Post Menopausal bleeding can be quite worrying … In clinical terms you reach menopause if you haven’t had a period for more than twelve months. We certainly know that bleeding after menopause can be a sign of something sinister like cervical cancer. However in 90% of cases the specific cause of bleeding remains undiagnosed. This isn’t necessarily a bad thing as long as you rule out cervical & uterine cancer as soon as possible. For this reason it is imperative to see your Doctor straight away if you experience post menopausal bleeding.
Thankfully, there are also quite a few benign reasons for post menopausal bleeding. Most of which are easily diagnosed & treated by a gynecologist. Personally, I think the problem diagnosing random bleeding or spotting after menopause comes when there is excessive stress involved. Sudden stress or prolonged stress can trigger estrogen production & kick-start menstruation. As women, we’re always happy to blame these stressful times for everything from mood swings to abnormal bleeding. Although it’s fair to say stress exacerbates every problem, there’s no doubt it boils down to hormones. When those babies aren’t balanced, shit goes down. Does this sound familiar?
“Oh I wouldn’t worry, it’s just the stress of your situation right now”
In actual fact I’m experiencing this joyful time myself right now. Let’s start from the beginning…
WHY AM I BLEEDING TWO YEARS AFTER MY LAST PERIOD?
It all started when I had this awesome idea to change my HRT delivery method. I decided to have the Mirena fitted to deliver my Hormone Replacement Therapy directly where it’s needed. Oh how I wish I’d left my body alone…
After a torturous Peri-menopause & experimenting with various types of treatment I settled on Evorel patches & Utrogestan pills. This combination was a complete success & I was living my best life. Sleeping well, no menopause symptoms at all & absolutely no bleeding what so ever.
Then I read that the safest delivery for HRT is the Mirena. I could stop using patches & would no longer take a pill every night, thus protecting my kidneys. All I had to do was have the tiny device fitted & I’d be good for seven years AWESOME! It sounded so simple.
Well, it wasn’t. From day one of having the Mirena I bled. Some days it was lighter than others but it was every single day. I knew beforehand this was a possible side effect of healing from the Mirena “settling in”. However, by the fourth month, I’d had enough. Me and Mirena are clearly not getting along.
I asked my GP to remove it. That in itself was a palaver, my Doctor explained it could take up to six months settle. She strenuously advised me to wait a little longer so I gave it another two months. When I saw my Doctor again she remained unconvinced that removing the Mirena was the right thing to do. Arrrgh by now, I was totally over it, I wanted that bloody thing out of me STAT! So on my third visit, I told her if she was unwilling to remove the Mirena I would go home & do it myself.
Out it came.
The next day we moved to America…
STRESS MESSES WITH YOUR HORMONES
Moving to the U.S was a tad stressful, as you can probably imagine (read about that here) I fully expected my hormones to be messed up by the recent change in treatment. What I wasn’t expecting was the constant bleeding for three months straight. I was back on my original dose of HRT medication so I assumed everything would settle down again before too long. Naturally, my uterus had to heal & there was the extra stress of moving overseas to consider too. So I waited. And waited.
Eventually, after three months the daily bleeding stopped. Unfortunately, my relief was short-lived, by the following month to my complete & utter disappointment, a regular “period” returned. Of course, the worst bleeding occurred when my stress levels peaked during our second month living in America. I just accepted it was the natural by-product of such a major move which hadn’t gone smoothly. Coupled with the fact I’d started taking HRT meds orally again, I wasn’t worried.
Fast forward five months & FLOW is still visiting regularly… unannounced.
She also brought along her friends, lethargy & mild depression.
Adding insult to injury is summer break. You may recall I have three children? Yep, three kids in a new country.
Admittedly some days I just want to stay in bed but for the most part, I can tolerate feeling like utter shite for the sake of my family. This move has been tough on all of them for various reasons & ultimately I’m responsible for making their new life in America as painless as humanly possible. It was my idea after all.
The stress of that process has been huge for sure, you can see how much weight I’ve lost. However, we’re pretty much through the worst of it now. Finally, I feel confident everyone is happily settled here so why is my body not responding in kind?
The time has come to say goodbye postmenopausal bleeding & hello new gynaecologist. Totally past due wouldn’t you agree? I’m way too busy to suffer such nonsense, it has to stop. I booked an appointment to discuss my HRT history/dosage & have some tests to eliminate the big C.
TESTS FOR POSTMENOPAUSAL BLEEDING
- Take a swab to check for infections
- Do a smear test to check for cervical cancer cells.
- Take a blood sample
- Do a transvaginal ultrasound or hysteroscopy to get images of the cervix, uterus, and ovaries
- Take a tissue sample, also known as a biopsy to check for cancerous cells
Most likely these tests will be carried out at the clinic & hopefully on the day. For those of you experiencing postmenopausal bleeding here is a list of possible causes, in no particular order. I left off the obvious yet least likely one, cancer. No need to postulate.
COMMON CAUSES OF POSTMENOPAUSAL BLEEDING
- Endometrial atrophy – Thinning of the tissue lining of the uterus causing it to bleed. This is due to not enough Estrogen.
- Endometrial hyperplasia – The overgrowth of cells lining the uterus causing heavy or irregular bleeding. Often caused by excess estrogen without the hormone progesterone to offset it.
- Polyps – Usually these are non-cancerous growths in the uterus or cervix.
- HRT – Changing or stopping Hormone Replacement Therapy.
ALWAYS LOOKING UP
Keep moving forward & always look up are my favourite sayings for a reason. Slightly pithy I admit but in times of uncertainty, it helps to remind myself that nothing ever stays the same. Besides that, I’m a steadfast rationalist to my very core. I truly believe the most likely reason for my post-menopausal bleeding is hormone imbalance. Checking my levels & adjusting my medication dosage will probably fix it. Also, it wouldn’t hurt to test my iron & vitamin D. Although I’ve kept this bleeding issue to myself, I’m honestly not panicked about it at all. Mostly it’s just annoying, at worst, frustrating & occasionally debilitating.
As most of you know, I share my Meno journey in the hope that some of this information helps other Women. There just isn’t enough info around, we must talk more about it because our experiences can be quite different. You never know what small thing you say could help someone else in a big way. In any case, I want my gorgeous girl crew to know that I’m O.K. Let’s sit tight until after my Doctors appointment at which time I’ll fill you in on the test results & course of action. If any of this strikes a chord with you or you have experience to pass on, please feel safe to share with us here. Information is power right?
Lots of love Mx
*Sources – National Health Service UK | US Food & Drug Administration | Royal Women’s Hospital Victoria Aus | MAYO CLINIC
Comments ( 27 )
Rozanne
This is another wonderfully honest and rational post Michelle, bravo for sharing and helping to keep us talking about menopause. I’m still lurching through perimenopause, with all the wonderful little surprises that brings, but it is so helpful to hear about other people’s experiences. The whole subject needs normalising. I’m sure there is a whole new landscape of possibilities that awaits once we have trekked through this jungle, and posts like this are such a comfort to other women going through the same changes. Your blog epitomises style and substance and that is why I love it. Sending you a big transatlantic hug and looking forward to reading more. Take extra gentle care of yourself when you do feel down. It helps to remind ourselves that it isn’t us, it’s our sodding hormones, the little shits ;o) X
MT
Rozanne…I don’t know what to say to this, thank you. Your support means the world to me xx
Lizzy
Oh Michelle, you need a big hug. And then some. First of all, thank you for writing so brilliantly and so honestly about this. As you know, I have been totally overwhelmed with my own heavy bleeding which is now rectified after a uterine ablation. However, before that, I too tried the Mirena and bled every day for 12 months before getting absolutely desperate and demanding its removal.
Fingers crossed things will settle down, along with a reduction in your stress levels. I too am certain that your rational thoughts are correct. It is simply a hormone imbalance which needs remedying with the right HRT etc. I’m so sorry to hear about the mild-depression and lethargy. Let’s hope they pack their bags for good too, along with Flow once you get answers and the correct treatment. good luck my darling friend xxxx
MT
That’s interesting about your experience with the Mirena Liz. I rarely heard the negative side before I got it but I’m hearing this more & more now. Evidently it isn’t the miracle cure after all. Geez I wish it was…
Thanks for the big hug, you’re friendship & daily support really makes a difference darling girl xx
Michele
Thank you for this straightforward practical article. Well timed too as a change in HRT has delivered this outcome 2 weeks into the new tablets. But my super GP warned me, so am inconvenienced but not alarmed. Oddly I have those weird stomach cramps you get with a period. Feeling strangely nostalgic but may wear off after a few days if this persists! Less happy was a heavy one off unexpected bleed 4 months ago. The NHS rose to the challenge – GP sent off for emergency scan, 10 days later scan (with on the day results) plus swabs etc. Nothing nasty. Phew! But still no answer as to why it happened. I certainly wasn’t stressed – quite the reverse. Fab new boyfriend Really happy. So is just change part of it I wonder? Have to say it was 4 years since my last natural bleed. So fairly alarming at the time.
Why isn’t the factual content in this piece readily available online?
MT
Hi Michele, Blimey that is good timing. Just goes to show how common these bleeds are but all the same that doesn’t make it right or normal. I’m so happy to hear you got the all clear & yes the NHS is a wonderful thing. I’m in private health now being in America but that doesn’t give me any better service or care that I’ve seen so far. Paying through the nose but still can’t get an appointment before four weeks! Perhaps one day we’ll be able to buy a simple DIY home test kit? At least to eliminate cancer before further investigation & tests. It would certainly make the wait less stressful. As for you still not knowing the reason, I think (from what I’ve read) that is often the case. Perhaps if men went through menopause there’s be more money for research, probably be a cure! 😉
Gladys
I have been on HRT since Dec I have been using the Climara Pro patch which is low dose estrogen and progesterone in one. I did get a 3 day period this month. I don’t know if that will continue , the bleeding is suppose to stop in a few months.
I think a 3 day light period is a small price to pay for HRT which keeps me sane.
I also have the Climara patch 0.50 with 0.35 progestin pill which is a slightly higher dose. I may try those next month to see if the slightly higher dose makes the period not return.
I like you was blind sided by menopause at 42 and it’s symptoms.
Not enjoying this change but I will adjust.
MT
Hi Gladys,
I agree with you that a light “period” is a small price to pay but I do hope it goes altogether. I think it sucks that we have to endure these horrible symptoms of menopause or be grateful for a light period. This isn’t much of a choice and seems pretty unfair. I haven’t had a bleed since I found out about the progesterone build-up in my system. All it took was two weeks off taking it, for my body to go back to normal. So now I’m back to one progesterone pill every night with an estradiol patch twice a week.
I shall research the combined patch as an easy alternative. That’s if I can get my doseage right. Let me know how you get on Gladys and thank you so much for sharing and contributing to the priceless info we have here xx
Gladys Wisener
I have noticed that the bleeding seems to occur the day after i change patches. i am thinking that maybe the bleed is being caused by the drop in hormones when changing the old patch and putting a new one on.
This last time i waited to long to change patches and i think the hormone ran out before i put on the new patch.
I am going to try to be more careful when changing patches.
I think the problem is how do you really know when the patches has ran out?
My frustration is you really don’t know when the patches run out of hormones, is it 3 days or 4 (if you are on the twice a week) or is it really 7 days (Climara pro patch)?
I am going to try the Climara patch with the progestin pill next month, see how that goes.
My mom was on hormone replacement for 10 years, she was on pills, she said she never bled.
If worse comes to worse i am willing to change to pills.
I think HRT is imperfect because it can’t really replace what the body did automatically and with precise calculations.
I will keep you posted.
MT
Hmm I get what you’re saying about changing patches but I believe it takes more than just a few days for the hormone to leave your system. At least it did for me when I over dosed on progesterone. Perhaps the estrogen is another matter when delivered via patch? As you say, it’s impossible to tell. I would love to know if any of these pharma brands are running a test on this. I think it’d be incredibly useful to follow a few different Women taking this form of HRT. They could do daily blood samples to calculate the ebb and flow of delivery. I bet there are so many underlying factors like the persons weight and diet. No doubt what we eat impacts the efficacy of the drugs we take. Thanks for the update Gladys xx
Abby@midlifecrisisnut
Thank you so much Michelle for this honest post! In relation to HRT etc I don’t even know where to start. 😒 I’ve been reading about Mirena (and progesterone overdose) some time ago when I messed up my hormones and was bleeding heavily (postmenopausal) for a while. It freaked me out and I started reading. And guess what I discovered? In a bid to go safe and counteract estrogen doctors prescribe progesterone for menopausal women in HUGE quantities to thin out their lining until they bleed their guts out. You can never balance out that amount of progesterone that is delivered in those devices or even as a pill of 200mg daily. Plus this thing accumulates in your body (liver, brain etc) for months (see years – in my case) which causes additional bleeding for months even when stopped completely. Which is why I cannot take patches because my body uses them in a day and then they stop working. I can only imagine how worried you are and how all that stuff just wears you down while all you need now (after moving countries etc) is some rest and not some bloody affairs. I’m sure that all the tests will reveal that everything is alright and that you just thinned your lining to extremes, hence the bleeding. So don’t worry, everything will be fine I’ve noticed over the months that you’ve lost weight at a speed of light and was worried about you. Now I know what’s behind it and feel a bit relived to see that as usual it’s those damned hormones. As I always say: if men had to suffer one day from menopause, there would have been a cure for it a hundred years ago. All the rollercoasters of emotions, the mood swings, the depression, the bleeding, the bloating, the insomnia etc. They wouldn’t put up with it one sec … Sending you lots of love and a big hug! xx Abby
MT
Snap Abby! I just said that very same thing about men & a cure Hahahaha Great minds!
Now that I’ve re-read your comment a couple of times & got my head around this new intel…I’m bloody astounded although unsurprised to be honest. This is great information lady, thank you so much. I’m going to ask the ObGyn about my patch dosage which could very well be accumulating in my body & causing the grief. If that’s a possibility I’ll look at another delivery method & lower the dose. I can’t bear the thought of going back to the dark days before HRT, I’ll try other delivery alternatives before I do that. Thank you so much sweet one xxx
Laz Daisy Jones
Sending hugs MT !
if you lived nearer I’d drag you out for wine and Gin and girly chats and a big hug !
Fell better soon my lovely I know you will sort it all out in your usual ‘positive way’
Stay sane until then
Ashley xxxxxx
MT
Aw geez Ashley I’d bloody love that! Thanks mate xx
lisa the sequinist
What a great article, MT. Honestly, you have been such a great help to my own peri menopause situation, and I really rely on your research and common sense to guide me through the decisions I make. After you and Liz, I’m never EVER going to have a Mirena! I’m keen to know what your doctor says and what the RIGHT solution is for you. This is really the very last thing you need right now, while you have so much to cope with. I’m glad you’re also having iron levels checked, because losing that much blood can cause iron to plummet, and that brings about the lethargy and depression. It can only get better from here, and I await your results! Hugs and love to you, babe. xx
MT
Thank you darling, it makes me so happy to know I’m helping you. We’re all in this together right? xxx
Karen
Hello Michelle,
Just come across this by chance, very interesting blog and I love the way you have been so open and honest about something that is often
brushed aside.
I too have had a few issues going on and the menopause has totally baffled and annoyed me. I have had mixed opinions from doctors, nurses and even a gyno specialist. What I have found interesting is a UK website called menopause matters. Its was actually recommended by one of the doctors I saw last year. Whilst it isnt the answer to all our questions, the forums are very helpful and often they can point you in the right direction and offer comfort and support.
I hope you are getting some more answers, feel sure you will be ok, take care and thanks Karen.
p.s. I am currently trying a hormone gel and tablets on a fortnightly basis…..early days and the jury is still out ha ha !!!
MT
Hi Karen, thank you for this website address. I’ll take a proper look through it tonight.
Regarding your new treatment, I’m actually considering the gel myself. Let’s see how we both get on with that? Stay in touch xx
caz
Fibroids cause bleeding too
MT
Hi Caz, yes that’s true although not for me in this case.
SANDRA BOND
PLEASE SIGN ME UP FOR YOUR NEWSLETTER
MT
Hi Sandra, I’m sorry I can’t sign you up without an email address. If you’d like to receive an email notification when I publish a post just go to the bottom of any page where you will see a pink box that asks for your name and email. I hope to see you again soon, MT
Terena
Hi, are you still doing a newsletter? If so could you sign me up?
Thank you
MT
Hi Terena,
I’m taking a break until the new year…..but if you’d like to get a notification when I publish next, just scroll down to the bottom of this post and leave your email address in the subscribe box.
Thanks for asking! x
Terena
Thank you
libby
Hi… interesting read. I’ve been going thru some bouts of much heavier than what used to be normal bleeding, like to the extent that I’m worried about iron deficiencies. These have unfortunately tended to coincide with vacations, not the most fun thing to think about when packing for an extended backpacking trip in bear country. Sigh. I had a hysteroscopy that resulted in the removal of a couple of tiny endometrial polyps, but three month later with a vacation starting tomorrow, here we go again. What the heck?
MT
Oh geez Libby, I feel ya….Last August I also had a hysteroscopy to remove polyps. Coincedentally I also had bleeding follow a month later. That stopped for a few weeks but recently reappeared suddenly when I was working which was quite anxiety inducing. I’m sick of it!
So I went back to my gynecologist and had bloodwork to check the hormone levels. Turned out they were normal but my gyn said lets raise your estrogen a little anyway and I agreed. Now the bleeding has stopped and my energy has returned although don’t be fooled that I’m suddenly a party girl lol. However, I do feel a lot better so perhaps it’s worth you looking into HRT? I’m taking bio identical estrogen patch + bio identical progesterone pill. I don’t think the brand name has any bearing on the efficacy but the dosage certainly does.
Whatever you decide to do, I really hope you have a fun and relaxing holiday sans bleeding xx