abnormal bleeding? Additionally, I have been craving certain foods recently (similar to cravings during pregnancy), and my husband is wondering if it is possible that I could be pregnant (I have not taken any contraceptive measures since menopause)? Is it possible to suddenly ovulate and become pregnant after 7-8 years of menopause? I appreciate your insights on these questions.
Thank you.

gg, 40~49 year old female. Ask Date: 2011/04/16

Dr. Cai Yonglong reply Obstetrics and Gynecology

Dear Dr.
Tsai Yong-long of the Department of Obstetrics and Gynecology at Tainan Hospital, Ministry of Health and Welfare,
Postmenopausal or post-coital bleeding is considered abnormal and requires a visit to the obstetrics and gynecology outpatient clinic for a Pap smear and related examinations (such as for polyps).
It is also possible that bleeding may occur due to the intake of hormones or foods rich in soy isoflavones (such as evening primrose oil, royal jelly, etc.).
However, after 7-8 years of menopause, it is unlikely for menstruation to resume or for ovulation to occur, making pregnancy improbable (though not guaranteed).
Further examination is necessary for confirmation.
Wishing you good health and all the best!
Sincerely,
Department of Obstetrics and Gynecology, Tainan Hospital, Ministry of Health and Welfare

Reply Date: 2011/04/16

More Info

Unexpected menstrual bleeding after a long period of amenorrhea can be concerning and may raise several questions regarding its causes and implications. In your case, having experienced endometriosis and the surgical removal of one ovary, along with a history of amenorrhea for 7-8 years, the sudden onset of bleeding warrants careful consideration.

First, it is essential to understand that amenorrhea, particularly in the context of menopause or post-menopausal status, typically indicates that ovulation has ceased. However, there are instances where women may experience unexpected bleeding even after years of amenorrhea. This bleeding can be attributed to several factors, including hormonal fluctuations, the presence of uterine polyps, endometrial hyperplasia, or even malignancies. Given your medical history, it is crucial to rule out any serious underlying conditions.

Regarding your question about the possibility of resuming menstruation after such a long period, it is generally uncommon but not impossible. Factors such as hormonal changes, stress, significant weight fluctuations, or even certain medications can trigger a return of menstrual bleeding. While dietary supplements like royal jelly are often touted for their health benefits, there is no substantial scientific evidence to suggest that they can induce menstruation or ovulation in post-menopausal women.

Your concern about the possibility of pregnancy is also valid. Although the likelihood of conceiving after 7-8 years of amenorrhea is low, it is not entirely out of the question, especially if there is any residual ovarian function. If you have not been using contraception, it is advisable to take a pregnancy test to confirm or rule out pregnancy as a cause of your symptoms.

The presence of yellow discharge followed by menstrual-like bleeding could indicate several things, including an infection or hormonal imbalance. If the bleeding is accompanied by unusual symptoms such as pain, fever, or a foul odor, it is crucial to seek medical attention promptly.
In summary, while it is unusual to experience menstruation after a prolonged period of amenorrhea, it is essential to consult with a healthcare provider for a thorough evaluation. This evaluation may include a pelvic exam, ultrasound, and possibly endometrial biopsy to assess the uterine lining and rule out any serious conditions. It is vital to address any concerns regarding your reproductive health, especially given your medical history. Regular follow-ups with a gynecologist can help monitor your condition and provide appropriate management options tailored to your needs.

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