Most women attain menopause between the ages of late 40s and early 60s, the average age being about 51. This is an important milestone in a women's gynecological history. One major change is altered female hormone levels, and this leads to a lot of physiological changes. From hot flashes to mood swings, there is also increased predisposition to osteoporosis and uterine cancer.

If you have not had your menstrual cycles for close to 12 months, chances are you are into menopause. So, that means absolutely no vaginal bleeding anymore whatsoever. However, if you experience bleeding, even spotting, be on the alert. It is not normal and needs to be examined, and if required, diagnosed and treated.

Postmenopausal bleeding or PMB, as it is popularly called, can be due to a variety of reasons. While it could be something as trivial as inflammation of the uterine or vaginal lining, it could also be an indication of more severe issues like cancer.

Atrophic vaginitis: Decreasing hormonal levels lead to increased dryness and therefore inflammation of the vaginal and uterine tissue. This is one of the common causes of bleeding after menopause.

Endometrial atrophy: Also caused by lower hormone levels, the lining of the body of the uterus gradually thins down and can get inflamed.
Polyps: Noncancerous growths in the uterus, cervix, vulva, or vagina can also lead to bleeding.

Infections: General infection of any area along the uterine tract could lead to occasional bleeding.

Cancers: Though only 1 in 10 PMB cases turn out to be cancers, the prognosis improves with early diagnosis and intervention.

Diagnosis: As repeated above, reach out to your doctor if you notice postmenopausal bleeding.  

Diagnostic methods could include the following:
1. Physical exam
2. Transvaginal ultrasound
3. Endometrial biopsy
4. Hysteroscopy
5. Dilatation and Curettage

Treatment: Needless to say, this would depend on the diagnosis. For very minor cases with diagnosis like altered hormone levels, no treatment may be required other than modification of the hormone replacement therapy. For endometrial atrophy and atrophic vaginitis, use of estrogen creams and pessaries would be sufficient. Polyps would require removal followed by cauterization (application of slight heat) to stop the bleeding.

Cancer: This would depend on the type and location and require a combination of chemotherapy and surgery.  Removal of the uterus also may be required in some cases. So, if you have had bleeding of any sort after a year of menopause, do not ignore it. 


Is Postmenopausal Bleeding Normal?

A collection of symptoms typically occurring between ovulation and menses (discharge of blood and from the uterus) is defined as premenstrual syndrome (PMS). Premenstrual syndrome symptoms can either be physical or emotional.

Physical symptoms and signs include:
i. Muscle or joint pain
ii. Headache
iii. Fatigue
iv. Weight gain due to fluid retention
v. Bloated abdomen
vi. Breast tenderness
vii. Acne breakouts
viii. Diarrhoea or constipation

While other behavioural and emotional symptoms include:
i. Anxiety or tension
ii. Depressed mood
iii. Crying spells
iv. Anger or irritability and mood swings
v. Food cravings and appetite changes
vi. Insomnia
vii. Social withdrawal
viii. Poor concentration

Causes 
The exact cause of PMS is unknown. But there are several contributing factors, such as:
1. Cyclic hormonal changes: The hormones oestrogen and progesterone fluctuate a lot while preparing for a normal menstrual cycle. This fluctuation causes some of the symptoms of PMS.
2. Chemical changes: The fluctuation of serotonin, a kind of neurotransmitter (brain chemical), affects the mood, which causes some of the emotional symptoms of PMS. For instance, insufficient serotonin triggers premenstrual depression, insomnia, food cravings and fatigue.
3. Depression: If the PMS symptoms are severe, depression could be the underlying cause, though it doesn't usually trigger all of the symptoms.

Treatment
There is no permanent cure for PMS, but a few lifestyle changes and home remedies can work very well for you. Some treatment options include:

1. To ease abdominal bloating, drink lots of fluids
2. Eat a balanced diet comprised of plenty of vegetables and fruits. Reduce your alcohol, caffeine, salt and sugar intake.
3. You can take supplements such as magnesium, calcium, vitamin B-6 and folic acid to reduce mood swings and cramps.
4. Take vitamin D supplements to relieve symptoms
5. Sleep for at least eight hours in the night to counter fatigue
6. Exercise to improve your emotional health and reduce bloating
7. Try to reduce your stress as much as you can; read a book or walk to relieve some stress.

Besides, these lifestyle changes, you can take over-the-counter medications such as aspirin and ibuprofen to reduce stomach cramps, muscles aches and headaches. Diuretics (drugs that increase urination) are excellent treatments for bloating and fluid retention. However, consult your doctor before consuming any medication or supplement.

Causes and Treatment of Premenstrual Syndrome

Vaginal bleeding is something that most women experience between their periods when they are not due for a menstrual cycle. It is considered as an abnormal occurrence when you bleed before you are expecting your menstrual period, or after you are done with your monthly cycle. It is usually characterised by bouts of spotting where a thick brown reddish discharge may be experienced. Also, this kind of bleeding is considered abnormal if it occurs during pregnancy or menopause.

Here are a few causes of abnormal vaginal bleeding:
1.  Hormones: An imbalance in the hormones like the estrogen and progesterone can lead to abnormal vaginal bleeding. These are the hormones that help in regulation of the monthly menstrual cycles. An imbalance can occur due to side effects caused by birth control pills that may not suit the individual, a contraceptive patch, or even contraceptive implants and injections. Further, an intrauterine device may also be the cause for this kind of bleeding. The hormonal balance can also get affected due to internal ailments like a dysfunctional thyroid gland and ovaries.

2. Pregnancy and Delivery: Some amount of spotting is considered normal in the first trimester of one's pregnancy. Yet, severe bleeding and persistent spotting must be reported to the gynaecologist immediately. Women also bleed for a while after the delivery of the baby, in the postpartum period. This may also happen when an abortion takes place as the uterus may not have come back to its original size and due to remaining foetal tissues within. Complications during the pregnancy like an ectopic pregnancy or a miscarriage can also lead to such kind of bleeding. An ectopic pregnancy is one where the egg gets implanted in the fallopian tube instead of entering and implanting itself in the uterus.

3.  Fibroids: Uterine fibroids are usually considered as non-malignant and non-cancerous growths within the uterus. These are common in many women who have gone through childbirth. These fibroids can also cause some amount of bleeding and spotting.

4. Infections: When there is an infection in the reproductive organs like the ovaries and uterus of the patient, there may be some amount of bleeding. An infection in this area can also cause inflammation, which is one of the primary causes of abnormal bleeding. This can also occur due to a sexually transmitted disease or STD, as well as painful intercourse and sexual abuse which can lead to scarring as well.

5. Cancer: One of the least common causes includes cervical, ovarian and other forms of cancer. 
Stress and diabetes can also cause abnormal vaginal bleeding in rare cases. It is best to see a doctor as soon as such bleeding takes place.

Causes of Abnormal Vaginal Bleeding

Heavy menstrual bleeding, technically called menorrhagia, is one of the most common types of abnormal bleeding from the uterus. Menstrual bleeding is said to be heavy if there is so much blood that a tampon or pad remains soaked for several hours. 

Here are all the possible causes of heavy menstrual bleeding:
1. Hormonal imbalance
Estrogen and progesterone levels are the primary control mechanism for periods. If the ovaries have a problem in functioning, hormonal imbalances may occur. Heavy menstrual bleeding is most common in females who are at the start of menopause. Puberty menorrhagia can occur in adolescents who are experiencing their first menstrual period. 
2. Fibroids
Fibroids most commonly occur around the age when women can get pregnant. Uterine fibroids are non-cancerous growth on the uterus.
3. Ectopic pregnancy
An ectopic pregnancy is when a fertilized egg stays in the fallopian tube, but does not reach the uterus.
4. Blood thinners
These are medicines, which are usually anticoagulant or antiplatelet drugs.
5. Problems with iud
A non-hormonal intrauterine device is a t-shaped device used for birth control which is inserted into the uterus.
6. Adenomyosis
This is a condition in which the muscular wall of the uterus also gets the lining of the uterus intermingled with it. However, this condition is rare and only happens in middle aged women with several children.
7. Pid
Pid stands for pelvic inflammatory disease and refers to any infection within the organs of the reproductive system.
8. Cancer
Uterine, ovarian and cervical cancer are just some of the cancers, which may cause heavy menstrual bleeding.
9. Other diseases
Liver, kidney and thyroid diseases are all included.

Possible Causes of Heavy Menstrual Bleeding

7 causes of heavy menstrual bleeding you must know about

Heavy menstrual bleeding, also known as Menorrhagia, refers to the state of abnormally heavy bleeding during periods. It's common for women at the premenopausal stage of their life to experience heavy bleeding during periods; but if you are not among them, heavy menstrual bleeding is a matter of severe concern.

If you normally lose a lot of blood during your periods or experience severe cramps that prevent you from leading your normal lifestyle, you must first identify the cause of it.

Here are some of the most common conditions that are responsible for causing Menorrhagia.

Disturbed hormonal balance: Menstruation involves the shedding of the lining of the uterus (endometrium), whose build-up is generally controlled by the balance between oestrogen and progesterone, the two significant hormones of your body. It sometimes happens that there is excess endometrium generation due to disturbed hormonal balance, which results in heavy menstrual bleeding.

Polyps: Sometimes heavy menstrual bleeding occurs due to the occurrence of uterine polyps, which are tiny growths appearing on the uterus lining. This condition is mostly prevalent among women of child-bearing age caused due to raised levels of hormones.

Intrauterine device (IUD): People who use birth control methods like intrauterine device or IUD are likely to experience certain side effects which include heavy menstrual bleeding. If the cause behind your menorrhagia is an IUD, you might need to remove it to get relief from the condition.

Pregnancy complications: If you experience your period later than usual and it is associated with excessive bleeding, it may be caused by a miscarriage. Moreover, you might also experience menorrhagia incase of an ectopic pregnancy, a condition when the fertilized egg is implanted within the fallopian tube in place of the uterus.

Uterine fibroids: Women of reproductive age may develop noncancerous (benign) tumours in the uterus known as uterine fibroids. These fibroids can be responsible for giving you periods lasting longer than usual accompanied with excessive bleeding.

Cancer: Though it is a rare case, sometimes the reason behind heavy menstrual bleeding may be uterine cancer, cervical cancer or ovarian cancer.

Medications: consumption of certain prescription drugs such as anticoagulants and anti-inflammatory medicines may lead to prolonged or excessive menstrual bleeding.





7 Causes of Heavy Menstrual Bleeding You Must Know About

The amount of emotional upheaval that periods, or no periods (for that matter) can cause, is something that every woman is aware of. It's normal to miss your period for different reasons occasionally, but it is a matter of concern if this absence persists over a period of time. The condition is then termed as a case of secondary amenorrhea. Although most people are quick to consider pregnancy while dealing with the various reasons for missed periods, there are a number of possibilities which are seldom mulled over, but should be considered in order to take effective precautions and seek proper medical care:

1. Weight
Body weight is responsible for affecting hypothalamus and this may, in turn, upset your menstrual cycle. BMI level under 18-19 may result in triggering irregularities since enough estrogen will not be created. This is also why underweight women, who suffer from bulimia or anorexia, tend to miss their periods frequently. 

On the other hand, overweight women may stop ovulating due to increase in the production of estrogen and therefore, have heavy, infrequent periods. Therefore, it is essential that body weight be regulated to avoid any disappointment at 'the time of the month.'

2. Stress
Any type of physical or emotional stress is bound to affect your cycle. This is because, the production of stress hormones in the body increases and an elevated level of adrenaline and cortisol may impair the functioning of the reproductive system. Under stressful situations, the body employs its amino acids to assist the neurotransmitters to produce stress hormones over sex hormones. As a consequence, the chances of missing your periods increase.

3. Exercising Too Much
While regular workout is indispensable for battling a sedentary lifestyle, overdoing it might cause your body to produce lesser estrogen and delay your periods. Women, who are into athletics and gymnastics, are more likely to suffer from amenorrhea. In fact, other aspects of over-exercising, like sleeping less, fasting, and infections also contribute to such irregularities.

4. Breastfeeding
Prolactin is the hormone that aids in milk production and may also repress ovulation for a while. Many breastfeeding moms may not get their periods for a month or more as a result. But this doesn't do away with your chances of getting pregnant. A span of three months is expected to pass before the abnormalities are done away with.

5. Food Allergies
Celiac disease or untreated gluten allergy can directly harm hormone production. They are directly related to your gut health and your adrenal glands which is why they can influence the sex hormone creation.


5 Reasons For Absent Periods

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