Menopause is the best time of our lives

In the continuation of the series ‘Sex in the City’ there was a scene in which one of the characters is ‘surprised’ by an unexpected red stain on her white trousers, because – as she says – ‘but I already stopped bleeding!’. Quite a few women recalled their slip-ups after watching the episode, but many insisted that you can’t bleed any more at this age. So what is this bleeding all about?

Menopause is not called the period when symptoms begin to appear, but the moment when menstruation stops completely as a result of the irreversible loss of follicular activity of the ovaries. Menopause is therefore the last menstrual period in a woman’s life, and one of its criteria is 12 months without bleeding.

In the peri-menopausal period, on the other hand, cycle disorders are one of the symptoms associated with the slow decline of oestrogen. And they can go in two directions: either the cycle shortens and bleeding occurs e.g. every 20 days, or it lengthens and occurs once every 40 days. No matter how long your cycle lasts, this bleeding can be more or less heavy. This can happen, but of course it does not always mean the norm.

And how is a woman supposed to recognise that this bleeding is worrying? Most women just take it as the norm that their bleeding will be slightly different.

Any bleeding that is out of the ordinary should arouse our vigilance: heavier, prolonged bleeding, spotting in the middle of the cycle, but also bleeding that has sudden breaks and recurs, e.g. five days of bleeding, then three days of break and then a recurrence of blood. All these cases always require verification. It’s better to go to a gynaecologist who will reassure you that it’s just the premenopausal period than to sleep through a developing cancer.

But that’s the way it is, a woman still thinks of her children, her husband, her parents first, and her health comes last.

This is unfortunately the case. There are even patients who can bleed for six months. And then they say in the study: ‘I thought it would just disappear by itself’.

We should remember that today we live much longer than our ancestors. If we calculate what biology has given us – that is, we enter menopause between the ages of 48 and 55 – then, with a life expectancy of 80 to 90 years, we are left with a third of our lives unprotected by hormones. It is therefore worth preparing for this time and discussing it with your doctor beforehand.

And should hormone tests be done to determine if this is already the case?

Doing hormone tests will do little if you are still menstruating, because even if it is already premenopausal period, the oestradiol will not fall much and the FSH will not rise much. The doctor therefore relies on data such as the patient’s condition, the abundance of bleeding, and the thickness of the mucous membrane instead.

And this mucosal hyperplasia is very important in terms of diagnosis.

the premenopausal period there is often overgrowth of the mucosa. It becomes thick, uneven and may develop polyps or small myomas. Such changes can be seen and must be treated. But to diagnose them, you first need to go for an ultrasound, followed by a biopsy or hysteroscopy (an endoscopic method that allows you to assess the internal condition of the uterine walls) to assess whether there is a precancerous or oncological condition. If everything is in order, you can start hormone therapy, which will stabilise the membrane. You may also consider inserting an IUD with progesterone to prevent further mucosal growth. .

When the hormones are balanced and the mucous membrane of the uterine cavity returns to normal, the patient starts to feel better and the unpleasant symptoms – including bleeding – disappear or stabilise.

However, we do not just offer hormone therapy to patients with overgrown mucous membranes. Any woman whose prolapse symptoms manifest themselves strongly – they have night sweats, difficulty concentrating, hot flashes, dizziness and headaches – should consider this form of treatment, as MHT (menopausal hormonal therapy) is by far the number one way to relieve prolapse symptoms and if started early enough, the patient will go through the process very gently.

Are abnormalities on the uterine wall the only things that can cause increased bleeding during this period?

Not just that. We have a kind of health triad.

The number one enemy by far is obesity. If we gain even a few kilos, the cancer risk increases by 20-30 per cent. And this is regardless of whether or not we use hormone replacement therapy.

Number two are stimulants. If you reach for alcohol or cigarettes, the bleeding will also increase. Unfortunately, sometimes at a certain age alcohol becomes a form of escape from the ‘imaginary end of life’ that menopause is for many women. Suddenly, we start eating unhealthy food and drinking alcohol to deal with this stress. This is a big problem and not very well publicised, and recent studies show that most 200ml bottles of vodka are bought in Poland by perimenopausal women.

Number three is lack of movement. Of course, no one is going to suddenly force anyone to play sports, but physical activity is very important.

We have not been instilled to take care of ourselves. And the modern woman needs to find this time for herself. When this happens, we often pass through this menopausal time completely unnoticed.

We fight these end-of-life myths, and they keep coming back.

Meanwhile, menopause is the best time of our lives. We no longer have to use contraception, we do not stress about an unexpected pregnancy, the monthly bleeding stops, and we usually have a good professional position and a stable home situation. And if not, perhaps this is a great time to make a change? Let’s lift the menopause’s spell.

But when bleeding still occurs sometimes, can we still get pregnant?

We can, because it’s not like we suddenly magically lose our fertility once we turn 48. In fact, there is no good test that tells us: ‘Stop, from now on you will 100% not get pregnant’. To say we are post-menopausal, the aforementioned FSH must be above 30-40 units and oestradiol must drop to below 15. But anything can happen. We are a living organism and a hormonal switch can occur in such a way that fertilisation takes place. The body can decide for itself – even in a forty-year-old woman – that it is a good time for pregnancy. Besides, we should remember that the centre of our fertility and sexuality is not the uterus at all, but the brain.

What about women who do not want or cannot use MHT?

There are many patients who cannot use this therapy. The use of MHT, for example, is severely restricted if there are numerous large myomas. For these women, lifestyle changes are particularly important. It is important that they change their diet, increase their physical activity and give up stimulants. Of course, we can also support ourselves with pharmacotherapy and preparations of plant origin. When taken regularly and over a long period of time, they also have an effect, although obviously not as spectacular as with hormone therapy. But the most important thing is still to have a positive attitude towards the menopause itself.

This attitude is very important because the taboo associated with the menopause is still firmly entrenched in society. As many as 70% of women hide menopausal symptoms at work. We started our conversation with an unexpected blurb. For many women, it is also a source of great embarrassment.

Unfortunately, we do not enter the menopause alone, but with a certain burden, because we do not know how these changes will be perceived by the environment in which we function every day.

In 2021, the British Medical Menopause Society conducted a survey of two thousand British female doctors. They were asked to answer how they felt about going through the menopause and whether they were somehow harassed during this period. As many as one third of those surveyed said that not only did they not feel supported by their peers, but they were also subjected to biting remarks! And this was a medical environment that is familiar with the topic that was surveyed.

The taboo is fortunately slowly disappearing. In my lectures I tell the very positive story of a woman who sued her employer precisely for menopausal harassment and won the employment tribunal case.

So I’ll keep reminding you – after the menopause, we are in for a really great time, we just need to learn to take care of our bodies. We should repeat to ourselves over and over again that it is not the husband, not the boss, not the house, but it is we who are most important.

Professor Violetta Skrzypulec-Plinta – Polish gynaecologist, endocrinologist, sexologist, lecturer

Author: Magdalena Keler

Zdjęcie: pexels.com

The text was published on wysokieobcasy.pl on 19 March2022