Abnormal Bleeding: Endometriosis and Menopause Symptoms

Bleeding or menstrual period?

Hello Doctor, I am almost 45 years old and have endometriosis.
During my menstrual period, I experience severe rectal pain and a strong urge to defecate.
I underwent surgery in July 2010.
My last menstrual period started on April 3rd, and on the second day, I had an extremely heavy flow (using a 23 cm long pad that overflowed in less than an hour).
From April 30th to May 2nd, I had a small amount of fresh blood on the first day (very brief, lasting only a few minutes, and there was none on the second trip to the restroom).
After that, I only had a small amount of brown discharge (similar to the end of a period).
On the third day, I experienced mild rectal pain, which I thought was a sign that my period was coming, but on May 4th, the brown discharge stopped.
Then from May 13th to May 18th, I had a similar experience on the second day, with a small amount of fresh blood that was also very brief, lasting only a few minutes, followed by a small amount of brown discharge (again, like the end of a period).
I would like to ask Dr.
Lin: 1.
What do these two occurrences indicate? 2.
Is this a sign of ovarian function decline? 3.
Or could it be symptoms of menopause? 4.
Given my condition (endometriosis), would it be appropriate for me to supplement hormones like someone going through menopause?

Lin, 40~49 year old female. Ask Date: 2012/06/10

Dr. Lü Lizheng reply Obstetrics and Gynecology

Dear Lin,
Hello,
1.
Abnormal vaginal bleeding can have many causes, with the most likely being irregular menstruation.
Other possibilities include pregnancy, inflammation, or the presence of growths, among others.
2.
It is unlikely to be due to ovarian function decline.
3.
It is not likely to be a symptom of menopause.
4.
Based on the symptoms, hormone replacement therapy is not appropriate.
Wishing you peace and health.
Sincerely,
Dr.
Lu Li-Cheng
Director, Department of Obstetrics and Gynecology
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2012/06/10

More Info

Abnormal bleeding can be a significant concern for many women, particularly those with underlying conditions such as endometriosis. Your situation, as described, involves a complex interplay of symptoms that may be indicative of several underlying issues, including hormonal imbalances, the effects of endometriosis, and potentially the onset of perimenopause or menopause. Let’s break down your questions and concerns.

1. What are the phenomena observed during the two instances of bleeding?
The episodes of bleeding you described, particularly the short-lived instances of bright red blood followed by brown discharge, could be attributed to several factors. In women with endometriosis, the uterine lining (endometrium) can respond abnormally to hormonal fluctuations, leading to irregular bleeding patterns. The presence of endometrial tissue outside the uterus can cause inflammation and pain, which may also contribute to the sensations you experience during your menstrual cycle. The brief episodes of bleeding you noted could be related to ovulation bleeding, which is common, or could indicate a response to hormonal changes in your body.

2. Is this indicative of ovarian function decline?
At nearly 45 years old, it is possible that you are experiencing changes in ovarian function. The ovaries gradually produce less estrogen and progesterone as women approach menopause, which can lead to irregular menstrual cycles and changes in bleeding patterns. However, the presence of endometriosis can complicate this picture, as it may continue to cause symptoms even as ovarian function declines.

3. Are these symptoms signs of menopause?
The symptoms you are experiencing could indeed be related to perimenopause, the transitional phase leading up to menopause. During this time, women often experience irregular periods, changes in flow, and other symptoms due to fluctuating hormone levels. However, given your history of endometriosis, it is essential to consider that some of your symptoms may be directly related to this condition rather than menopause alone.

4. Is hormone replacement therapy (HRT) appropriate given my endometriosis?
Hormone replacement therapy can be a double-edged sword for women with endometriosis. While HRT can help alleviate menopausal symptoms, it may also stimulate endometrial tissue, potentially worsening endometriosis symptoms. Therefore, it is crucial to discuss this option thoroughly with your healthcare provider. They may recommend alternative treatments or a tailored approach to managing your symptoms while considering your endometriosis.

In conclusion, your symptoms of abnormal bleeding and associated pain are multifaceted and likely influenced by your endometriosis and the natural aging process of your reproductive system. It is essential to maintain open communication with your healthcare provider, who can help you navigate these changes and develop a management plan tailored to your specific needs. Regular monitoring and possibly further diagnostic evaluations, such as imaging or hormonal assessments, may be warranted to ensure that any underlying issues are addressed appropriately.

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