Can you have periods after menopause?
So, you’re going through menopause.
You’re experiencing the works – hot flashes, brain fog, mood swings, vaginal dryness. But at least you don’t have any more periods, right? And then the unexpected happens.
You randomly have your period after menopause, leaving you confused and concerned.
You wonder what could be happening since 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. So, you’re no longer producing estrogen. But that doesn’t necessarily mean that 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 an actual period. 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, your uterine lining sheds, which is an actual period.
During the 5-15 years before menopause, called perimenopause, you make much less progesterone. So your periods can become irregular. Your bleeding can be heavier, and you might even skip periods all together. Once your last egg ovulates, you enter menopause. Estrogen is made by the developing follicles that try to be the egg of the month. When there are no more follicles, this means no more estrogen from your ovaries, which causes your pituitary FSH to rise to menopausal levels.
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 what looks like a period after menopause. 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 can be tricky getting estrogen and progesterone levels balanced enough to prevent periods after menopause.
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 “periods” after menopause 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. This means that 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 during all of this, my adrenals robbed my uterus of the bioidentical progesterone I was taking. I had awful breakthrough bleeds that looked like I was hemorrhaging and I knew what it was. But just in case, I got a pelvic ultrasound and an endometrial biopsy. Both were normal. I adjusted 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, get checked by your healthcare provider.
A pelvic ultrasound can determine if your uterine lining is too thick, which can be an early sign of endometrial cancer. If you’ve been using hormone replacement therapy for over two years without a period and you start bleeding, talk to your healthcare 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, etc.) your uterus takes its time adjusting to the exogenous (not your own) hormones.
Going through menopause can be hard. What you really need to help you through this process is a plan. Sign up today for my free guide on how to develop your own Menopause Action Plan.
Menopause and the Human Hypothalamus: Evidence for the Role of Kisspeptin/Neurokinin B Neurons in the Regulation of Estrogen Negative Feedback
The Interrelationship Between Serum Pituitary Hormones in Healthy Adults