The menopause is the period in which women’s menstrual periods come to a complete end. When no menstrual period is experienced for about 1 year, the menopause is understood to have begun. Today the average age of the menopause is known to be 51 in western societies and 46-47 in our country. However, this age varies between 45 and 55.
The period before this is the premenopausal period. In the premenopausal period the change in hormone levels causes various changes both in ovulation and in the menstrual period. The changes occurring in this period can arise from the premenopausal period as well as from other different conditions. For this reason it is advised to follow the menstrual cycles carefully in the premenopausal period.
The period from regular periods to the menopause, when periods stop completely, is called the menopausal transition period. In the transition period irregular periods (frequent periods, delayed periods, heavy menstrual bleeding and the like) are common.
The changes that occur
In a normal cycle the levels of the hormones oestrogen and progesterone increase and decrease in a regular way. Ovulation occurs right in the middle of the cycle. About 2 weeks after this, if pregnancy does not occur, the inner layer of the uterus breaks down and menstrual bleeding occurs. In the premenopausal period the hormone levels may not follow this regularity.
As a result, situations such as irregular bleeding or spotting, bleeding that is heavier and lasts longer in some months and is very light and short in others, are accepted as entirely natural. In addition, in this period a decrease or increase in the number of days between menstrual cycles, and even the absence of periods in some months, can also occur.
Which is abnormal?
In the premenopausal period the menstrual cycle can become irregular. However, this definitely does not occur in the form of abnormal bleeding. For this reason, in situations where there is abnormal bleeding, it should not be attributed to the premenopausal period. Every bleeding that occurs after the menopause is abnormal bleeding and a specialist must certainly be consulted.
Continuously excessive bleeding in the monthly cycle, bleeding lasting longer than normal, bleeding occurring in less than about 3 weeks, and bleeding after sexual intercourse or between menstrual cycles are among the signs of abnormal uterine bleeding.
Does a woman’s age matter in abnormal vaginal bleeding?
If there is abnormal bleeding before entering the menopause, endometrial sampling (biopsy) is recommended especially in women over the age of 40 (in some countries 45). With methods such as endometrial biopsy, ultrasound, sonohysterography or diagnostic hysteroscopy, the cause of the abnormal uterine bleeding can be determined. The main aim is to diagnose conditions such as cancer of the uterus or cancer of the cervix. The treatment of the disease varies according to the cause of its appearance.