The large majority are discomforted with excessive and lengthy bleeding, frequent flow, seldom periods, spotting and blood after intercourse. All of this, of course, occurs to varying degrees. Changes in menstrual flow can cause problems in a woman’s daily life and make her a social recluse, often leading to contact with health care organizations.
Normal menstrual flow and a regular menstrual cycle is subject to a well-functioning interaction between the hypothalamus-pituitary gland in the brain and the ovaries, as well as a normal uterus. During menopause, both hormonal imbalance and changes in the uterus occur which can lead to irregularities in menstrual flow.
Hormonal imbalance is caused by what we can call a fatigued system due to aging. The role between the sexual hormones estrogen and progestagen is disrupted which then can lead to shorter cycles and irregular menstrual periods. A cycle without ovulation, which isn’t unlikely at the end of a reproductive age, can also cause irregular menstruation. In addition, other hormonal changes in the body’s glands, such as the thyroid and pituitary glands, can also affect menstruation.
The uterus is a muscle with a hollowed space. During mid- to late forties, it isn’t uncommon to experience so-called myoma, or fibroids, in the uterus. What happens is that parts of the muscle that make up the uterine wall develop into benign fibroid tumors due to changes in hormonal balance. If the fibroids lie along the uterine lining that is shed at each menstruation this can be one of the reasons for problems with bleeding.
Other conditions which can affect menstruation are uterine polyps, infections and endometriose. The reasons for these are many and treatment depends on each individual woman’s symptoms and causes. For some, the discomforts can be so great that it is necessary to remove the uterus (hysterectomy) during this aging phase.
An easier alternative could be to remove the lining of the uterus (transcervical resection of the endometrium or TCRE). If the uterus is normal, treatment with a hormonal IUD could be a good option to reduce excessive and lengthy bleeding.
It is very rare that problems with menstrual bleeding during menopause are due to a malignant illness, such as uterine or cervical cancer. A clinical examination at the doctor’s office, including a pap smear and ultrasound test, can easily eliminate this.
After menopause, the uterus shrinks, along with any existing fibroids. The uterus then is about the size of a small, grey pear. It almost feels as if it has no further function in menopause when it no longer serves as the female body’s ‘brooding box.’