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Heavy bleeding in the menopause is known as menorrhagia. It is characterized by heavy flow and/or prolonged duration. It is one of the most common gynaecologic complaints, affecting up to 20% of women of reproductive age.  If you are changing your pad or tampon more than 6x/day and passing clots this is not normal.

Heavy bleeding during menopause can be a concerning symptom that requires medical attention to determine the underlying cause and provide appropriate treatment. The pathophysiology of menorrhagia is complex and multifactorial. There are a number of factors that can contribute to heavy bleeding in menopause or menorrhagia, including:

Ovulatory dysfunction: Ovulatory dysfunction is the most common cause of menorrhagia. It occurs when the ovaries do not release an egg each month. This can lead to an imbalance of oestrogen and progesterone, which can cause the endometrium to thicken excessively and bleed heavily.  The menstrual cycle is regulated by a complex interplay of hormones, including gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), oestrogen, and progesterone.

In a normal menstrual cycle, GnRH is released from the hypothalamus, which stimulates the pituitary gland to release LH and FSH. LH and FSH stimulate the ovaries to produce oestrogen and progesterone.

Oestrogen causes the endometrium to grow and thicken. Progesterone helps to control the growth and shedding of the lining.

When ovulation occurs, the corpus luteum forms in the ovary and begins to produce progesterone. Progesterone levels continue to rise until the corpus luteum regresses. When the corpus luteum regresses, progesterone levels fall, and the endometrium is shed, resulting in menstruation.

In anovulatory cycles, ovulation does not occur. This can lead to an imbalance of oestrogen and progesterone, with too much oestrogen and not enough progesterone. This imbalance can cause the endometrium to continue to grow and thicken without being shed. This can lead to menorrhagia.

Structural abnormalities: Structural abnormalities of the uterus, such as fibroids, polyps, and adenomyosis, can also cause menorrhagia.  Fibroids are benign tumours that grow in the muscle of the uterus.  Polyps are benign growths that form on the lining of the uterus. They can increase the surface area of the endometrium, leading to heavy bleeding.

Adenomyosis: Adenomyosis is a condition in which the endometrium invades the muscle wall of the uterus. This can cause heavy bleeding, pain, and cramping.

Systemic disorders: Certain systemic disorders, such as von Willebrand disease and other bleeding disorders, can also cause menorrhagia. These disorders can impair the blood’s ability to clot, leading to excessive bleeding.

Medications: Certain medications, such as anticoagulants and nonsteroidal anti-inflammatory drugs (NSAIDs), can also increase the risk of menorrhagia.

In some cases, menorrhagia is idiopathic, meaning that no underlying cause can be identified.

Endometrial hyperplasia is a thickening of the endometrium, the lining of the uterus. It is caused by an imbalance of oestrogen and progesterone, two hormones that play a role in the menstrual cycle.

Oestrogen causes the endometrium to grow and thicken, while progesterone helps to control the growth and shedding of the lining. If there is too much oestrogen and not enough progesterone, the endometrium can continue to grow and thicken without being shed. This can lead to endometrial hyperplasia.

There are a number of factors that can contribute to an imbalance of oestrogen and progesterone, including:

  • Perimenopause and menopause: During perimenopause and menopause, the ovaries produce less oestrogen and progesterone. This can lead to endometrial hyperplasia.
  • Hormone therapy: Oestrogen therapy, such as that used to treat menopausal symptoms, can also increase the risk of endometrial hyperplasia.
  • Polycystic ovary syndrome (PCOS): PCOS is a hormonal disorder that can cause irregular menstrual cycles and high levels of androgens (male hormones). This can lead to endometrial hyperplasia.
  • Obesity: Obesity can increase the levels of oestrogen in the body.
  • Other medical conditions: Certain medical conditions, such as diabetes and thyroid disease, can also increase the risk of endometrial hyperplasia.

In most cases, endometrial hyperplasia is not cancer. However, some women with endometrial hyperplasia develop abnormal cells that can become cancerous over time. This is why it is important for women with endometrial hyperplasia to be monitored closely.

If you are experiencing heavy bleeding in the menopause or any of the these symptoms, Pause and Co Healthcare can help manage your symptoms so that you don’t have unbearable heavy periods that can sometimes cause anaemia.

Nadira Awal

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