What causes bleeding and breast tenderness during menopause?

Posted on Sat, 22 Mar 2014

Question: Hi my name is XXXXXXX I am 53 years old and have been post menopausal for 4 years. Over the past month I have had some strange occurances happen and it all came to a head this week when I began bleeding on Monday. It was very light pink but no matter scared me. I went to my GYN on Tuesday where he did an endo biopsy. He said the results would take about a week maybe a little less. I have not heard yet so of course it being friday evening I know I have to wait atleast another two days before I start to wonder if he is going to call me. What I wanted to say was that about three weeks prior to my bleeding again I was diagnosed with a UTI infection. urine tests showed wbc and so I went on an antibiotic. My symptoms of the infection were frequent urination and bloating in my stomach. I also felt awful. After a few days on antibiotic I noticed a clear almost raw egg white type of vaginal discharge. I had not seen that since I was still getting my periods years before. Then I started to have sore breasts again jsut like when I would ovulate and then this continued with terrible emotional outburst another PMS symptom from my past. All of those symptoms disappeared once I began to bleed this week. My doctor said that there is no reason for my periods to have stopped for four years other then menopause however I was never tested for hormone leves to confirm it was menopause. I suppose my questions are: 1) could something other than menopause put a temporary stop to my period 2) Why would I have PMS symptoms if it was just bleeding 3) why would all of my menopause symptoms such as dry skin, vaginal dryness, low libido, hot flashes, night sweats all go away over the past couple of weeks? I am perplexed and hoping things turn out ok. I wanted to also add that I have not stopped bleeding. It went from light pink on Monday which is only on the toilet paper to a brighter red since. Over the past couple days it has begun to lighten up. I have not bled excessively and not enough to even change a pad during the day. It is merely spotting on the pad and bleeding mostly when I wipe after urinating. Sometimes there is some blood in the toilet bowel.

Answered by Dr. Cori Baill (21 hours later)

Brief Answer: unpredictable Detailed Answer: Hi, Thanks for your query. The average age of menopause is 51. There is however a great deal variation around this number. The symptoms you describe the breast tenderness etc. are called catamenial symptoms and are consistent with ovulation. It is entirely possible to ovulate after a long break. It is also possible for the hormones to fluctuate quite wildly accounting for deamatic PMS and breast tenderness, more dramatic than any other time in your reproductive life. Blood tests now would likely be normal but previously may have been consistent with menopause. The FSH can rise and fall in response to the ovarian response to stimulation. As long as you still have a few viable eggs in the ovaries, brain stimulation can still result in a period and the fall of the menopausal FSH values. Your doctor is doing the correct workout. Any abnormal bleeding after age 40 warrants an endometrial biopsy. Some bloodwork is also in order particularly thyroid and prolactin. All this will likely settle down on its own. Unfortunately there's not a predictive test to tell you whether or not this was your final period. Or if it will come again. One would expect that if the ovaries are active estrogen levels will rise accounting for the absence of symptoms such as vaginal dryness. The urinary tract infection was purely coincidental. The abnormal irregular bleeding is because the efficiency of the ovaries is less as we age. Again I think it deserves to work up but I expect it will all be normal. I hope this answers your questions and you find it reassuring. Regards,

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Cori Baill (16 hours later)

Dr. BAill, I want to tell you how reassuring your words are. My doctor did call for blood work, it was for four different things each after I looked them up all had to do with hormones. One absolutely was thyroid also. So what you are saying is that even after four years of no periods I could still have this happen. I am so relieved and I understand that there is still that awful chance that something bad can happen but it makes me feel so much better hearing your words that I can breath again. Quite honestly after experiencing the throws of menopause and now getting rid of all of the menopause symptoms I will take a monthly flow for a little while just to feel and look young again. I had no idea how great it was to not be in menopause. Well thank you so much. I wish I could tell you later how the biopsy results come out but I want you to know how much I appreciate the time you took to answser me. Best regards, XXXX

Answered by Dr. Cori Baill (5 hours later)

Brief Answer: So glad I helped Detailed Answer: If you feel so much better, after this episode settles down, which could be after a few more months of cycles, or in a few days, depending if the ovaries respond to the brain's prodding again, you might want to consider hormone replacement. There is little downside to five years or so of therapy, and a few women need lifelong replacement to feel well. Quality of life matters, and risks have been greatly overplayed in the media. As a nurse, you know how that goes. Be well. Ask for me if I can assist you further.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Cori Baill (5 hours later)

Dr. Baill, Thank you again for your response. I am not a nurse. I apologize if I made you think I was. I am just a women, mom, patient that worries...alot! Thank you for your take on HRT. I have heard that it does work wonders. You are right about the side effects that are overplayed in the media and yes they are what have frightened me. However you are right after this I will be discussing with my doctor. Thanks again. XXXX

Answered by Dr. Cori Baill (3 hours later)

Brief Answer: You are very welcome Detailed Answer: Hi, Don't be afraid of all the media hype. Regards,

Above answer was peer-reviewed by : Dr. Raju A.T