Do you think you’re having a period even though you recently completed menopause? Or is it more likely that this means cancer somewhere in the reproductive tract?
Many women want to know if a woman after menopause can suddenly have a period, and this question almost always pertains to those who’ve completed menopause fairly recently.
Dr. Karen Patrusky, a board certified OBGYN and F.A.C.O.G. in private practice for 20+ years, says that some women experience an ultimate ovarian surge.
Dr. Patrusky will be explaining that in-depth in a moment.
But first, here is what my gynecological nurse stated, when I began experiencing what felt exactly like PMS aches and cramps about three months after completing menopause:
“It’s certainly possible it’s related to hormone fluctuation. Menopause is not a linear thing.
“I can count on one hand the number of patients who’ve had that [a period after menopause], producing enough of a hormone to have a cycle here and there.”
At the time I was speaking with her, I had not had any spotting, let alone flowing.
I asked: “Could this be a phantom period from a resurgence of hormones since the 12-month rule for menopause isn’t cut in stone?”
She replied, “I have had [in her patients] documented high FSH level and had period, and FSH level came down to 30.
“For some reason their ovaries kicked in and started ovulating again. It’s not common but it happens. Ovaries kick in. I’ve seen it.”
The Last Hurrah
You may have read somewhere that it’s NOT possible to menstruate one more time after the menopausal process is complete.
My OBGYN nurse also explained:
“You are correct there are varying kind of ranges for FSH level. It’s a little tricky; it’s not a be-all end-all.
“It’s kind of used as a guide. If I have someone who’s in their 30s and 40s, they can be in the menopausal range, but I wouldn’t be comfortable telling them to stop birth control [if they didn’t want to get pregnant].
“It’s [FSH] one of those things I don’t use as a be-all end-all. It’s a guide.
“I have seen patients who are very high [FSH], and for whatever reason they start menstruating again. Their ovaries have kicked back in.”
No Bleeding, but Aches and Cramps
What feels like uterine cramping, PMS joint aches and abdominal bloating may be from fluctuating hormones at levels that are not high enough to cause menstruation (shedding of the uterine wall that leads to bleeding).
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In my case, the abdominal cramping and other aches ultimately turned out to be from a flareup of microscopic colitis (a few weeks later the diarrhea came with a vengeance).
But for other women, there really CAN be an ultimage ovarian surge.
Bleeding Soon After Menopause Is Over
“Any vaginal bleeding after this is defined as postmenopausal bleeding and should be evaluated,” says Dr. Patrusky.
“Every once in a while, a woman can have a bleed shortly after this point, and it can be determined to be due to a response to an ultimate ovarian surge.”
In menstruation, “The pituitary gland triggers the ovary to respond with a release of hormones, estrogen and progesterone, and if pregnancy does not ensue, then the drop in these hormones results in the shedding of her uterine lining, menstruation, and the cycle then repeats,” explains Dr. Patrusky.
“As a woman becomes perimenopausal, the pituitary gland has to release a lot more of its hormones in order to generate a response from the ovaries.
“And then, once she is menopausal (missing 12 consecutive periods), then any bleeding thereafter is considered postmenopausal bleeding and should be evaluated.”
Cancer and precancerous lesions can cause bleeding after menopause, though it’s more likely that the blood is from a benign condition (e.g., vaginal or urethral atrophy, cervical polyp, even a hemorrhoid).
“Every once in a while, in the short-term after a woman is defined as menopausal, the pituitary gland is able to generate an ovarian response — the last hurrah so to speak — and that is ultimately reflected in a bleed.
“Although this is considered postmenopausal bleeding — and therefore should be investigated if it’s the ultimate ovarian response as the etiology of the bleed — then it will be realized to be non-pathologic.”
So don’t assume that what seems like a postmenopausal period is an ovary’s last hurrah.
It could be, yes, but it’s much more likely something else – including a cancer anywhere in the reproductive tract.
See your gynecologist for a workup.
“This is done by a pelvic exam and sonogram,” says Dr. Patrusky.
“If there is any thickening of the uterine lining, a biopsy may be necessary.”
