So you’re going through menopause – hot flashes, brain fog, mood swings, vaginal dryness…the works…but at least you don’t have any more periods, right?
And then you spring a leak…nope, not just spotting…a full blown period! What’s up? Your health care provider confirmed with a blood test that you’re menopausal.
Your health care provider probably ran an FSH – Follicle Stimulating Hormone – which indicates how much estrogen you’re making.
An FSH over 30 means you’re menopausal that you’ve run out of eggs so no more ovarian estrogen production. But that doesn’t mean your bleeding stops. In fact it can take a couple of years or longer if you’re using hormone replacement therapy to stop bleeding. Menopausal bleeding is not actual periods. It’s more of a breakthrough bleed caused by hormonal imbalance.
Your uterus lining is built up by estrogen and stabilized by progesterone. In an actual reproductive menstrual cycle, the high levels of estrogen in the first half of the cycle build up the uterine lining, then after ovulation, progesterone stabilizes the lining. If pregnancy does not occur, the uterine lining sheds.
During perimenopause (the 5-15 years before menopause), you make much less progesterone so your periods can become irregular, your bleeding heavier, and even skip periods all together. Once your last egg ovulates, then you’re menopausal. Your FSH rises in response to your lower estrogen levels, as ovarian estrogen is made by the developing follicles that try to be the egg of the month. No more follicles, no more ovarian estrogen.
But your adrenal glands make some estrogen and your fat cells store estrogen. So after menopause even if you’re not using hormone replacement therapy, you can still have enough estrogen on board to build up your uterine lining. That lining will shed which looks like a period. Your adrenal glands also make about five percent of your progesterone. Or if you’re taking hormone replacement therapy, the progesterone you’re taking helps stabilize your lining.
It’s tricky getting estrogen and progesterone levels balanced in menopausal women to prevent periods.
When estrogen is too low, your uterine lining becomes friable which leads to spotting, especially after intercourse or high impact exercise. When progesterone is too low compared to estrogen, your menopausal “periods” are heavy. When you’re under considerable stress, the progesterone you’re taking as hormone replacement therapy is used by your adrenals to make the stress hormone cortisol. Which means your menopausal bleeding can be excessive.
The year my mother became terminally ill was really stressful. In spite of my best efforts, the stress of taking care of her, my family, my patients and running my businesses took a toll. Thankfully, I supported myself with extra Genesis Gold so I didn’t get sick. But my adrenals robbed my uterus of the bioidentical progesterone I was taking. I had terrific break though bleeds that looked like I was hemorrhaging. I knew what it was, but just in case got pelvic ultrasound and an endometrial biopsy. Both were normal. I adjust my bioidentical hormones accordingly and stayed sane and relatively dry until my mother passed away.
If you’re post menopausal and haven’t had a period in over two years and you start bleeding, you need to get checked by your health care provider. A pelvic ultrasound can determine if your uterine lining is too thick which can be an early sign of endometrial cancer. If you’re using hormone replacement therapy for over two years without a period and you start bleeding, you need to talk to your health care provider to order a pelvic ultrasound and help you adjust your hormones.
Remember most menopausal women do not just stop bleeding. Their uterus kind of peters out over a year or two. While using hormone replacement therapy can really help mitigate the symptoms of menopause (hot flashes, insomnia, moodiness, brain fog…) your uterus takes her own sweet time adjusting to the exogenous (not your own) hormones.
Some menopausal women continue to cycle with the moon and other younger women. You may even get PMS followed by a little spotting. Your body has been in rhythm with nature especially other women since you first started having periods. That’s why women who live together and work closely together tend to cycle together. It’s biology getting in sync. Just because you’re menopausal doesn’t mean your hypothalamus has forgotten the rhythm. My body still cycles with my daughter and my young assistant – breast tenderness, cramping, spotting, a little moody (my husband would say more than a little), sometimes profound fatigue. I take it as a reminder to slow down and take extra good care of myself.
I recommend you just go with it. You don’t need a full blown period to take some downtime and cherish yourself every month. Especially in menopause, it’s important to celebrate your femininity. Unlike reproductive women, you’re no longer bleeding out your wisdom every month. So take your menopausal moon time to gather the wisdom you’ve gained as a woman, mother, grandmother, sister, wife, lover, friend, leader and write it down. What might you share with the younger generation? Menopause is your time to shine as a sage! You’ve got lots to share! Enjoy this beautiful chapter of your life!