Patient's question:
Menstrual irregularities during menopause, how can menstruation be normalized?Doctor's answer:
Women enter menopause when ovarian function begins to decline. First, the corpus luteum function progressively deteriorates. When follicles develop to a certain extent, they atrophy on their own without ovulation. Without corpus luteum formation, fertility declines. The interval between menstrual cycles extends, intermittent amenorrhea. The cycle length changes from the normal 20–30 days to every 2–3 months or longer. The amount of blood flow may remain normal or decrease, with intervals gradually extending to every 4–5 months or 6 months before menstruation occurs again. Eventually, menstruation completely stops. It can be said that the irregular menstruation during menopause for the vast majority of women is a natural process that will ultimately end with menopause.It can be said that the irregular menstruation during menopause for the vast majority of women is a natural process that will ultimately end with menopause. However, sometimes menstruation extends or becomes persistent vaginal bleeding that lasts for 1–2 months without stopping; it may also involve heavy vaginal bleeding, like hemorrhage. The patient may develop anemia, pale complexion, general fatigue, palpitations, and shortness of breath. There are many factors or causes that can lead to irregular menstruation during menopause—whether the bleeding is heavy, intermittent, or sudden amenorrhea. Therefore, at any time when menstrual abnormalities occur, it is essential to consult a doctor and check for the following factors that may cause irregular menstruation.
(1) First, it must be confirmed whether it is amenorrhea or pregnancy, as this is possible for women from puberty to menopause. The decline of the ovaries during menopause is not a straight downward trend; it often takes a period of endocrine fluctuations before complete menopause occurs. During this time, if sexual activity occurs, an accidental ovulation and pregnancy may happen, though it is not absolutely impossible. Abnormal pregnancies, such as early ectopic pregnancy or early miscarriage, may cause short-term amenorrhea followed by bleeding. If this is not ruled out and is misdiagnosed as menopausal dysfunctional uterine bleeding, treatment may be delayed, or complications such as infection may worsen the condition.
(2) Reproductive tract infections, whether acute or chronic, especially tuberculous endometritis, often cause abnormal uterine bleeding. If the functional layer of the endometrium is obstructed, hindering its regeneration, it can lead to prolonged bleeding or alternating cycles of amenorrhea and bleeding.
(3) Submucosal uterine fibroids are prone to intermittent heavy bleeding.
(4) Functional ovarian tumors, such as theca cell tumors or granulosa cell tumors, secrete large amounts of estrogen, stimulating endometrial hyperplasia and causing endocrine dysfunction-related uterine bleeding. Postmenopausal women with such ovarian tumors may also experience uterine bleeding again.
(5) Endometrial cancer may cause irregular vaginal bleeding, especially long-term irregular bleeding and postmenopausal bleeding, which should be taken seriously.
(6) Coagulation disorders, such as idiopathic thrombocytopenic purpura, leukemia, or aplastic anemia, can manifest as uterine bleeding or excessive menstrual flow. Blood tests, including complete blood count, platelet count, coagulation tests, and bleeding time, are needed to confirm the diagnosis.
(7) Cardiovascular diseases, such as hypertension or heart failure, also increase the risk of uterine bleeding. Liver diseases can also lead to bleeding. These conditions need to be ruled out through testing.