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?

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

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

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

How to ensure a normal period when you're suffering from PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal disorder affecting 12-18% of women of reproductive age. PCOS is a condition where at least two of the following conditions occur:

1. Appearance of acne, excessive hair on your body

2. Irregular delayed periods

3. The presence of 10 to 12 small cysts in the ovaries.

You do not ovulate each month, and some women do not ovulate at all if they are suffering from PCOS. This is because although the ovaries of women, suffering from PCOS, usually have many follicles, they do not develop fully and so ovulation often does not occur. If you do not ovulate, you may not have periods.

So what can you do to have normal periods?

Although some women with PCOS have regular periods, high levels of androgen and also the hormone insulin, can disrupt the monthly cycle of ovulation and menstruation. If you have PCOS, your periods may be irregular or may stop altogether. The average menstrual cycle is 28 days with one ovulation, but anywhere between 21 and 35 days is considered normal, and for a woman suffering from PCOS, this cycle can take as much as 3 months to complete.

To ensure a normal period during PCOS, your doctor can prescribe hormonal contraception. The medication can also reduce menstrual cramps, acne, and excess hair growth. The estrogen and progesterone in hormonal contraception act to override the body's normal hormonal control of menstrual cycle and ovulation. Production of hormones such as testosterone is greatly reduced by the oral contraceptive pill. Some oral contraceptive pills not only aim to block the effects of testosterone but also increase insulin resistance.

By allowing the regular shedding of the uterus lining during menstruation, the pill can reduce the risk of developing endometrial cancer while ensuring you get normal periods.

Note: it is important that you closely watch your weight. Lifestyle changes and weight reduction help a lot when you are suffering from PCOS.

If you would like to consult with me privately, please click on 'consult'.
Related Tip: How Not to Miss Your Workout During Your PERIOD

How to Ensure a Normal Period When You're Suffering from PCOS?

Periods, on their own, can be very uncomfortable but sometimes it can also trigger a rash making it all the more uncomfortable. This is a common problem faced by women who use commercial pads or sanitary napkins during this period. This is because they contain plastics, scents and chemicals that can irritate the sensitive skin in your genital area. Here are a few tips to help you deal with these rashes:

Change Your Pads Regularly: Whether your flow is light or heavy, the same pad should not be worn for more than 4 to 6 hours. Change your pads even if your pad does not look full once this time has passed. Along with menstrual blood, sanitary napkins also soak up sweat and bacteria. The groyne area is naturally moist and warmer than the rest of your body making it the ideal condition for bacteria to grow. Changing your pad regularly keeps these bacteria from multiplying.

Consider Alternatives: One of the main reasons pads cause rashes is because they rub against the skin and this friction irritates the skin. Hence, consider alternatives like tampons and menstrual cups that do not rub against the skin. You could also try cloth pads made using natural unbleached cotton.

Wear Right Underwear: Avoid synthetic underwear and use the only cotton while you are on your periods. This allows the skin to breathe and keeps moisture from building up inside the underwear. Also, ensure that your underwear fits well and can hold your pad in place.

Clean Well: Do not use wipes or tissue to clean your genital area but instead wash gently with water a few times a day. Once washed, dry the skin thoroughly before putting your underwear on. Do not use any type of soap, body wash or scents in the area. Also, avoid bubble baths and saunas.

See a Doctor: In some cases, a rash can also be a symptom of herpes or a vaginal yeast infection. If you alternate between pads and tampons, a rash could also be a sign of toxic shock syndrome. Hence, if the rash persists for a few days, consult a doctor. Your doctor can prescribe a topical cream to be used to relieve the itchiness and inflammation depending on the rash. You could also use an anti-chafing cream on your bikini line. Diaper rash cream is an over the counter cream that usually works well in such cases.

How To Deal With Rashes Due To Periods?

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