When do most women experience menopause. How does late menopause affect health. What causes postmenopausal bleeding. How to determine if you’ve reached menopause. What are common menopause symptoms.

The Age of Menopause: What’s Normal and What’s Not

Menopause is a natural biological process that marks the end of a woman’s reproductive years. But when exactly does it occur? The average age for menopause is 51, but it can vary widely among individuals.

Is it possible to have periods in your 60s? While extremely rare, some women may experience menstrual-like bleeding well into their 60s. However, this is often not true menstruation and requires medical attention.

• Average menopause age: 51 years
• Normal range: 45-55 years
• Late menopause: After 55 years
• Extremely late menopause: After 60 years (very rare)

Can women have periods after 60? True menstrual periods at 60 or older are highly unlikely. Any bleeding occurring at this age should be evaluated by a healthcare provider to rule out underlying health conditions.

Distinguishing Between Late Periods and Postmenopausal Bleeding

For women experiencing bleeding in their late 50s or 60s, it’s crucial to determine whether it’s a late period or postmenopausal bleeding. The latter can be a sign of various health issues and should not be ignored.

Signs of True Menstrual Periods

• Regular, cyclical bleeding
• Consistent flow and duration
• Accompanied by other menstrual symptoms

Signs of Postmenopausal Bleeding

• Sporadic or continuous bleeding
• Unusual flow or duration
• No other menstrual symptoms

How can you differentiate between late periods and postmenopausal bleeding? A healthcare provider can perform tests, including hormone level assessments and imaging studies, to determine the cause of the bleeding.

Medical Conditions That Can Cause Postmenopausal Bleeding

Postmenopausal bleeding can be caused by various conditions, some of which require immediate medical attention. Understanding these potential causes can help women recognize when to seek medical help.

• Endometrial polyps
• Uterine fibroids
• Endometrial hyperplasia
• Uterine cancer
• Vaginal atrophy
• Hormone therapy complications

Why is it important to investigate postmenopausal bleeding? While often benign, postmenopausal bleeding can sometimes indicate serious conditions like uterine cancer. Early detection and treatment can significantly improve outcomes.

Factors Affecting the Timing of Menopause

The age at which a woman experiences menopause can be influenced by various factors. Understanding these can help women better predict and prepare for this life transition.

Genetic Factors

Genetics play a significant role in determining when a woman will experience menopause. The timing often runs in families.

Does your mother’s age of menopause predict yours? While not an exact predictor, there is often a correlation between when a mother and daughter experience menopause.

Lifestyle Factors

• Smoking: Can lead to earlier menopause
• Body Mass Index (BMI): Extreme low or high BMI can affect timing
• Diet: Some studies suggest diet may influence menopause timing
• Exercise: Regular physical activity may delay menopause

Medical Factors

• Chemotherapy or radiation therapy
• Hysterectomy (even if ovaries are retained)
• Certain autoimmune disorders

How do these factors interact to determine menopause timing? The interplay of genetics, lifestyle, and medical history creates a unique menopause timeline for each woman.

The Perimenopausal Transition: What to Expect

Perimenopause, the transition phase leading up to menopause, can last several years and is characterized by various physical and emotional changes.

Common Perimenopausal Symptoms

• Irregular periods
• Hot flashes and night sweats
• Mood swings
• Vaginal dryness
• Sleep disturbances
• Changes in libido

How long does perimenopause typically last? The perimenopausal transition can last anywhere from a few months to several years, with an average duration of about four years.

Changes in Menstrual Patterns

During perimenopause, women often experience changes in their menstrual cycles. These can include:

• Shorter or longer cycles
• Heavier or lighter flow
• Skipped periods

Are irregular periods during perimenopause normal? Yes, fluctuations in cycle length and flow are common during this transition phase. However, very heavy bleeding or prolonged irregularity should be evaluated by a healthcare provider.

Determining If You’ve Reached Menopause

Confirming that you’ve reached menopause can sometimes be challenging, especially if you’re experiencing irregular bleeding. Here are some ways to determine if you’ve entered menopause:

Absence of Menstrual Periods

The primary indicator of menopause is the absence of menstrual periods for 12 consecutive months. However, this can be complicated by sporadic bleeding or use of hormone therapies.

Hormone Tests

Blood tests can measure levels of hormones associated with menopause:

• Follicle-stimulating hormone (FSH)
• Estradiol
• Anti-Müllerian hormone (AMH)

What does an elevated FSH level indicate? High FSH levels often suggest that the ovaries are no longer producing sufficient estrogen, a hallmark of menopause.

Symptom Evaluation

The presence of menopausal symptoms, combined with age and menstrual history, can help confirm menopause status.

Can symptoms alone confirm menopause? While symptoms are suggestive, they’re not definitive proof of menopause. A combination of factors, including age, symptoms, and hormone levels, provides the most accurate assessment.

Health Implications of Late Menopause

Experiencing menopause later than average can have both positive and negative health implications. Understanding these can help women make informed decisions about their health care.

Potential Benefits of Late Menopause

• Reduced risk of osteoporosis
• Lower risk of cardiovascular disease
• Potential cognitive benefits

Why might late menopause offer cardiovascular benefits? The extended exposure to natural estrogen may have a protective effect on the heart and blood vessels.

Potential Risks of Late Menopause

• Slightly increased risk of breast cancer
• Potentially higher risk of endometrial cancer
• Extended exposure to menstrual symptoms

Does late menopause significantly increase cancer risk? While there is a slight increase in risk for certain cancers, the overall impact is generally small and should be considered alongside other risk factors.

Balancing Risks and Benefits

The health implications of late menopause vary among individuals. Regular check-ups and discussions with healthcare providers can help women navigate this transition effectively.

How can women mitigate potential risks associated with late menopause? Maintaining a healthy lifestyle, including regular exercise, a balanced diet, and routine health screenings, can help minimize potential risks.

Managing Menopause Symptoms: Strategies and Treatments

While menopause is a natural process, its symptoms can be challenging for many women. Fortunately, there are numerous strategies and treatments available to manage these symptoms effectively.

Lifestyle Modifications

• Regular exercise
• Healthy diet rich in calcium and vitamin D
• Stress reduction techniques (e.g., meditation, yoga)
• Avoiding triggers for hot flashes (e.g., spicy foods, alcohol)

How can exercise help with menopause symptoms? Regular physical activity can help alleviate mood swings, improve sleep quality, and potentially reduce the frequency of hot flashes.

Non-Hormonal Treatments

• Over-the-counter lubricants for vaginal dryness
• Prescription medications for specific symptoms (e.g., antidepressants for mood swings)
• Herbal remedies (though efficacy varies and should be discussed with a healthcare provider)

Hormone Therapy

Hormone replacement therapy (HRT) can be an effective treatment for many menopause symptoms. However, it’s not suitable for everyone and carries certain risks.

What are the potential benefits and risks of hormone therapy? HRT can effectively relieve hot flashes, vaginal dryness, and may help prevent bone loss. However, it may increase the risk of certain health conditions, including breast cancer and blood clots. The decision to use HRT should be made in consultation with a healthcare provider, considering individual health history and risk factors.

Alternative Therapies

• Acupuncture
• Cognitive behavioral therapy
• Mindfulness practices

Can alternative therapies effectively manage menopause symptoms? While scientific evidence varies, some women find relief from menopause symptoms through alternative therapies. It’s important to discuss these options with a healthcare provider to ensure they’re safe and appropriate for individual needs.

Managing menopause symptoms often requires a multi-faceted approach, combining lifestyle changes, medical treatments, and sometimes alternative therapies. The key is to work closely with healthcare providers to develop a personalized management plan that addresses individual symptoms and health concerns.

Having Periods after 50? Specialist Answers for Menopause

Q1. Is it unusual to still have your period at age 62?

Yes, it’s extremely unusual to have a true menstrual period at the age of 62. The average age that a woman goes through menopause is 51 years old. A very tiny fraction of women go through it as late as 58 to 60 years old, but after this age a vanishingly small number of women enter menopause.

The question you need to ask is whether your bleeding is a true menstrual period or if you’re undergoing postmenopausal bleeding due to a medical condition such as a polyp, fibroid, endometrial hyperplasia, or even uterine cancer. Is your bleeding regular and cyclical or is it sporadic or is it continuous? Be sure to talk to your doctor and get an FSH test, which measures the level of follicle-stimulating hormone in your blood to determine whether or not you’ve reached menopause. If you are in fact menopausal and you’re still experiencing vaginal bleeding, you’ll likely need a biopsy of your uterus and endometrium and possibly an imaging test of the uterus to determine the cause of the bleeding. It’s best to get it checked out now so you know exactly what you’re dealing with.

Q2. I am turning 50 this year. When I was 18, I had my left fallopian tube removed due to an ongoing disease that basically took the life out of it. The tube was gangrenous and dead when it was removed. What will menopause be like under these circumstances? I have not had any symptoms as of yet and can only hope that they will be mild because of my scenario.

The good news is you’re nearly 50 years old and it seems like so far having only one fallopian tube (and possibly only one ovary) has not had much of an effect on your premenopausal years. I don’t know whether your ovary was removed along with your fallopian tube — it’s not clear from your question:

However, you can still get good estrogen production with only one ovary, so either way your surgery shouldn’t have a major impact on your menopausal experience, and I don’t expect anything unusual to occur.

In fact, you may even undergo a milder menopause experience than most women if you have had an ovary removed. Why? Because you may already be producing less estrogen, so the change may not be as dramatic at menopause, when estrogen levels drop. You may be lucky enough to avoid the severe symptoms that some women experience, such as hot flashes and night sweats. If you don’t have symptoms yet and you’ve stopped having menstrual periods, you’re not likely to get severe symptoms. The bottom line: I wouldn’t worry too much about it.

Q3. I am 52 years old and have not yet gone through menopause. The only symptom I have ever had is that my periods are closer together (24 days apart instead of 30) and they are lighter. I am wondering when I will actually go through menopause, as some of my friends have already gone through it and they are younger than me.

The average age of menopause is 51, although some women don’t have their final menstrual period until they are almost 60. The best predictor for an individual woman is when her mother had her last period. Smoking makes menopause come earlier because it is toxic to the ovary.

The menstrual changes you’ve described are typical changes that precede menopause for many women, but no one can predict for sure what will happen to you next or when. About 90 percent of women experience changes in their menstrual cycles for four to eight years before actual menopause.

Q4. Are there any advantages to still having periods at the age of 56? Is there a benefit to late menopause, or is it better to undergo it earlier?

— Rosemary, Pennsylvania

Having a late menopause (menopause after the age of around 55) is a double-edged sword. There’s some evidence that a later menopause carries a decreased risk of coronary heart disease, but there may also be a slightly higher risk of breast cancer. However, the associations between these health conditions and menopause aren’t very strong. The other good news is that there are ways to avoid many health problems — such as doing regular exercise, following a healthy diet, maintaining a healthy weight, and so forth. There is an association between menopause and smoking — smokers often have an earlier menopause. You are probably a nonsmoker, though, which is also good for your health.

Keep in mind too that 56 is well within the normal age range for menopause, though it’s toward the upper end of the spectrum. So you have nothing to worry about right now.

Q5. I was four days short of one year from finally being free of periods — only to get another! Does this mean I’m not menopausal, that I have to count a full year without periods again? How would I know I’m menopausal otherwise?

— Diana, Canada

A woman is considered to be menopausal when she goes one year without periods. A year is a long time to go without a period and then start bleeding again — it’s not a common occurrence. You’re close enough to the one-year mark to be considered menopausal, in which case your bleeding may be considered to be postmenopausal bleeding. There are many benign causes for postmenopausal bleeding, such as fibroids, benign polyps, endometriosis, hyperplasia, and a benign overgrowth of the uterus. The bigger concern, however, is that endometrial or uterine cancer may be the cause. So let your doctor know about the bleeding, and find out whether he or she wants to evaluate you for postmenopausal bleeding. The doctor may want to check for the conditions mentioned above and make sure that the lining of your uterus is normal. I doubt that your doctor will be such a stickler about whether or not you’re menopausal that he or she won’t evaluate you.

Q6. Will I hit menopause at roughly the same age my mother did? Can I expect similar symptoms? In general, what’s the age range for menopause symptoms to start?

The average age of menopause is 51. For an individual woman, the age her mother went through menopause is sometimes a predictor of what will happen to her. On average, women who smoke experience menopause a year or two earlier than non-smoking women. Other risk factors for cardiovascular disease, such as higher cholesterol and increased blood pressure, have also been linked to earlier onset of menopause.

The symptoms of menopause often start in a woman’s mid to late 40s, but they can be earlier.

Learn more about postmenopausal bleeding in the Everyday Health Menopause Center.

Bleeding after menopause: Is it normal?

I thought I was in menopause because I haven’t had a period in three years. But then last month, I suddenly got my period again. What’s up? I’m 50 years old.

Answer From Shannon K. Laughlin-Tommaso, M.D.

Menopause is the end of menstruation. In clinical terms, you reach menopause when you haven’t had a period for 12 months.

Vaginal bleeding after menopause isn’t normal and should be evaluated by your doctor.

Postmenopausal vaginal bleeding can be caused by:

• Cancer of the uterus, including endometrial cancer and uterine sarcoma
• Cancer of the cervix or vagina
• Thinning of the tissues lining the uterus (endometrial atrophy) or vagina (vaginal atrophy)
• Uterine fibroids
• Uterine polyps
• Infection of the uterine lining (endometritis)
• Medications such as hormone therapy and tamoxifen
• Pelvic trauma
• Bleeding from the urinary tract or rectum
• Excessive overgrowth of the cells that make up the lining of the uterus (endometrial hyperplasia)

The cause of your bleeding may be entirely harmless. However, postmenopausal bleeding could result from something serious, so it’s important to see your doctor promptly.

With

Shannon K. Laughlin-Tommaso, M.D.

• Caffeine and menopause symptoms

Sept. 16, 2020

Show references

1. Frequently asked questions. Gynecologic problems FAQ162. Perimenopausal bleeding and bleeding after menopause. http://www.acog.org/Patients/FAQs/Perimenopausal-Bleeding-and-Bleeding-After-Menopause. Accessed July 10, 2018.
2. AskMayoExpert. Postmenopausal bleeding (adult). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
3. Stiles M, et al. Gynecologic issues in geriatric women. Journal of Women’s Health. 2012;21:4.
4. Goodman A. Postmenopausal uterine bleeding. https://www.uptodate.com/contents/search. Accessed July 10, 2018.

See more Expert Answers

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Q&A: A Spotlight on Gynecologic Oncologists | Fox Chase Cancer Center

Cancer in a woman’s gynecologic tract requires specialized care. A gynecologic oncologist has unique training and expertise in this area. Stephanie Angela King, MD, a gynecologic oncologist at Fox Chase Cancer Center, answers some common questions about her role in treating women.

What is a gynecologic oncologist?

“Gynecologic oncologists specialize in diagnosing and treating any cancer that starts in a woman’s reproductive organs,” King said. “They are initially trained as obstetrician/gynecologists (OB/GYN) and then receive three to four years of advanced training exclusively in cancer treatment.”

When might I be referred to a gynecologic oncologist?

“Usually, you’ll see a gynecologic oncologist if you have been diagnosed with a serious precancer or a cancer of any of the areas of the gynecological tract,” King said.

Diseases treated by gynecologic oncologists include:

If you are told you have one of these cancers, ask to be referred to a gynecologic oncologist.

“Most OB/GYNs who have a patient diagnosed with cancer want to send that patient to a specialist,” King said. “If you have the opportunity to see a gynecologic oncologist, you should.”

What can a gynecologic oncologist offer that my OB/GYN does not?

Gynecologic oncologists treat cancer exclusively. That means they have experience a regular OB/GYN doesn’t.

“A lot of our surgeries require you to do a little more,” King said. “Take, for example, cervical cancer. It requires a careful dissection of areas around the organs. It requires technical skills that a general OB/GYN doesn’t have. Sometimes there’s a lot of bowel surgery involved too.”

Couldn’t a surgeon do this procedure with the assistance of a gynecologist?

“They could,” King said. “But they might not know the right time to do the surgery—we know when to do it and when to hold off and not do it. We understand the disease, and we weigh the risks and benefits,” she said. “If you don’t deal with a particular cancer all the time, you don’t know. We have a better feel for what to do in certain situations because we do this every day.”

What should I bring to my first meeting with a gynecologic oncologist?

Like any doctor visit, it’s a good idea to come prepared. At Fox Chase, when you make an appointment, you’ll talk with a nurse navigator who will help make sure you have everything you need for your first appointment. Many times, this will include:

• Medical records, including pathology and radiology reports
• A CD-ROM of pictures from any imaging tests, if possible
• A current list of all medications and supplements you are taking
• Your past medical and surgical history, including gynecologic and obstetric history
• Your family medical history, including a list of family members who’ve had cancer
• A list of doctors you’re currently seeing
• Questions to ask your gynecologic oncologist

How can I make an appointment with a gynecologic oncologist at Fox Chase?

Fox Chase has some of the top gynecologic cancer specialists in the U. S. Make an appointment online or call 888-369-2427.

Q&A About Ovarian Cysts | Fox Chase Cancer Center

If you’re a woman with ovaries, chances are you’ve had an ovarian cyst at some point in your life—they’re very common. It’s possible that you never even knew it. Most of the time they’re harmless, don’t cause symptoms, and go away on their own. While most ovarian cysts will never develop into cancer, it still pays to know the answers to some frequently asked questions about ovarian cysts.

Q: What exactly are ovarian cysts?

A: They are fluid-filled sacs that develop on or in the ovary. Many women get them. Women who are menstruating often develop at least one cyst a month. Cysts are less common after menopause.

Ovarian cysts vary in size and can range from less than one centimeter (about one-half inch) to larger than 10 centimeters (4 inches).

Q: What causes ovarian cysts?

A: The most common causes include:

• Hormones. Drugs that help with ovulation can cause cysts. Hormonal problems can trigger them too. Most hormone-related cysts go away on their own.
• Pregnancy. A cyst usually develops early in pregnancy. It’s there to help support the pregnancy before the placenta forms.
• Endometriosis. Women with this condition can develop cysts called endometriomas. This type of cyst can cause pain during menstruation and sex.
• Severe pelvic infection. Cysts can form when infections spread to the ovaries and fallopian tubes.

Q: Can ovarian cysts be a sign of cancer?

Most ovarian cysts are benign and are not caused by cancer. “And benign cysts don’t increase the risk of cancer,” said Christine Chu, MD, a gynecologic oncologist at Fox Chase Cancer Center.

It’s rare for cancer to be the cause of an ovarian cyst in premenopausal women. Cysts on or around the ovary are somewhat more likely to be cancerous in postmenopausal women.

If an ovarian cyst is cancer, it means the cancerous cells inside the ovary have multiplied in an uncontrolled way to form a tumor. If not treated, these tumor cells can spread to nearby tissues and to other places in the body.

Q: What are the symptoms?

A: Since most ovarian cysts are small, they typically don’t cause symptoms. But if they grow, you may have symptoms.

“Ovarian cysts are tough because they can be quite large before there are any symptoms,” Chu said. “A lot of the symptoms can be very nonspecific—pelvic pain, pelvic discomfort, pressure on the bladder or rectum, discomfort with intercourse. Or you can have no symptoms at all. But, if you have any symptoms that are persistent, or worsen over time, you should call your physician.”

Q: How are ovarian cysts diagnosed and treated?

A: Sometimes, cysts can be detected during a routine pelvic exam or when you’re being examined for symptoms. Your doctor may order a pelvic ultrasound to confirm the diagnosis. And one or more blood tests may be done to pinpoint the cause of a cyst.

Ovarian cysts don’t always require treatment. For premenopausal women, cysts usually go away on their own within a month or two. That’s typically not true in postmenopausal women; ovarian cysts tend to hang around longer in this group.

If a cyst is painful, large, or suspicious for cancer, treatment usually means removal.

“Ovarian cysts can’t be biopsied like you can biopsy skin or the cervix,” Chu explained. “You have to surgically remove them either by cystectomy (removing only the cyst) or oophorectomy (the entire ovary).”

If a cyst isn’t causing problems, monitoring any symptoms and repeating ultrasounds is a common approach.

“The most important take-away message about ovarian cysts is to not panic,” Chu said. “Management of cysts really depends on a person’s age and how a cyst looks. A lot of cysts can be followed with scans to make sure they are going away or not growing.”

If you are concerned after receiving a diagnosis of an ovarian cyst or are having unusual symptoms that are worrisome, it is a good idea to see a specialist.  

Bleeding After Menopause Could Be a Problem. Here’s What to Know.

My patient “Rosa” has come to my office for an appointment, but it’s not for her annual visit. Instead, she’s here for vaginal bleeding that has taken her by surprise. Rosa is a woman in her mid-60s who’s well past menopause.

Most women who experience bleeding after menopause are understandably concerned. After all, they thought they were done with it. (Menopause is officially confirmed if it has been 1 year since your last menstrual period.)

Rosa asks, “What could it be?”

Getting to the bottom of it

Postmenopausal bleeding can range from light spotting that is pinkish-gray or brown, all the way to a heavy flow, like a regular period. Most of the time, there is no pain with the bleeding. No matter your exact symptoms, you’ll want to get in touch with your ob-gyn right away if this happens to you.

Any evaluation should start with a detailed conversation, either in person or via telehealth (a phone call or video chat). Your ob-gyn should ask questions such as:

• When did you go through menopause? The longer it’s been, the greater cause for concern and the more testing we might need to do.
• Are you taking any new medications? Some drugs, such as blood thinners and some mental health medications, can have vaginal bleeding as a side effect.
• What else is going on with your health? Other medical conditions could be relevant.

A pelvic exam usually is needed when we’re talking about unexplained vaginal bleeding. During the exam, your ob-gyn may look at your vagina and cervix and feel the size of your uterus.

The next steps will depend on your age, how long it has been since you reached menopause, and how much bleeding you’re experiencing. Your ob-gyn might suggest a pelvic ultrasound to look at your uterus more closely or a biopsy to take a tissue sample from the lining of your uterus. You might even need both.

Some cases call for a more complex procedure called a diagnostic hysteroscopy with dilation and curettage (D&C). In this procedure, your ob-gyn will place a camera into the vagina, through the cervix, and into your uterus. Cells are removed from the lining of your uterus. This tissue sample is sent to a lab for testing.

Causes and treatments

One reason for postmenopausal bleeding could be that the tissue of your vagina and vulva has gotten thinner. This can happen during menopause due to hormone changes. If you experience the bleeding after sex, it may be from friction against this thinner, more sensitive skin—but your ob-gyn still should do a full evaluation to be sure.

Topical estrogen cream often resolves this kind of postmenopausal bleeding. Using lubrication during intercourse can help as well. If the lining of your uterus is super-thin, your ob-gyn might consider hormone therapy in the form of pills or an intrauterine device (IUD).

Bleeding after menopause is not normal, so take it seriously. Go directly to your ob-gyn.

Dr. Tamika C. Auguste

Polyps also can cause vaginal bleeding. If your ob-gyn discovers these benign (noncancerous) growths in your uterus or on your cervix, you might need surgery to remove them.

Another possibility: You could be bleeding because the lining of your uterus is becoming too thick. In some cases, the cells of the lining can become abnormal, leading to cancer.

Cancer is the most serious, but also least likely, cause of bleeding after menopause. If testing finds cancerous cells or cell changes that could lead to cancer, your ob-gyn should refer you to a specialist called a gynecologic oncologist.

Even if it isn’t cancer, you may need future ultrasounds to keep an eye on things. If you find the bleeding or follow-up tests to be very bothersome, and other treatments haven’t worked, talk with your ob-gyn. In some cases, you could consider a hysterectomy to remove your uterus. You and your ob-gyn can discuss what might be right for you.

Rosa’s plan

After performing a pelvic exam and an ultrasound, I could tell that Rosa’s uterine lining was thicker than it should be at her age. Obesity and diabetes put her at high risk for endometrial cancer, so I recommended we collect some tissue for testing. After discussing the options, Rosa chose to have a D&C and a hysteroscopy. Thankfully, Rosa’s test results showed no evidence of cancer.

But Rosa wasn’t out of the woods. Her bleeding returned about 3 years later, kicking off the process all over again. She has been clear that she wants to avoid a hysterectomy. As long as she keeps coming to see me every time she has bleeding, we’ll stick to this approach—keeping an eye on her with pelvic exams, ultrasounds, and other tests as needed. It’s a plan that is both safe and aligned with her wishes.

Act now, not later

Bleeding after menopause is not normal, so take it seriously. Go directly to your ob-gyn. Chances are, there’s no reason for panic. But only through careful evaluation can we be sure what we’re dealing with.

Published: October 2020

Last reviewed: October 2020

Copyright 2021 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women’s health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

Why your periods might suddenly come back

Read the full video transcript below

Today’s topic

Hello and welcome to my weekly video blog. And today on A.Vogel Talks Menopause, I’m going to be looking into periods stopping and starting.

Now, I have talked about this before in a number of other blogs when I’ve been talking about lots of different things that can happen with your periods, but I have noticed just recently that an awful lot of women have been contacting me because they’ve been not quite sure what’s going on.

They thought that their periods had stopped for good and suddenly they get them back or they get the odd one back, and they’re wondering if this is perfectly normal, whether it’s something they should be worried about, whether they should just sit tight, or whether they need to go and see their doctor. So I thought I’d go into it in a little bit more detail today.

Missing periods – the first sign of the menopause

Now missing periods are usually one of the first signs that you are approaching the menopause. The problem is, though, that every single one of us will have a completely different combination. And this particular phase, it can be a very short one, it can be a long one, or it can be a really, really long one. And we don’t know. And none of us are going to know how long this is actually going to last. So let’s look into some of the different combinations that you can get.

Periods just stop

For some very lucky women, their periods will literally just stop, and that’s it, gone for good. They really are lucky ones.

Periods come and go

For the majority of us, there will be some missing ones and some coming back. So some of you might find that you miss one period, then you get some back again, and then a few months down the line, you miss another one and then they come back for a little while.

For some of you, you might find that you might miss one, get one, miss one, get one, and that can go on for quite a while, too. For some of you, you might miss two or three periods and then get one back. And the problem with this situation is that very often when you’ve missed two or three periods and you get one back, that one can be quite a heavy one.

It’s almost as if the body’s been saving up for it for some reason. For some women, they will miss three or four periods and then maybe get one back. And each time that you miss, the number of missed periods will get bigger and bigger until you suddenly realize, “Oh, I’ve not had a period for a year or more. “

So as you can see, there’s all sorts of different combinations. And they’re all quite normal. It just depends on how your own hormones are falling or going up and down at that particular time.

No period for over a year

Now, for some women, they might find that they have got to a year or even a year and a bit without a period, and suddenly they get one back again. And this is very often the time when they can get a little bit worried. Some schools of thought say that you are through the menopause once you have not had a period for a year. In our experience, we find that a number of women will get periods back, or they’ll get the odd one back after a year or more.

Why does this happen?

Hormones

Now, this can be caused by a variety of factors. Very often it’s just your hormones having one last fling. They go, “I don’t want to stop yet. I want to have one more go at having periods before I calm down for good.” So this is usually the most common reason.

Diet

But another interesting fact is if you decide to overhaul your diet, and a lot of women going through the menopause get to the point where they say, “I need to do something about my diet. I need to eat healthy, or I need to exercise a bit more. ” If you are giving your body a lot more extra nutrition, that can very often feed your hormones as well. And that can be one of the primary reasons for getting a period back, if you have decided just to sort everything out.

Prolapses

Now, there can be other reasons as well. There’s something called a prolapse, where the pelvic floor muscles tend to get a little bit weak. And that allows either the womb, or the bladder, or the bowel to slightly shift position. And this could maybe irritate the womb and trigger a bleed as well.

Fibroids

There can be other issues as well such as fibroids, which you might not even been aware that you had. And suddenly because your hormone levels are changing or maybe sometimes the womb starts to get a little bit thinner as you go through the menopause, this could irritate the fibroid. So when you get to this stage, it is really important that you just get things checked out by your doctor as well.

Two years or more without a period

There are also a few women that will go for two years or more and find that they get a period back. This is not really very common. And as far as we’re concerned, once you have not had a period for two years, then that’s…you’re well and truly through the menopause.

So if you get any kind of bleeding, either a proper period, or you just get a little bit of smearing, or you get a little bit of spotting, then it really is important that you just get this checked out by your doctor just to make sure that there isn’t anything else going on.

So I hope this has given you a little bit of a better picture of one of the more puzzling aspects of what can happen to your periods as you approach the menopause.

If any of you have any other questions on this or you’ve had a slightly different combination, then please do get in touch, and I’ll be happy to answer your questions. And I will see you next week for another A.Vogel Talks Menopause.

Postmenopausal Bleeding: Causes, Diagnosis & Treatment

Overview

What is postmenopausal bleeding?

Postmenopausal bleeding is bleeding that occurs after menopause. Menopause is a stage in a woman’s life (around age 51) when reproductive hormones drop and her monthly menstrual periods stop. Vaginal bleeding that occurs more than a year after a woman’s last period isn’t normal. The bleeding can be light (spotting) or heavy.

Postmenopausal bleeding is usually due to benign (noncancerous) gynecological conditions such as endometrial polyps. But for about 10% of women, bleeding after menopause is a sign of uterine cancer (endometrial cancer). Uterine cancer is the most common type of reproductive cancer (more common than ovarian or cervical cancers.) Talk to your healthcare provider if you experience any bleeding after menopause.

Who is more likely to have postmenopausal bleeding?

Anyone can have vaginal bleeding, especially during perimenopause. Perimenopause, the time leading up to menopause, usually occurs between ages 40 and 50. It’s the phase when a woman’s hormone levels and periods start to change.

How common is postmenopausal bleeding?

Postmenopausal bleeding occurs in about 10% of women over 55.

Symptoms and Causes

What causes postmenopausal bleeding?

The most common causes of bleeding or spotting after menopause include:

Other causes can include:

• Cervical cancer (cancer in the cervix).
• Cervicitis or endometritis (infection or inflammation in the cervix or uterus).
• Bleeding from other areas, nearby, in the bladder or rectum or bleeding from the skin of the vulva (outside near the vagina).

Diagnosis and Tests

How do you know the cause of postmenopausal bleeding?

• Identifying the cause of the bleeding can include the following:
• Exam by your provider of the vagina and cervix.
• Pap smear to check the cervical cells.
• Ultrasound, usually using a vaginal approach, which may include the use of saline to make it easier to see any uterine polyps.
• Biopsy of the endometrium or uterus. In this procedure, your healthcare provider gently slides a small, straw-like tube into the uterus to collect cells to see if they are abnormal. This is done in the office and can cause come cramping.

Management and Treatment

How is postmenopausal bleeding treated?

Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments.

Medications include:

• Antibiotics can treat most infections of the cervix or uterus.
• Estrogen may help bleeding due to vaginal dryness. You can apply estrogen directly to your vagina as a cream, ring or insertable tablet. Systemic estrogen therapy may come as a pill or patch. When estrogen therapy is systemic, it means the hormone travels throughout the body.
• Progestin is a synthetic form of the hormone progesterone. It can treat endometrial hyperplasia by triggering the uterus to shed its lining. You may receive progestin as a pill, shot, cream or intrauterine device (IUD).

Surgeries include:

• Hysteroscopy is a procedure to examine your cervix and uterus with a camera. Your healthcare provider inserts a hysteroscope (thin, lighted tube) into your vagina to remove polyps or other abnormal growths that may be causing bleeding. This can be done in the office for diagnosis. To remove any growths, hysteroscopy is often done in the operating room under general anesthesia.
• Dilation and curettage (D&C) is a procedure to sample the lining and contents of the uterus. Your healthcare provider may perform a D&C with a hysteroscopy. A D&C can treat some types of endometrial hyperplasia.
• Hysterectomy is a surgery to remove your uterus and cervix. You may need a hysterectomy if you have uterine cancer. Your healthcare provider can tell you about the different approaches to uterus removal. Some procedures are minimally invasive, so they use very small cuts (incisions).

Living With

When should I contact my doctor?

Contact your healthcare provider if you experience vaginal bleeding:

• More than a year after your last menstrual period.
• More than a year after starting hormone replacement therapy (HRT).

A note from Cleveland Clinic

It’s normal to have irregular vaginal bleeding in the years leading up to menopause. But if you have bleeding more than a year after your last menstrual period, it’s time to see your healthcare provider. It could be the result of a simple infection or benign growths. But in rare cases, bleeding could be a sign of uterine cancer.

90,000 Premenopause: what is it, symptoms, signs of premenopause, treatment | Periods before menopause

What is premenopause?

Premenopause is as natural as puberty and pregnancy. Different women experience this stage of life in different ways. Some women hardly notice any changes, while others find the symptoms of premenopause very uncomfortable. If you are worried about these unpleasant manifestations, do not worry, there are many ways to deal with them.

Signs of premenopause

The cycle before menopause is characterized by decreased production of hormones. In view of this, you may encounter the following symptoms:

• the menstrual cycle becomes irregular, or its intensity changes;
• periods in premenopausal women become longer or, conversely, much shorter;
• discharge may occur between periods;
• Premenopause may be accompanied by symptoms such as hot flushes, increased sweating at night, insomnia, or increased heart rate;
• You may feel a lack of energy or have mood swings.

Coping with Premenopausal Symptoms

Below are 5 basic tips for coping with emerging premenopausal symptoms.

1. Stress only aggravates the signs of premenopause, so you need to look for ways to relax. Take a bath or read your favorite book.
2. Create a regular exercise program.
3. Dress warmly, and then, if you are thrown into a fever, it will be easier to ease your condition by undressing.
4. Keep your bedroom cool for better sleep.
5. Some women cope better with age-related premenopausal symptoms with hormone replacement therapy.

Talk to your GP or gynecologist about the best premenopausal symptom relief option for you in your situation. Only a specialist knows the characteristics of your body well enough to make the right decision.

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How to stay young and beautiful after 40

Burning eyes, a slender figure, passion for their work and excellent health – a woman should be like that at any age.Nature has given women the strength and energy to bear children. But, as you know, only up to a certain age. Fertility stops when menopause occurs, or, as the people say, menopause. Menopause is a woman’s last spontaneous menstruation, which occurs at about 51–52 years.

We understand that after 40 years it is impossible to look and feel the same as at 20. But this does not mean at all that during premenopause (the time before menopause, when the body prepares for the last menstruation), a woman must certainly gain weight, look bad and take new sores for granted. In the 21st century, modern doctors are sure: a woman should and can remain beautiful, healthy and active … even after menopause. No, we are not talking about plastic surgeries and expensive creams, we are talking about modern endocrine medicine.

April 29 18:30, registration by phone: 224-44-44

• What happens in a woman during menopause.
• How to avoid drastic changes in the body before and after menopause.
• How to stay beautiful and healthy after 40 years.

Presenter – Nelly Mikhailovna Samukova, expert doctor of the Department of Gynecology.

Why are we getting old?

The reason for the changes in the female body and appearance is hormonal. After about 40 years, a woman’s production of sex hormones decreases, and we begin to change. This period is called premenopause (the time before menopause, when the body prepares for the last menstrual period).

It is easy to stay slim up to this point: the gym and fasting days are quickly put in shape, and the elasticity of the skin is easily maintained by cosmetic procedures. But as soon as hormone deficiency begins in the body, everything becomes more complicated and the simplest procedures no longer bring the desired effect.

Three main female sex hormones:

• progesterone – pregnancy hormone,
• estrogen – beauty hormone,
• testoterone is a hormone of sexuality.

It is these natural sources of feminine power that are beginning to leave us. So, if, first of all, the deficiency of hormones begins with the beauty hormone estrogen – we observe the appearance of wrinkles.And if testosterone makes itself known first, the initial symptoms can be strong emotional changes: unwillingness to intimacy and loss of “zest for life.”

Hormones affect many processes in the body, so wrinkles and lack of mood are only the first signs of hormone deficiency. After 45 years, the deficiency manifests itself more acutely: hot flashes and sweating, urogenital problems (dryness, irritation, itching, decreased sex drive, problems with urination).

After 56 years, already in the postmenopausal period (the time after the last menstruation), other risks increase: acute urogenital problems, cardiovascular diseases, osteoporosis (decreased bone strength), type II diabetes mellitus.

And after 66 years we reach the peak of hormonal depletion, which leads to more global problems. Due to hormonal deficiency, we have an increased risk of fractures due to osteoporosis, visual and hearing impairments. And it’s no secret that it is at this age that we are most at risk of heart attack, stroke and Alzheimer’s disease.

This is how hormone deficiency manifests itself on the female body. We think that such symptoms are inevitable, but only in Russia is menopause considered a process that does not require intervention.But a way to maintain women’s health, and therefore beauty, after menopause has been invented, and its name is hormone replacement therapy (HRT).

The Secret of Hollywood Stars Youth

We are often surprised by celebrities who do not seem to change over the years. Yes, they have unlimited funds for personal care, but they also have the best doctors working with them, which means they are the first to receive information about the most advanced technologies in medicine. The benefits of hormone replacement therapy for women in the West are not news for a long time.But in Russia there is a historically established attitude towards hormones. We are afraid of them, although we do not have accurate information about the effect of the drugs. Meanwhile, for example, in Sweden, hormone therapy is already received by 87 percent of patients.

It has been proven that if this therapy is used before the age of 60, the risk of disease is reduced by 30-60 percent.

No amateur performance

Naturally, such therapy can only be selected with an experienced gynecologist. First, he will prescribe examinations to exclude contraindications and choose the type and form of therapy.

Therefore, after 40 years, and even more so if you have already found the first signs that your body is preparing for the last menstruation, go to the gynecologist. How to understand this? One of the symptoms may appear, which is better not to ignore: menstruation comes less than once every 40 days or does not come for several months, the menstrual cycle is less than 25 days, and the number of days of menstruation has sharply decreased, urinary incontinence, hot flashes, brittle nails, loss hair loss, excess hair growth, or baldness.

It is important to see a specialist on time, not after the cessation of menstruation, but before, in order to prevent the start of a drop in hormone levels.

Research Needed to Assess Women’s Health

• FSG
• Ultrasound of the mammary glands (up to 40 years old), mammography (after 40 years)
• Study of smear for oncocytology
• Ultrasound of the pelvic organs

Depending on the general state of health, the list may increase by 2-3 types of research: a study of the lipoprotein series, coagulogram, functional tests of the liver and pancreas.

In what cases is therapy contraindicated?

HRT is definitely contraindicated in two cases: with a history of breast cancer and uterine cancer. In other situations, individual analysis and examination are required. The main point is that all actions are taken only with a doctor.

Myths about hormonal preparations

The main myth associated with HRT and with the use of hormonal drugs is that hormones can lead to cancer. But the fact is that cancer cannot always be diagnosed right away.If a woman starts taking HRT and cancer begins to develop in the body at this time, the drugs can provoke the onset of symptoms, but not the cancer itself.

Therefore, before the appointment of hormone therapy, it is imperative to check the condition of the mammary glands.

And, of course, such drugs are believed to increase weight. 60% of women notice weight gain during the period of decrease in the level of sex hormones. Hormone therapy can prevent this from happening. It is important to understand that with taking medications, no one canceled proper nutrition and physical activity.

Proven Benefit

So, hormone replacement therapy will improve the quality of life of a woman after menopause, help prevent the state of sudden changes in the body and stay young and active longer.

Most importantly, by preventing hormone deficiency, there is a chance to reduce by 60 percent the risk of diseases such as stroke and heart attack, which are at the top of the list of causes of death.

How will vitamin D help us?

It is worth remembering that even hormone therapy is not a panacea and our health is in our hands.Therefore, even during hormone therapy, one should not forget about proper nutrition and physical activity: walk more, do fitness or go to the pool – choose what you like.

Eat more vegetables and fruits, reduce your consumption of red meat, drink more fluids. And, of course, don’t smoke. Have you all heard this many times? But now, every good habit will help you stay young for longer.

You should also pay attention to vitamin D. It is this vitamin that has an active effect on all vital processes and regulates the level of hormones in the body.The main source of vitamin D is food (remember fish oil) and the sun. In Russia, there are not enough sunny days, as in Northern Europe, so we are at risk of vitamin D deficiency.

Symptoms of a vitamin deficiency are obvious: increased nervousness, depression, sleep disturbances, a feeling of dry mouth and throat, sweating, muscle cramps, joint pain, weight loss or gain. If these signs are ignored and vitamin D levels are not adjusted, the risk of serious illness is high.Increasing your vitamin level is simple: eating foods rich in vitamin D (fatty fish, eggs, etc.), sun exposure for 10-13 minutes a day.

Want to know more?

Make an appointment with the gynecologist at the Nureyevs’ Clinic and get a personal consultation on this matter.

843 212-22-44

90,000 “Put off old age.” Gynecologist On How To Prepare For Menopause | HEALTH: Events | HEALTH

Climax. This word makes many women shiver.Is this transition period as terrible as they say about it? Is it possible to ease its course? doctor-gynecologist-endocrinologist Lyudmila Karakhalis answered the questions of “AiF-Yug”.

“Think from a young age”

Olga Kisileva: Lyudmila Yurievna, what is menopause? And when does this turning point in a woman’s life usually come?

Lyudmila Karakhalis : Most women have menopause between 45 and 55 years of age, but it can start earlier or later. Menopause is often referred to as menopause. However, from the point of view of medicine, these are different concepts. Menopause is the year after the last menstrual period. It is preceded by perimenopause, i.e. period when menstruation is irregular. This stage is completed by postmenopause. But often all three concepts are combined, called menopause or menopause.

– Do I need to prepare for this moment, at what age do I need to think about it?

Soy is the leader among food products that contain phytoestrogens.There are many of them in legumes (peas, beans, lentils). And also in dairy products (milk, cheese, cottage cheese, sour cream), cereals (wheat, barley, rice), vegetables (carrots, cabbage, asparagus, parsley, garlic), vegetable oils.
– As soon as the girl had her first period, it means that her ovaries began to consume follicles. I am speaking quite frankly. Every month the supply of the reproductive system is spent, menopause is approaching. The age of reproduction is of great importance – from 18 to 45 years. How correctly a woman will live it will depend on her condition during menopause.What does right mean? Avoidance of abortion, constant sexual partner, absence of bad habits, proper nutrition, physical activity, use of hormonal contraception, attentive attitude to one’s health. Often, patients come who cannot become pregnant at the age of 20-25. It turns out that the problems were still in adolescence. Due to unfavorable factors, the reserve will be prematurely depleted, and the onset of menopause will approach. Today, there are more and more patients with early menopausal manifestations.This is called premature ovarian failure. There is no ovulation. This can happen even at the age of 30. First of all, of course, a young woman must visit genetics to rule out genetic abnormalities. But even in such a situation, she can become a mother. By donor egg and in vitro fertilization with the spouse’s sperm. Today there are many opportunities, the main thing is not to sit idly by.

– How to alleviate the condition of a woman during this period? And what changes in her body should she be ready for?

– The first thing that worries most women is vegetative fluctuations, i. e.e. tides. Blood vessels expand and contract. Possible attacks of rapid heartbeat, pain in the heart, feeling short of breath, darkening in the eyes, cold sweat, chills, numbness of the limbs, insomnia, weakness, fatigue, anxiety, irritability, dizziness, problems with urination, etc. During this period, a woman can gain weight quickly enough. In postmenopausal women, carbohydrate metabolism is often disturbed, and type II diabetes mellitus develops.Due to a decrease in estrogen levels, there is a risk of developing hypertension, which is fraught with hypertensive crisis and vascular pathologies. All menopausal symptoms can and should be treated. To do this, you need to consult a gynecologist-endocrinologist. You cannot self-medicate.

Less stress

– Which therapy is considered the most effective?

– Menopausal hormone therapy. This medicine should be prescribed by a doctor after a complete examination of: mammary glands, genitals and thyroid gland.Only after that, drugs are prescribed, taking into account a personal family history. All analyzes are repeated once a year. It is recommended to keep a diary for the first three months to understand how well the treatment is tolerated. I would like to note that today there is a huge amount of funds that can be combined. Almost any woman can find the right therapy. And this is not only pills, skin patches, vaginal suppositories. My patients call this an opportunity to prolong youth, and I agree with them. The unpleasant symptoms of menopause are eliminated.Plus the prevention of atherosclerosis and cardiovascular diseases, and therefore their complications – myocardial infarction, stroke. Normalization of lipid and carbohydrate metabolism, prevention of obesity, diabetes mellitus, secondary arterial hypertension, prevention of osteoporosis and its consequences – fractures of the spine and limb bones. If the body has enough estrogen, the aging process slows down.

You can continue to take hormonal contraception until old age, because even at 75, women want to look and feel good.

It is easier and easier to switch to menopausal therapy after hormonal contraception, so I recommend using it in the reproductive period, especially since it is also the prevention of oncology. In addition, a woman can become pregnant at the age of 40-45. Unfortunately, many have abortions, which aggravates their condition. And competent contraception will protect you from this. By the way, if a woman takes hormonal contraception for two years, then the age of onset of osteoporosis – bone loss – is postponed by five years.It can be used during menopause and for another two years after it, and then switch to menopausal hormone therapy. It is important to start taking these drugs or alternatives (for example, herbal origin) strictly before the age of 60. You can continue to a ripe old age. After all, even at the age of 75, women want to look and feel good, especially those who are constantly in sight: doctors, lawyers, teachers, politicians, managers, businesswoman.

– What advice can you give to women who have already entered menopause? How to build your life further?

– Consult a gynecologist-endocrinologist, undergo the necessary examination and jointly choose the optimal treatment.Together, monitor your diet and lifestyle: less stress, giving up bad habits, moderate exercise and walking in the fresh air.

See also:

Uterine cancer

Uterine cancer is a malignant tumor.

The uterus is a hollow, pear-shaped organ located in the pelvic region. During pregnancy, the development of the fetus occurs in it.

In most cases of uterine cancer, endometrial cells are affected. The endometrium is the layer of cells that covers it from the inside.Other types of uterine cancer are extremely rare.

This is one of the most common cancers in women. Most often it occurs at the age of 50-65.

It is often detected at an early stage, as it causes atypical bleeding from the vagina, which forces the patient to consult a doctor. When diagnosed early, cancer responds well to treatment.

Synonyms Russian

Endometrial cancer, cancer of the body of the uterus.

English synonyms

Endometrial cancer, Uterine cancer, Cancer of the uterus.

Symptoms

• Bloody vaginal discharge after menopause (permanent cessation of menstruation).
• Long periods between periods, bleeding between periods.
• Atypical watery or bloody vaginal discharge.
• Pain during intercourse.
• Pelvic pain.

General information about the disease

The uterus is a hollow pear-shaped organ of the female reproductive system.It is located in the pelvic area, between the bladder and rectum. From below, the body of the uterus passes into a rounded part – the cervix. During pregnancy, the fetus is carried in the uterus.

In cancer of the uterus, as a rule, cells of the endometrium are affected – the mucous layer that covers the organ from the inside. Other types of uterine cancer are very rare.

Women after menopause (at the age of 50-65) are more likely to suffer from uterine cancer.

Recently, however, there has been a steady increase in the number of young women with uterine cancer.In case of uterine cancer in a woman of childbearing age, disorders of the hypothalamic-pituitary-ovarian system may be mistakenly diagnosed, which happens in some cases due to the similarity of the symptoms of the diseases.

Cancer of the body of the uterus involves the transformation of healthy cells of the uterus into cancerous cells. Unlike healthy cells, which appear in the right amount and die off at a certain time, giving way to new ones, cancer cells begin to grow uncontrollably without dying off at the right time; their clusters form a cancerous tumor.

Cancer cells can also spread to nearby body tissues (metastasize). Cancer of the body of the uterus metastasizes to the lymph nodes, cervix, bladder, rectum, lungs and other organs.

Stages of uterine cancer:

1) the cancer is located within the uterus;

2) the cancer is located within the uterus and cervix;

3) cancer spreads outside the uterus, affecting the lymph nodes of the pelvis, while it does not affect the rectum and bladder;

4) cancer spreads outside the uterus, affecting the bladder, rectum, lungs and other organs.

Who is at risk?

• Women with a violation of the balance of female hormones in the body. The ovaries secrete female hormones: estrogen and progesterone. Fluctuations in their level cause changes in the endometrium of the uterus. A disease or condition that increases estrogen levels can also increase your risk of developing uterine cancer. It can be caused by irregular ovulation, polycystic ovary syndrome, obesity, and diabetes. Taking hormones after menopause also increases your risk of endometrial cancer.
• Women who started menstruating before age 12, women with late menopause (after age 52). The longer your period lasts, the higher your risk of developing uterine cancer.
• Women who have never given birth.
• Women undergoing hormone therapy for breast cancer. Most often, this effect is caused by taking tamoxifen.
• Women with a hereditary predisposition to uterine cancer.

Diagnostics

If cancer is suspected after a Pap test and determination of the level of tumor markers, a biopsy is performed; if necessary, hysteroscopy is performed (examination using an optical system, which is inserted through the vagina into the cervix) or transvaginal ultrasound, confirming the diagnosis.After the diagnosis of uterine cancer is made, tests are carried out to detect metastases – tests to assess liver and kidney function, complete blood count, abdominal ultrasound, chest X-ray and ECG. For diagnostic purposes, laparoscopy can also be performed (examination is performed through holes in the abdominal wall 0.5-1.5 cm in size, into which a tube with a camera is inserted).

Laboratory research

• Cytological examination of smears-scrapings from the surface of the cervix and external uterine pharynx – Papanicolaou staining (Pap test) – collection of cells and their microscopic examination on a glass slide.This method is widely used to detect precancerous and cancerous changes in the cells of the uterus. The effectiveness of the study increases in combination with transvaginal ultrasound.
• Tumor markers: CA 15-3, CA 72-4, CEA, CA 125 II. These are proteins that may indicate the presence of cancer. However, it can also be elevated in a healthy body. Therefore, the analysis for tumor markers is used as an auxiliary method for diagnosing cancer, for diagnosing cancer recurrence and evaluating the effectiveness of its treatment.

Other research methods

• Transvaginal ultrasound examination (ultrasound).To get a more detailed image of the uterus, an ultrasound probe is placed in the vagina. This study allows you to identify the presence of a cancerous tumor, its size and location.
• Biopsy – taking cells from the body of the uterus for subsequent examination under a microscope. Allows you to determine the type of cancer of the uterus.
• Hysteroscopy. Examination of the uterine cavity through the cervix. A thin, flexible tube with a light source (hysteroscope) is inserted through the vagina and cervix into the uterus.Hysteroscopy allows the doctor to examine the inside of the uterus, revealing suspicious areas or cancerous growth. During hysteroscopy, a biopsy is performed – taking cells for further examination.

Treatment

The cancer treatment strategy is determined by the doctor, taking into account the stage, type of cancer, health status and individual characteristics of the patient.

• Surgery. For the treatment of uterine cancer in the early stages, a hysterectomy is performed – removal of the uterus.Additionally, the fallopian tubes and ovaries and nearby lymph nodes can be removed. After the removal of the uterus, the woman loses the ability to have children; after the removal of both ovaries, the woman also loses the ability to bear children, menopause occurs – the final cessation of menstruation.
• Radiation therapy. This uses radiation to destroy cancer cells. It can be used after surgery. Radiation therapy can be external or internal. External beam therapy involves exposure to radiation from the outside; internal – brachytherapy – involves placing a special device filled with radioactive material next to a cancerous tumor.
• Hormone therapy. In cases of advanced uterine cancer, progesterone therapy can be performed, which slows down the growth of cancer cells.
• Chemotherapy. Chemotherapy uses drugs to kill cancer cells. It is often combined with radiation therapy.

Prevention

There are ways to reduce the risk of developing uterine cancer:

• Withdrawal from hormone therapy after menopause.
• Taking contraceptives may reduce the risk of developing uterine cancer. To do this, you must take the drugs for at least one year. The reduction in the risk of uterine cancer persists for several years after the end of contraceptive use.
• Maintaining a healthy weight. Being overweight increases your risk of uterine cancer, so you need to maintain a healthy weight and, if necessary, lose weight through diet and exercise.
• Physical activity.Physical activity should be at least 30 minutes a day during each day.

Recommended analyzes

• Cytological examination of smears-scrapings from the surface of the cervix and the external uterine pharynx (Pap test).
• CA 15–3

• CA 72–4
• REA
• CA 125
• Complete blood count
• Serum creatinine
• Urea in whey
• Alanine aminotransferase (ALT)
• Aspartate aminotransferase (AST)

“It is no longer fashionable to suffer, get fat and break down on loved ones”

On gynecology for older women and hormone phobia

In 2008, a large study was conducted on the frequency of use of menopausal hormone therapy in menopausal disorders.It was attended by women from Switzerland, the USA and Russia. It turned out that in Switzerland, women taking menopausal therapy account for 15% (more than 153 thousand). In the United States – 10% of the female population, that is, four million women out of 40 million of the population. In Russia – out of 145 million of the population, only 130 thousand women take therapy, that is, 0.6%.

Russian specificity in the field of gynecology of older women is associated with a well-known trait that can be called hormone phobia. This phobia manifests itself at a young age when hormonal contraceptives are prescribed to patients and is gaining momentum when it comes to replacement therapy at an older age.Hormones, according to Russian women, are a terrible risk, a danger that it is better not to know anything about. And the most unpleasant thing in this story is that not only the patients, but also the gynecologists themselves, are afraid of hormones. Even if a woman is not averse to trying hormone therapy, she sees doubt in the eyes of the gynecologist, and then the treatment is either not prescribed or is ineffective.

Fortunately, every year the awareness of obstetricians-gynecologists still increases, as well as the awareness and interest of patients in this therapy.But still many have doubts and uncertainties, and often doctors mistakenly reason in one voice with patients: “Climax and all its manifestations are normal, sooner or later we will all be there. Humble yourself and accept it. ” In recent years, I have been telling my patients: “It is no longer fashionable to walk with hot flashes, suffer from insomnia, get fat, conflict at work and break down on loved ones.” Humanity is aging. There are more and more women over the age of 55 all over the world, world science, demographers and sociologists promise us that we will live even longer, so the active working age is increasing.In Russia, with the increase in the retirement age, this is more relevant than ever. Accordingly, the quality of life and health are issues that arise before us very acutely.

About climacteric syndrome

Perimenopause, or menopausal transition, is the period in a woman’s life between the reproductive phase and old age. It begins with a disturbance in the rhythm of menstruation, is accompanied by an increase in the level of FSH (follicle-stimulating hormone produced by the pituitary gland), a decrease in the level of estradiol – and ends with the last menstruation with a gradual shutdown of ovarian function.This transition takes years. Menopause can be diagnosed when 12 months have passed since the last menstrual period. The average age of menopause in women is 51 years.

Against the background of restructuring of the body, climacteric syndrome may occur, the manifestations of which are very important to catch on time. The earlier therapy begins during the menopausal transition, the more effective it is.

Photo: Maria Mozharova

About hot flashes, fractures and other key symptoms

Someone goes through the menopausal period completely painlessly, others experience symptoms of climacteric syndrome – it all depends on genetics, environmental factors and the characteristics of a particular woman.

The first sign of perimenopause is changes in the menstrual cycle: menstruation becomes irregular, changes in quantity and nature, delays of several months are possible. The woman may not be bothered by anything else at this stage. In this case, she often thinks that everything is not lost yet, the cycle will still be restored and just quietly waits, but in vain.

The level of estradiol – of the main female sex hormone gradually decreases in the body. This significantly complicates the life of a woman, because among the organs that are susceptible to the concentration of estrogen, not only the ovaries and the uterus themselves – the entire urogenital tract, the brain and the cardiovascular system also have receptors for estrogen.

Low estradiol is a risk of osteoporosis, hence fractures and bone pain in women over 45 are possible. Moreover, in the northern part of Russia we are already at risk for osteoporosis due to the lack of sunny days. Hormones, on the other hand, reduce the risk of fractures in old age – women taking substitution therapy do not need additional studies of bone density.

The most severe consequence of climacteric syndrome is the risk of cardiovascular disease.There is a large Danish study in which 46 thousand women took part in 16 years. It showed that in the group of women who were prescribed menopausal hormone therapy during the first seven months after menopause, the risk of myocardial infarction and mortality in general decreased by 52%, the body mass index decreased, and at the same time the risk of any other cancer did not increase compared to with average indicators in women who did not receive hormonal therapy. This is the most important data, because the fear of oncology when prescribing substitution therapy is the cornerstone: “You prescribe me pills, my hot flashes will go away, but in a year I will be diagnosed with breast cancer, like my friend?” No, it is not, but the most important thing is to start on time.Timeliness of appointment is half the battle.

Most often, the effect of menopause on cognitive function is manifested by impaired memory and mood. As far as memory is concerned, research shows that the main shock to the neurons in the brain occurs in the first year of climacteric syndrome. At the same time, some Western researchers argue that hormone replacement therapy has a positive effect on this function as well. Other studies say the therapy does not affect cognitive performance.Thus, a timely corrected hormonal imbalance is a guarantee that the condition will not worsen.

The most common menopausal symptom is the so-called hot flashes. This is a vasomotor vascular reaction in which a woman feels either fever or chills. At this time, women often complain: “I changed the blanket and two sheets per night, I am sweating, I can’t sleep, I am in no mood. We need to continue to work and feed the family, but life is not a joy. ” Most often, hot flashes are the first reason for a perimenopausal woman to see a doctor.She spoke to her mother or older friends, and they said, “Yes, yes, this is it.” The woman finally comes to the gynecologist, and so we met.

How substitution therapy is prescribed

Gynecological problems in older women are dealt with by the gynecologist in conjunction with a cardiologist or therapist, if necessary, an endocrinologist is involved. Before prescribing menopausal hormone therapy, it is necessary to undergo a series of examinations – the gynecologist must take an anamnesis, find out a family history with regard to breast cancer, thrombosis, early strokes and heart attacks.Plus, you need a gynecological examination, examination of the mammary glands, their mammography or ultrasound, transvaginal ultrasound. In addition, it would be good to combine the moment of appointment with the consultation of a cardiologist, who will assess the general somatic risks, look at the glucose level and the level of lipids in the blood. This is usually enough.

After an appointment in our clinic, patients always have all the doctor’s contacts, and we ask that even with the most “stupid” questions and “minor” complaints, do not hesitate and contact – in such things it is better to play it safe.

About drugs and forms of therapy

Menopausal therapy is divided into two types. The first is monotherapy, that is, pure estrogens, which come in the form of tablets, gels or injections. There is also a cream that is used only symptomatically for vaginal dryness and sexual dysfunctions – by the way, it can be used at any age, this cream has a tangible local effect.

The second type of therapy is combined. It consists of two components: estrogen and progesterone, the main female sex hormones.Women with a preserved uterus are prescribed combination therapy in 99% of cases. If, for some benign indications, the uterus has been removed to a woman, she does not need the second component, because progesterone is responsible for controlling the endometrium (the lining of the uterus).

There is another important female hormone – androgen, which is responsible, among other things, for a woman’s libido. During menopause, the concentration of androgens in the blood also gradually decreases. But, unfortunately, not a single drug for women with androgens has been registered in Russia.Fortunately, there are certain forms of progesterone that also have a positive effect on libido, but nevertheless, in this matter, Russian women have so far been a little less fortunate.

Combination therapy is usually given in the form of daily pills. But sometimes a woman can say that she still wants to menstruate. In this case, the administration of drugs is prescribed in a cyclic mode, which imitates the physiological cycle. This, of course, is only a pharmacological effect, an external attribute that makes it impossible to get pregnant.

After 52 years, the drug regimen is adjusted. After five years of therapy, a woman can easily say: “I’m tired of taking these pills. I feel myself good. I look good. Doctor, cancel. ” If we have done all the necessary research and the results show that she is doing well, we can cancel. According to modern world research, ten years of substitution therapy are considered safe. New research is constantly emerging. Perhaps they will remove certain restrictions on the appointment of MGT.After that, the continuation of therapy can be considered on an individual basis, depending on the state of health and risk factors. But in any case, once a year, a woman should undergo a full examination – examination by a gynecologist, examination of the mammary glands with mammography or ultrasound of the mammary glands, transvaginal ultrasound and a smear.

Photo: Maria Mozharova

About climacteric syndrome in young women

There are two situations in which the climacteric period occurs regardless of age, while the symptoms of climacteric syndrome are the same as during physiological menopause.The first case is “surgical menopause” after surgical removal of the uterus and ovaries. Feeling of heat and hot flashes is most often felt already in the first days after the operation. Unfortunately, not all women who have undergone surgery are aware of this. It happens that after the operation, a woman waits for the results of a histological examination for some time – at this stage, it is impossible to prescribe replacement therapy for her. And after being discharged, the doctors say: “Go to the clinic.” And here it is very important that at the stage of outpatient care in the clinic, the attending obstetrician-gynecologist prescribes the appropriate therapy.Unfortunately, this continuity does not always work.

The second situation is called premature ovarian failure syndrome. This condition is more often caused by genetic causes. In this case, a woman often thinks: “I am only forty, this is hardly a menopause, I will wait until fifty. But when early menopause occurs, it is critical not to miss the therapeutic window.

Basic fears and myths about hormone therapy

The main phobia is oncology. In fact, the risk factors for cancer are smoking, physical inactivity, obesity, age and, if we talk about women, the absence of childbirth or late childbirth.Menopausal hormone therapy does not appear anywhere on this list.

Among other fears, weight gain occupies an important place: “Doctor, you prescribe hormones for me, I will definitely gain excess weight.” In fact, there is a physiological change in weight in the first three months of taking substitution therapy due to edema, which then goes away – and the weight is completely normalized. In order not to gain weight, you need nutrition in which the number of calories consumed does not exceed the number of calories spent, plus regular physical activity.If you don’t follow these rules, you can get fat, but menopausal hormone therapy has nothing to do with it.

And finally, another myth is the risks of thrombosis and venous insufficiency. In fact, with the right approach to prescribing MHT, these risks do not increase.

In addition, there are significant additional benefits to hormone replacement therapy. Among them, for example, improving the quality of the skin. It happens that patients come without any acute indications, they feel good, but they say: “I met a friend who lives in America.She said that almost all the women there are taking hormone therapy, they are vigorous, energetic and even old women look younger than me, they have perfect skin. I would like the same thing. ” And if a woman came with a request for a cosmetic and anti-aging effect, we did not find any contraindications – why not, of course, you can start. Doctors-dermatologists-cosmetologists perfectly perceive substitution therapy, combining it with local prescriptions.

And, finally, hormones improve the psycho-emotional state.If a woman does not sleep well, is anxious, looks bad, feels eternal fatigue – just to crawl under the covers and not leave the house, and we remove all these symptoms – of course, therapy improves her life.

Asya Chachko

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