Menstruation is regulated by the female sex hormones oestrogen and progesterone, which, as you approach menopause, begin to decline. As levels of these hormones begin to fluctuate, so too will your periods, and at times come more frequently, whilst at others, be further apart. There are also factors of stress, changes in diet and lifestyle, and emotional strain at reaching this stage of life that can impact the frequency and nature of your periods.
Whilst irregular periods are commonly experienced by menopausal women (in fact, only 10% of women will cease to menstruate entirely without experiencing irregular cycles first), there are other conditions that may cause changes in menstrual bleeding, and, in some cases, irregular bleeding may be a sign of a larger health concern that is not related to menopause. Menstrual bleeding may be considered to be abnormal if:
- Your periods last several days longer than usual
- You experience spotting after sex
- Your periods occur closer together
- You spot between periods
- Your periods are very heavy, or have blood clots in them
If you are experiencing any of the above, it’s a good idea to consult your GP to be sure that nothing sinister is going on. Whilst in most cases causes of irregular bleeding are nothing to worry about, you should always have your symptoms checked out by a professional, who will best advise you how to move forward.
Should I be worried?
Where your bleeding is not caused by normal menopausal changes, it may be brought on by a number of different factors, each with different degrees of risk to your health. It is important to note that emotional and physical stress, as well as changes in body weight can also impact ovulation. Here are some of the most common, and uncommon causes of irregular menopausal bleeding, and the risks they may pose to your health:
A Polyp is a non-cancerous growth that attaches to the uterine wall, or develops on the endometrial (lining of the womb) surface, and can cause either irregular, or heavy vaginal bleeding. In some cases, they may also grow on the cervix, which may cause bleeding after sex. It is unknown what actually causes polyps, but some experts believe it is due to a poor diet high in fat and low in fibre, or genetic disposition.
Most polyps cause no symptoms, but there is a small risk that some can go on to become cancerous. Uterine polyps that develop near the fallopian tubes can actually obstruct the opening of the tubes, which may make it difficult to conceive. Whilst many women with polyps experience no symptoms, some experience heavy or excessive bleeding, which may lead to anaemia, dizziness, or extreme tiredness. Polyps can generally be removed quite easily at an outpatient clinic.
Thyroid problems (hyperthyroidism or hypothyroidism)
Your thyroid is the gland responsible for controlling bodily functions and hormone interactions. Hyperthyroidism is the condition where your thyroid is overactive, and hypothyroidism is when it is underactive. Women with hyperthyroidism may experience an increase in speed of their body’s processes, and may feel nervous, anxious, excessively sweat, have trouble sleeping, or have a rapid heartbeat. Those who have hypothyroidism may conversely experience tiredness, weight gain, constipation, aches, mental slowing, and depression. There are medications available to treat both conditions.
Heavy periods, frequent periods, or periods that last longer than normal can all be signs of hypothyroidism (an underactive thyroid). Thyroid problems can also bring on the early onset of menopause, whilst in turn, some of the symptoms of hyperthyroidism (overactive thyroid), including hot flushes, insomnia, and mood swings, can easily be mistaken as menopausal. Treatments for hyperthyroidism can also sometimes work to assuage actual menopausal symptoms.
Hormone imbalances during menopause can also cause inflammation of the cervix, which is called cervicitis. It is very common: more than half of all women were found to be affected by this condition at some stage of their adult lives. Typically, the inflammation is caused by an infection, which may be caused by sexual activity, but can also be caused by any number of factors: i.e. sensitivity to chemicals found in tampons.
Along with vaginal pain, and grey or white vaginal discharge that may have an odour, abnormal bleeding may be a symptom of cervicitis. It is important to note however that some women may only experience bleeding as a symptom. If untreated, cervicitis can lead to more serious conditions, such as pelvic inflammatory disease, infertility, or even cervical cancer: your cervix works as the barrier between the womb and viruses and bacteria, and when it is infected, there is a higher risk infection will carry into the womb. In some cases you may not need to treat cervicitis, but in others, there are antibiotic and antiviral medications available.
This is a condition where the lining of the uterus thickens, and is most often caused by excess oestrogen, without enough progesterone: two hormones whose levels fluctuate in the lead up to menopause. In some cases, cells of the uterine lining can become abnormal, which can sometimes lead to uterine cancer.
Women who don’t have what is called ‘atypical changes’ (where the cells have changed, and become abnormal) have a very small risk of developing cancer. Women who do have atypical changes are at a higher risk. Postmenopausal women with endometrial hyperplasia are also at a higher risk of developing womb cancer. However, endometrial hyperplasia can be treated, which, depending on your body, may be via progesterone (to balance the oestrogen levels), or, in severe cases, a hysterectomy.
In some rare instances, irregular vaginal bleeding may be a sign of endometrial cancer. Most cases are found in women aged between 50 and 60, and arise from cells that form the glandular tissue in the lining of the womb (endometrium). It’s important to remember that irregular bleeding during menopause is quite common, and in most cases, is not a sign of cancer. However it is always a good idea to check with a GP to be sure what you’re experiencing is nothing serious.
What you can do to help
Strategic changes to your diet and lifestyle can actually work to help manage irregular menopausal bleeding, via their effect on hormone levels, and boosting your overall health and immunity, which may help to prevent and fight off infection. For instance, a healthy hormone-balancing diet includes wholegrains, lots of fruit, vegetables, lean meat, and fish. Omega-3 essential fatty acids are also extremely helpful, and have been found to help alleviate depressive symptoms related to hormones.
Foods containing phytoestrogens— compounds produced naturally in plants that mimic the effect of oestrogen in the body— have also been touted for their role in managing menopausal symptoms, and can be found in flaxseed, wholegrains, and nuts. Foods containing iron can also minimise risks of becoming anaemic, or becoming tired and dizzy as a result of irregular bleeding.
For more advice and information about the menopause, please visit our Menopause Advice Centre.
From Monica Karpinski
Monica Karpinski is a London-based writer and content manager. Avidly interested in nutrition, she has written widely on health, lifestyle and women’s well being.