Periods After Menopause
Understanding What Causes Post-Menopause Menstruation
After menopause, some women do experience what may seem like a period.
This is usually a result of hormonal fluctuations, and does not mean that menstruation is going to resume.
However, if a woman is truly post menopausal, in the accepted definition of the term, then it is important to go to a doctor to make sure this is not a symptom of a more serious problem, like endometrial cancer.
Medical practitioners generally accept that if a woman at mid life has not had a period for a full 12 months, then she is post-menopausal. If a woman has no menstruation for, say, 4 months, then has a period, she must start counting again!
Periods can become irregular, skipping some months entirely, before perimenopause is finished. This makes it difficult to really define the end of menopause, and leads to some women believing they’ve finished menopause before they actually have.
Thus, what may seem like a period after menopause, may in fact be another irregular cycle!
But for women who truly are post menopausal, a number of relatively harmless things may trigger a period. Marcy Holmes, a menopause clinician, writes that bleeding after menopause is a “more common occurrence than you think.”
So, what can trigger these period-like episodes?
Hormone replacement therapy
There are different ways HRT is given, and these have different likelihoods of bleeding.The most common form HRT is given is in cyclic therapy. Here, estrogen is taken orally for 25 days, then synthetic progesterone is added in between the 10th and 14th day. Once the synthetic progesterone is added, both are taken together for the remainder of the cycle. No pills are taken for 3 to 5 days following this.MedlinePlus write that women experience monthly bleeding with cyclic HRT. This is considered normal, even after menopause. However, if your period is heavy, or long, or occurs after the synthetic progesterone period, then this is considered abnormal. This is also true if there is breakthrough menstrual bleeding.The other way to take HRT orally is called continuous, combined therapy. In this case, women take estrogen and a synthetic progesterone together, every day. Initially, women might have irregular menstrual cycles whilst taking this, though that should stop within a year of starting this type of HRT (Medline Plus). The Clinical Practice Guidelines of the Royal Women’s Hospital in Australia state that this type of bleeding should stop within 6 months of treatment starting. They consider anything after this abnormal. So, you may want to err on the side of caution, given such variations from medical experts.
For women on continuous therapy, if you bleed again after menstruating has stopped, and following the adjustment period, then this is also considered abnormal.
Changing the type of HRT, going from cyclic to continuous, may also result in irregular bleeding.
Poor nutritional choices
What we eat affects our hormonal balance, which in turn affects whether we have period like episodes. That is why so many menopause experts recommend following a good and balanced diet. If you think your diet may not be supplying all the essential minerals and vitamins you need, then its a good idea to use a daily supplement. There are some multi vitamins that also have other menopause herbs with them, though the herbs are not generally in a sufficient quantity to be effective. It’s best to stick to a multi vitamin and get herbs separately if you want to use them.Nutritional choices have particular impact in the area of insulin resistance. Many women after menopause develop insulin resistance, and this is a precursor to type 2 diabetes. Insulin is involved with metabolism, and regulates the growth of cells. In insulin resistance, more and more insulin is needed to get the same effects. And women who are insulin resistant tend to have higher levels of estrogen. They can convert progesterone into estrogen, which can lead to periods after menopause and bleeding that is not typical of post menopause.
More information on insulin resistance is available here.
Losing a lot of weight quickly
Estrogen is stored in fat tissue, and when a lot of weight is lost quickly, it is released into the blood stream. Sudden weight loss disrupts the balance of hormones, and can result in bleeding.
Like sudden weight loss, stress can affect our hormone balance.
Whilst periods after menopause can be attributed to any of these things, it’s still important to check with your doctor to find out what exactly is going on.