What causes abnormal bleeding?
The majority of the time, perimenopausal bleeding is caused by either: thyroid disorders, polycystic ovarian syndrome, the contraceptive pill, blood clotting issues, fibroids, polyps (growths in the cervix or uterus) which are usually not cancerous, and even pregnancy, as this cannot be completely ruled out until you completely cease to menstruate! All of these conditions, apart from pregnancy of course, are considered to be easily treatable.
In more rare and serious cases, bleeding may be due to endometrial hyperplasia (thickened endometrium), which is a risk factor for the development of endometrial cancer; endometrial cancer itself; or abnormalities in the cervix (which may be linked to cancer of the cervix), so it is imperative you get this checked out by a GP.
Fibroids are benign tumours which often grow larger during perimenopause, and tend to subside after menopause. They can lead to bleeding in between periods where they are near the uterine lining, or interfere with the mechanism that operates menstrual flow. Fibroids may cause heavy bleeding (menorrhagia), painful periods, prolonged periods, or spotting.
Oral contraceptives may cause various irregular bleeding patterns, particularly in the first few months of taking them. If you skip a pill, or are late with a pill, this can also cause bleeding between periods due to fluctuating hormonal levels of oestrogen and progesterone. Sometimes the pill can cause irregular bleeding between periods for undetermined reasons: if you are unsure why you are bleeding, it’s best to get a check-up with a GP, or with a sexual health specialist, to double-check nothing is wrong.
Irregular bleeding may be caused by inherited clotting disorders, such as Von Willebrand disease: a rare hereditary bleeding disorder that impairs the blood's ability to clot.
In some healthy pregnancies spotting is experienced, however spotting, or heavier bleeding may indicate ectopic pregnancy, miscarriage, placenta previa (a condition where your placenta lies unusually low in your uterus: next to, or covering your cervix), and other problems experienced in pregnancies that may lead to irregular bleeding.
Polycystic ovarian syndrome
This is an endocrine disorder characterised by a lack of ovulation, and few, or absent periods. Periods that do occur may be heavy due to abnormal build-up of the uterine lining, which is brought on by a lack of ovulation.
An overgrowth of cells in the endometrium can lead to the formation of uterine polyps, which are also known as endometrial polyps. These polyps are usually benign (non-cancerous), although some can go onto be cancerous (precancerous), or already be cancerous. These may cause heavy, prolonged, or irregular bleeding (often spotting).
Endometrial hyperplasia is an abnormal proliferation (thickening) of the endometrium. It is a risk factor for the development of endometrial carcinoma (cancer), however, it is not cancerous in itself. Chronic failure to ovulate can result in an overgrowth of cells lining the uterus, which is a risk factor both for abnormal bleeding, and for endometrial cancer. Endometrial hyperplasia is often brought on by an imbalance between oestrogen and progesterone: levels of which oscillate during menopause.
Uterine cancer is the malignant (abnormal) growth of the cells that comprise uterine tissue. Common signs and symptoms of uterine cancer are abnormal vaginal bleeding or discharge, pain with urination and sex, or pelvic pain. Whilst it’s not likely irregular bleeding during perimenopause is a sign of uterine cancer, it’s best to investigate any of these symptoms should you experience them.
In a very small number of cases, cervical cancer could be the cause of perimenopausal bleeding. Most cases are caused by the human papillomavirus (HPV), a common virus spread during sex. Cervical cancer often has no symptoms in its early stages. If you have symptoms, the most common is abnormal vaginal bleeding, so again, it is best to get yourself checked out as soon as possible.
How nutrition and supplements can help
It’s a good idea to include foods high in iron into your daily diet if you are experiencing irregular bleeding. Foods such as red meat, organ meats, green leafy vegetables, beans, and lentils are high in iron. You might also want to take an iron supplement if you are experiencing any significant blood loss, as this may introduce the chance of anaemia. Your GP may prescribe a higher dose of iron if need be.
In preventing cancer, and general inflammation within the body (which may then lead to cancer), a diet rich in antioxidants (vitamins A, C, E, and selenium), as well as vitamin D, zinc, and omega 3 would be beneficial. It’s also a good idea to take a general multivitamin and mineral, fish oil, and probiotic supplement, for optimal immunity. Probiotics also help to balance the beneficial flora of the gut and vagina, which may help to fight against inflammation and diseases.
From Claire Ward
Claire is a Nutritional Therapist with five years experience, specialising in sports nutrition, weight loss, hormonal and gut issues. Claire has a BSc Hons degree in Nutritional Therapy and runs her own nutrition and well-being business.
For more advice and information about the menopause, please visit our Menopause Advice Centre.