The word ‘menopause’ means cessation of periodic menstrual cycle in women once and for all. However while approaching menopause around the age 50 years, women generally experience irregular bleeding for months or even years till the menstrual cycle ceases for rest of the life. This period of irregular bleeding is known as ‘perimenopause.’ Menopause is said to have set in when a woman has gone without menstruation for one full year.

It is a known fact that women in there forties do not release eggs from the ovaries every month as they did when they were younger. This explains the difficulty in getting pregnancy in forties even if a woman desires for.

When women pass through perimenopause, she may not release eggs altogether or ovulation may become sporadic resulting in irregular menstrual periods that becomes more and more unpredictable with passing time.

The two hormones that are crucial for regular menstrual cycles in women are estrogen and progesterone. When ovulation stops during perimenopause, production of progesterone also stops resulting in loss of balance between the two hormones. This affects the menstrual cycle resulting erratic or no bleeding or a mid cycle bleeding in a given month. This hormonal misbalance may cause mood swing and some times behavioral problems in most women. It is here worthwhile to note that women may stop ovulation but still may experience menstrual cycle albeit erratic.

However when a woman enters menopause- do not have menstrual cycle for full one year- the perimenopausal problems disappear completely i.e. no more missed periods, shorter or longer periods, heavier or lighter periods. The mood swing problem also reasonably stabilizes.

Nevertheless irregular bleeding problems do occur in some cases even after menopause. If this happens, it may be a signal of serious health problem and a gynecologist should be consulted immediately. Similarly women experiencing menstrual cycle at age 55 or older should also seek medical attention.

In postmenopausal women there may be number causes of irregular bleeding. According to American College of Obstetricians and Gynecologists, the common causes of postmenopausal bleeding includes :-

1. Endometrial Trophy- meaning thinning of the uterus lining
2. Growth of Polyps- benign growth inside uterus
3. Endometrial Hyperplasia- meaning overgrowth of the uterus lining
4. Hormone Rebalancing- in women undergoing hormone replacement therapy
5. Endometrial Cancer – commonly called cancer of the uterus.

It is the last cause at ‘e’ above that is serious and needs exclusion by medical tests (like biopsy) or brisk treatment if proved positive by such tests.

Poor diet, life altering stresses and considerable weight loss due to dieting or otherwise may cause post menopause bleeding. It is stressed here that post menopause bleeding is not unusual and about 20% women may experience this. Menopause brings in various mental, emotional and physical changes in a woman and this may be at the root of re-start of irregular menstrual cycle even after menopause.

However there should not be any undue worry for post menopause bleeding and in any case if the bleeding occurrence is repetitive a gynecologist should be consulted to exclude cancer of the uterus or cervix and medication started.

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