Essential facts about periods & HRT
It's not called 'the curse' for nothing - periods can be painful, heavy and exhausting. But most women expect to have them regularly (unless they're pregnant or breast-feeding) from their early teens to their menopause. In the years leading up to the menopause (average age 51 in the UK) periods may get irregular and heavier - not a cause for concern but there are treatments available. But what about if you bleed when you're 'not supposed to'?
Lots of women like 'the pill' or combined hormonal contraceptive (COCP), because it gives them light, predictable, often painless periods. But it's common to bleed irregularly for your first few months on the COCP. If you miss a pill or take one late, or have severe diarrhoea or vomiting, you might also bleed. For most COCPs you can miss up to two pills without the risk of getting pregnant, while for some it's only one. Diarrhoea and vomiting can reduce the efficiency of absorbing the COCP into your system, so may make it less effective. If there's any chance you might be or could get pregnant, see your doctor.
Irregular bleeding is common with other forms of contraception, like the progestogen-only pill (as long as you haven't taken any pills late, it's nothing to worry about) and the hormone coil, Mirena® (it often settles down within a few months). Irregular bleeding with the contraceptive implant is less likely to settle - you need to decide if it's a price worth paying for reliable contraception.
Take notice of pain
Abnormal vaginal bleeding, accompanied by pain, always needs checking out. Painless bleeding between your periods or after you make love may be nothing to worry about, but better safe than sorry. It could be a sign of infection, ectopic pregnancy or something even more serious.
Bleeding between periods
Bleeding after sex or irregular bleeding between periods could be due to contraception; infection (you may have pain and discharge as well); a non-cancerous fleshy lump called a polyp on the neck of the womb; a harmless 'erosion' on the neck of the womb; or very rarely, cervical or vaginal cancer. Up to one in 50 women have 'spotting' for a day or two half way between periods. If that's all, it's nothing to worry about, but otherwise, see your doctor.
About one in 100 pregnancies develops outside the womb, usually on the Fallopian tubes that connect the ovaries with the womb. Most commonly you'll get one-sided low tummy pain and light vaginal bleeding a couple of weeks after you miss a period. Ectopic pregnancies are more common if you've had an infection or surgery on your Fallopian tubes before, if you smoke, are over 35 or have a coil for contraception. The timing and severity of symptoms vary enormously, but you need to see a doctor urgently. You'll need surgery and it won't be possible to save this baby, but you should be able to have a normal pregnancy in future.
There are three main kinds of hormone replacement therapy (HRT). Oestrogen-only HRT is reserved for women who've had a hysterectomy, because it can increase the risk of cancer if you have a womb. In the first year after the menopause, other women would need to take 'cyclical' HRT containing oestrogen and progesterone, which gives regular periods. After that, it's possible to take 'period-free' HRT, with a continuous low dose of both hormones. However, you can still get spotting and bleeding for a few months after starting this kind of HRT. It often settles, but tell your GP if it's troubling you.
Bleeding after the change
Vaginal bleeding a year or more after your periods stop - otherwise called post-menopausal bleeding, or PMB - always needs checking out. In about 90% of cases it turns out to be nothing to worry about, but it can be a sign of cancer of the endometrium (womb lining). More likely, it's due to thinning and inflammation of the lining of the womb or vagina, which is common as your oestrogen levels drop after the menopause. This can be treated with topical HRT cream or gel. It could also be due to a polyp (a non-cancerous fleshy growth) on the womb or cervix.
With thanks to 'My Weekly' magazine where this article was originally published.