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?

Missing out on your periods or irregular periods once in a while is common. However, the problem arises when irregular periods become every month s story. The irregularity can be an amalgamation of a host of factors. Ignoring the same for long will only complicate things further. For women of reproductive age, the problem can give rise to deleterious consequences, including difficulties in conceiving. In this article, we will discuss some of the common triggers that result in irregular periods and when to seek medical help.

What causes Irregular Periods?
The hormonal balance plays a significant role in the proper functioning of the vital organs of the body. More than often, irregular periods are found to be a manifestation of hormonal imbalance. Some of the conditions that trigger the hormonal imbalance include

PCO is a common medical condition that affects women of reproductive age. PCOS is characterized by the formation of cysts in the ovary (one or both) that affects the ovulation process. In PCOS, there is an increased production of Androgen, especially Testosterone that can cause irregular periods, hair fall, facial hair, weight gain etc.

Time and again doctors and health professionals emphasize the importance of leading a stress-free life. Research suggests stress and anxiety often interfere with the functioning of the Hypothalamus. As a result, the pituitary glands that control and regulate the activities of the ovaries, adrenal glands, and thyroid glands may be affected. These can also trigger a hormonal imbalance giving rise to menstrual problems such as Irregular periods. In case of extreme stress, there may be a short-term cessation of periods (Secondary Amenorrhea).

The hormonal imbalance and irregular periods can also be an outcome of other medical conditions such as endometriosis, a cancer affecting the reproductive organs, fibroids, obesity, diabetes, hyperprolactinemia (characterized by elevated level of prolactin) or even thyroid disorders.

Women who indulge in strict dieting can also suffer from irregular periods. Strict dieting (especially the ones that are without a proper nutritional guidance) can rob the body of the essential nutrients disrupting the hormonal balance.

Irregular periods are normal in women who are nearing their menopause.

When to seek medical assistance?
Irregular periods can be indicative of a severe health problem. Consult a gynecologist

If your regular cycles get delayed by more than 7 days.

There is spotting or bleeding in between the periods.

Your periods last for more than ten days or less than two days.

There is excruciating pain during periods.

The gap between two successive menstrual cycles is more than 35 days or less than 21 days.

Your periods are heavy and unmanageable, affecting your daily routine.

Irregular Periods - When To See A Gynaecologist?

4 Types of irregular periods and their causes

Menstruation is a cyclical process when at a certain time of the month, the lining of the uterus is shed and vaginal bleeding occurs. Sometimes there can be abnormalities in this cycle. Irregular periods in women are abnormal variations in the length, volume, duration and quality of menstrual cycle. Irregular periods aren't uncommon among menstruating women.

Abnormalities in periods can be of the following nature:

- Varying time between successive periods
- Loss of more or less blood than usual
- Varying length of your periods

Based on these categorizations, the different types of periods are:

1. Irregular menstrual bleeding - Irregular menstrual bleeding is characterized by bleeding that takes place for more than 20 days in a solitary cycle, which can lengthen over a period of a year.

2. Absent menstrual bleeding - In this type of menstrual bleeding, a woman does not get her period at all within a span of 90 days.

3. Heavy menstrual bleeding - This involves excessive blood loss that may intervene with a woman's physical, psychological and social quality of life.

4. Heavy and prolonged menstrual bleeding - This is less common than heavy menstrual bleeding and is different from in terms of duration. A different type of therapy is required to treat the condition as it is more severe in nature.

5. Light menstrual bleeding - Light menstrual bleeding is characterized by less blood loss than usual.

Irregular periods can be caused due to several reasons. Some of them are:

- Switching from one birth control pill to another or taking certain medication
- Excessive exercising
- Breastfeeding or pregnancy
- Stress
- Hyperthyroidism
- Polycystic ovary disease (PCOS)
- Uterine fibroids
- Getting an IUD (intrauterine device)
- Gradual thickening of uterine lining or the development of polyps on the uterine lining
- Scarring of the lining of the uterus can also be a possible cause

Changes in the body's level of hormones can also disrupt a woman's periods. Estrogen and progesterone are the chief hormones that play a crucial part in the menstrual cycle and influence the flow as well, thereby giving rise to abnormalities if their balance is disturbed.

When it comes to treating irregular periods, modifying your lifestyle, treating the underlying issue behind an irregular cycle, changing your birth control pills (if that is the cause), opting for hormone therapy or even surgery are viable treatment options.



All about Irregular Periods : Their Types and Causes

What Causes Light Periods in Women?

Light periods refer to menstrual periods that have very light flow and are characterized by a lesser number of days than usual. Although the menstrual cycles vary from a woman to another, the duration for a normal period is around every 28 days. Each period lasts for approximately four to seven days. The amount of blood loss in a normal period is around 20 ml to 80 ml. However, loss of blood below 20 ml can be considered as light periods.

The causes of light periods can vary for different woman. Some of them are:

- An imbalance in hormone levels in the body like PCOD (polycystic ovarian disease).

- Light periods are most common in women who are approaching menopause. This is because, at this time, women tend to produce less estrogen, a hormone responsible for regulating menstrual periods.

- Light periods can be common in girls who have just started to menstruate.

- Excessive bouts of exercise, a thyroid condition or an eating disorder can be also responsible for light periods in women.

- Women who use hormonal or oral contraceptives may also have a chance of experiencing light periods.

- An important cause of scanty menses is implantation bleeding. That means sometimes, despite being pregnant, little amount of bleeding can happen at the expected time of menses in the first three months of Pregnancy. So it's important to rule out pregnancy at the earliest.

Certain symptoms usually follow light periods. These symptoms vary according to the underlying causes of this condition.

Some of the common symptoms which accompany light periods are:

- Abdominal pain
- Frequent infections, namely yeast and other fungal infections
- Painful sexual intercourse
- Missed periods

In some cases, light periods might turn out to be a sign of a fatal condition that should be immediately administered to. An example of such would be an ectopic pregnancy, which can cause light or heavy bleeding. Although light periods are rarely due to serious diseases, neglect can lead to heightened complications and irreversible damage.

Some of the complications can are:

- Serious discomfort and pain
- Difficulty in conception or infertility
- Osteoporosis and osteopenia



What causes light periods in women?

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

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