Personal Symptoms of Menopause

For pretty much all women, the changes in the menstruation cycles leading up to and during the time of menopause will be due to ever changing hormone levels. It is quite normal and natural to experience irregular periods for anything up to seven or eight years prior to the last period. It is also nothing un-natural for periods to be either quite a bit lighter or considerably heavier, or even longer or much shorter.

At the time when the menstrual cycle begins to fluctuate, it is a good idea to visit your doctor just to double check that this change in cycle is due to perimenopause and nothing else. It is not normal for bleeding to occur more than one year after the last period. If bleeding occurs even six months later it should arouse suspicion and you should see your doctor quickly to find out the cause.

Investigation Of Abnormal Bleeding

When you visit your doctor complaining of any of the above and you are approaching 50, he or she will want to give you a complete examination and do tests to exclude any serious causes.

Testing Methods

Your doctor will perform a vaginal examination and cervical smear, and arrange blood tests for anemia and thyroid function.

You may be referred for an ultrasound examination of the pelvic organs (a transvaginal scan or TVS). This can be done in the ultrasound department of the hospital, but more commonly you would see a gynecologist who specializes in ultrasound investigation. If the scan shows the lining of the uterus is thickened or irregular, you may have an endometrial biopsy, when a small sample of the lining is taken using a thin plastic tube. This can be carried out at the same time as the scan and takes two minutes.

Alternatively, you may need a hysteroscopy and/or a D&C (dilatation and curettage) under anesthetic. Hysteroscopy involves examining the uterine cavity with a thin fiberoptic hysteroscope. A D&C involves dilating the cervix, scraping out the lining of the uterus and sending it for further tests. This method is often used as a treatment for heavy bleeding, and sometimes solves the problem.

Either method will help diagnose any abnormality of the endometrium, including polyps, infection, endometrial hyperplasia and cancer.

A cervical smear will help to diagnose the cause of any spotting or bleeding after sex. The test involves scraping some cells from the cervix and examining them for any signs of pre-cancer or cancer. Regular cervical smears after the age of 20 will help to ensure that any abnormality will be found early and can be dealt with before it becomes serious. If the smear is abnormal, further examination of the cervix, using a colposcope to magnify the area, will be necessary. Biopsies are done of any visualized abnormalities and sent to the pathologist.

Blood tests will help to show whether the abnormal bleeding is due to hormone imbalance. There is some concern that if you are bleeding heavily due to unopposed estrogen, your risk of certain hormone-sensitive cancers is increased.

When bleeding patterns change it is important to have blood tests to check the thyroid gland. Thyroid disease can give many of the same symptoms as perimenopause, and if left untreated can cause serious illness.