Menstruating after menopause

DEAR DR. ROACH: Do women who have their ovaries and uterus ever stop ovulating?

I am 70 and have begun having menses regularly again. I do know when I ovulate, and always have. My periods did not begin to cease until I was about 57. ANSWER: Yes, women stop ovulating, and they stop having periods. The age when this process begins varies, but it’s most commonly at about 51. This is referred to as menopause (literally meaning “the cessation of menses”).

It is common for women to have irregular periods beforehand, usually with longer-than-normal periods for a while before stopping.

Women sometimes think they are finished and then get one or two more periods, but it is menopause when there have been no periods for a year.

When women have vaginal bleeding after menopause, it traditionally has been termed “dysfunctional uterine bleeding” and is a serious concern.

There are many causes, but, like most physicians, I have been taught to immediately consider uterine cancer, even though 90 per cent of the time it is something less concerning, such as bleeding from atrophy, polyps or fibroids (a type of benign tumor of the uterus).

A women’s-health specialist will perform a careful history and do a physical exam, usually with an ultrasound. Depending on the results, an endometrial biopsy may be recommended (the endometrium is the lining of the uterus).

You should go to a gynecologist or other expert in women’s health; this includes advance practice nurses and some family medicine and internal medicine doctors.

Readers may email questions to ToYourGoodHealth@med.cornell.edu