Bleeding Patterns and the Menopause Transition

April 16, 2014

Prolonged bleeding as women transition into menopause is common. Although disconcerting, these changes generally require nothing more than watchful waiting.

Educating women about the changes in bleeding patterns as they transition into menopause is important, researchers suggested after finding that it is common for women to bleed for 10 or more days.

"For most women in their 30s, menstrual periods are highly predictable. With the onset of the menopausal transition in their 40s, women's menstrual periods can change dramatically. These dramatic changes can be disconcerting and often provoke questions about whether something is wrong," said Sioban Harlow, a researcher and professor of epidemiology at the University of Michigan, in a news release. "Women need more descriptive information about the bleeding changes they can expect. We need clear guidance to help women understand what changes in bleeding patterns do and do not require medical attention." 

Pertinent Points

- Most women aged 42 to 52 years experience bleeding lasting 10 days or longer as they transitioned into menopause.

- Prolonged spotting and heavy bleeding are also common as women transition into menopause.

- More study is needed, but this new information could be helpful in educating and reassuring patients as they enter into menopause.

Spotting for six or more days, heavy bleeding for three or more days, and prolonged bleeding were all found to be common among women going through the menopausal transition, Harlow and colleagues reported in BJOG: An International Journal of Obstetrics and Gynaecology.

Of the 1,320 women between the ages of 42 and 52 who were included in the study, 91% had between one and three occurrences of bleeding that lasted 10 days or more, the authors reported. In addition, nearly 88% of the women reported six or more days of spotting, and nearly 78% of the women said they experienced three or more days of heavy bleeding, according to the study results. These occurrences of prolonged bleeding happened within a three-year period as the women were entering menopause. However, more than a quarter of the women had as many as three episodes of prolonged bleeding occur within a six-month period.

Harlow and colleagues suggested that the data could help clinicians in advising and reassuring patients as they enter menopause, noting this stage can last anywhere from two to 10 years.

The long-term study was based on data collected from the Study of Women's Health Across the Nation (SWAN), which had participants from southeast Michigan, Los Angeles, and northern California record their experiences over a period from 1996 to 2006. Researchers reported that they included women who identified themselves as African American, Japanese, Chinese, and white.

While the researchers note a few racial and ethnic differences, they found the results were true for all women. Still, other health factors, such as uterine fibroids, use of hormones, and body mass index, had an impact on the results.

"This finding calls for further clinical research to determine the optimal diagnostic and therapeutic approaches for evaluating alterations in bleeding during the midlife,” said John Randolph, Jr, MD, a University of Michigan professor of obstetrics and gynecology and one of the authors, in a news release. “It forms the basis from which appropriate clinical trials can be designed, and may be reassuring to some clinicians at the initial presentation of any of these patterns that watchful waiting is an acceptable option."