Vaginal Bleeding In Perimenopausal Time Period

At midlife, a healthy lifestyle can help manage menopausal symptoms and reduce your risk of serious health conditions, like breast cancer, heart disease, and osteoporosis (thinning bones).

Abnormal vaginal bleeding in perimenopause can be unfortunately quite common. However, it cannot be assumed to be a normal part of entering menopause unless you have been evaluated for more serious causes such as uterine cancer or precancer. This evaluation is most commonly performed by an endometrial biopsy which is a minor procedure performed in the office where your provider takes a thin pipelle and passes it into the uterus to sample the lining. Alternatively, It also may be sometimes evaluated with a pelvic ultrasound evaluating the thickness of the lining of the uterus or with a procedure such as a d&c (dilation and curettage). Causes other than perimenopause or uterine cancer/precancer also include infection, inflammation, prescription hormones, abnormal growths, and injury. Your provider will help you determine the cause.

If you have had been seen recently and had a test to rule out uterine cancer or precancer and it was completely normal, then you can be reassured that the abnormal vaginal bleeding you are experiencing is likely a result of the hormone fluctuations that occur at this time period before menopause. You can never assume it is “normal” until your provider has evaluated it completely.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments advised, and call your provider if you are having problems. It is also a good idea to know your test results and keep a list of the medicines you take.

  • If your provider gave you medicine, take it exactly as prescribed. Call or email your provider if you think you are having a problem with your medicine.

When should you seek emergency help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You pass out (lose consciousness).
  • Any chest pain or severe shortness of breath.

Call your provider immediately or seek immediate medical care if:

  • You have severe vaginal bleeding. You are passing blood clots and soaking through a pad each hour for 2 or more hours.
  • You are dizzy or lightheaded, or you feel like you may faint.
  • You have a fever.
  • You have new belly or pelvic pain.
  • You have vaginal discharge that smells bad.
  • You feel weak and tired, and your skin is pale.
  • Your bleeding gets worse.

Suggested reading material for this problem as well as other issues common in perimenopause and menopause are on our Orange County’s Women’s Health Services website, the American College of Obstetrics and Gynecology Patient website or the North American Menopause Society website. At these sites, you can learn more about the changes to your body and your feelings at this time in your life as well as get unbiased and consistent evidence-based recommendations to help you optimize your health and well-being.

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