I have reached menopause, but my period comes on time every month. Is this normal?

Author: Yang Yueming, deputy chief physician of Foshan First People's Hospital

Reviewer: Wang Gang, Chief Physician, Sichuan Provincial Maternal and Child Health Hospital

Menopause is the transition stage from childbearing age to old age for women. It is a special period that all women go through. It usually lasts for 6 to 12 months. It is a period when menstruation becomes increasingly irregular and finally stops completely.

Women who enter menopause lack ovulation and corpus luteum formation, as well as the lack of progesterone to counteract estrogen and transform the endometrium. Long-term, single estrogen stimulation of the endometrium can easily lead to excessive endometrial hyperplasia, endometrial polypoid hyperplasia, atypical endometrial hyperplasia, and even endometrial cancer.

Therefore, women entering menopause should pay more attention to changes in menstruation. So, what manifestations of menstruation can determine whether the uterus has cancer?

Figure 1 Copyright image, no permission to reprint

1. Abnormal menstruation

Perimenopause, also known as the menopausal transition period, is a high-risk period for endometrial cancer. Menstrual abnormalities during this period may be caused by endocrine factors or benign organic lesions of the uterus or endometrium. A considerable number of them are precancerous lesions of the endometrium or even endometrial cancer, so we must be highly vigilant.

So, what does normal menopausal menstruation look like? How to determine whether menstruation is abnormal?

Menopause generally occurs in women between the ages of 45 and 55. Women who enter menopause often experience anovulatory dysfunctional uterine bleeding due to decreased ovarian function, and the following changes will occur in their menstruation.

1. Cycle extension: If the menstrual cycle changes from the original 28 days to more than 30 days, or even 2 months, this is a normal phenomenon.

2. Shortened menstrual period : A menstrual period of 2 to 7 days is normal. If it exceeds 7 days, it is usually abnormal.

3. Changes in menstrual flow If the menstrual flow is small but regular, this is generally not a big problem. If the menstrual flow increases, it may be a normal phenomenon, or it may be a sign of cancer. It is best to go to the hospital for examination and diagnosis.

2. The relationship between endometrial cancer and menstruation

After women enter menopause, the sensitivity of the follicles to the follicle-stimulating hormone in the body decreases, resulting in increased levels of follicle-stimulating hormone in the body, overstimulating the follicles, and causing excessive secretion of estradiol, even higher than the normal follicular phase level.

Estrogen can stimulate the growth and thickening of the endometrium. When estrogen withdraws, withdrawal bleeding will occur, which is manifested as increased menstrual flow. Therefore, increased menstrual flow during menopause may also be a normal physiological phenomenon.

However, this endogenous estrogen accumulation will inevitably promote endometrial hyperplasia. Without the conversion of progesterone, the endometrium is likely to overproliferate and gradually transform into atypical hyperplasia and eventually become cancerous.

Figure 2 Copyright image, no permission to reprint

The relative excess of estrogen in menopausal women will promote the progression of estrogen-dependent uterine lesions. For example, for menopausal women with a history of uterine fibroids, endometrial polyps, and adenomyosis, the lesions may rapidly increase in size and progress, leading to symptoms such as increased menstrual flow, prolonged menstruation, and secondary anemia.

How to determine whether you have endometrial cancer

If menopausal women experience increased menstrual flow, prolonged menstrual periods, and frequent menstruation, they should be highly alert to the possibility of endometrial proliferative lesions. They should go to the hospital in time to consult a specialist for advice and suggestions. Through B-ultrasound, diagnostic curettage, hysteroscopy and other examination methods, a clear diagnosis should be made in time to rule out endometrial cancer.

Especially for those with high risk factors for endometrial cancer, such as obesity, hypertension, diabetes, breast cancer or family history of endometrial cancer, timely diagnosis of endometrial pathology is necessary.

Figure 3 Copyright image, no permission to reprint

Some women are still a few years away from menopause. Although their menstruation is regular now, the menstrual flow is heavy. In this case, they should also complete relevant examinations as soon as possible to rule out endometrial cancer. If menopausal women have heavy menstrual flow, they can only treat it as a benign disease after excluding atypical endometrial hyperplasia and endometrial cancer.

Conclusion

When women enter menopause, their menstruation changes. Some changes are normal, while some are abnormal. Therefore, if an abnormality occurs, it is recommended to go to the hospital as soon as possible and find a professional doctor for relevant examinations.