Women can stop having menstrual periods during their fertile years for many reasons, including pregnancy. However, eventually women stop having periods altogether. This is called menopause.
Let’s start by revisiting what happens during the menstruation (aka period) phase of your menstrual cycle.
Overview of the Menstrual Cycle
Your menstrual period (i.e. the 5-7 days you have your period for roughly every month) is NOT the same as your menstrual cycle.
Your menstrual cycle is the entire month-long cycle (or on average 28 days) that your body goes through to prepare for the possibility of fertilization and pregnancy. Your menstrual period is just one phase of that menstrual cycle.
Your monthly menstrual cycle can be divided into four important phases.
- Follicular Phase
- Luteal Phase
Menstruation, aka Your Period
On the first five days of your menstrual cycle, your uterus sheds the lining of the uterus from the previous month’s menstrual cycle, resulting in the menses cycle or period.
This phase starts because the egg from the previous menstrual cycle was not fertilized. You shed your uterine lining (endometrium) to start over the process of preparing for pregnancy. During menstruation (or your period) you shed that uterine lining through your vagina.
- Abdominal cramps
- Breast tenderness
- Bloating or fluid retention
- Lower back pain
- Diarrhea or constipation
- Low energy, fatigue
- Mood related symptoms
- Trouble sleeping
What Causes Periods to Stop (Temporarily)
Your menstrual cycle is a very delicate process and fluctuations in hormone levels can disrupt it. Odds are most of us have experienced a late period due to stress, or even missed periods.
Some of the factors that can disrupt your menstrual cycle and cause periods to stop can also be cause for medical concern. But that doesn’t mean you should panic. Here are some of the many things that can have an impact on your menstrual cycle, including causing periods to stop:
- Stress & anxiety
- Diet & eating disorders
- Polycystic ovary syndrome (PCOS)
- Uterine fibroids or polyps
- Birth control & other medications
When Your Periods Slow: Perimenopause
Perimenopause usually begins in a woman’s 40’s and can last anywhere between 1 and 10 years. Perimenopause means “around menopause”.
This is a transitional time for the body and refers to the time your body is making a transition from fertility to menopause, which marks the end of your reproductive years. Perimenopause is sometimes called the menopausal transition.
According to the Mayo Clinic, “You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.”
Perimenopause is characterized by hormonal changes, including irregular estrogen and progesterone levels. These changes to your hormone levels can cause many symptoms, which if severe, you might want to seek medical advice for. Among those symptoms are changes in your menstrual period.
Even as your menstrual cycle becomes less regular it is important to know that you’re still ovulating (even if it’s infrequent). As long as you’re ovulating and having periods, you can become pregnant.
If you want to avoid pregnancy, use birth control until you've entered menopause, i.e. you’ve had no periods for 12 months.
During perimenopause, some may notice changes to the menstrual period. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of hormone levels.
Symptoms of Perimenopause
In addition to changes to your periods, some of the symptoms of perimenopause include:
- Hot flashes: Hot flashes are commonly associated with menopause. According to the Mayo Clinic, “The cause of hot flashes isn't known, but it's likely related to several factors. These include changes in reproductive hormones and in your body's thermostat (hypothalamus), which becomes more sensitive to slight changes in body temperature.”
- Night sweats: Night sweats are hot flashes that occur while sleeping. They can have the added complication of disrupting sleep and causing insomnia.
- Vaginal dryness: Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying and inflammation of the vaginal walls. During perimenopause this process can begin, resulting in dryness.
- Changes in sexual desire or satisfaction: Some women report changes in sexual desire and arousal due to fluctuating hormones.
- Sleep troubles: Apart from night sweats, general sleep can become unpredictable during perimenopause and beyond.
- Bone loss: The hormone estrogen can protect your bones. With declining estrogen levels, your bone density may decrease as you start to lose bone more quickly than you replace it. For some, this can increase the risk of osteoporosis — a disease that causes fragile bones in women.
- Bladder problems: Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.
- Cardiovascular disease: Cholesterol levels can change during perimenopause creating greater risk of cardiovascular disease or CVD (especially when combined with other risk factors). According to the US Cardiology Review, “CVD is traditionally thought of as being a problem of middle-aged men, but in fact CVD affects just as many women as men – if not more – albeit on average a decade later. This delay is thought to be due to the protective effects of oestrogen that occur in the years before the menopause. As oestrogen levels drop, often from the mid-40s onwards, the protective effect is lost and changes occur that lead to an increased risk of heart disease in the ensuing years.”
Many of these continue as symptoms of menopause.
When Does Menopause Occur?
Menopause happens when your menstrual cycle comes to a complete end. Given the irregularity of perimenopausal bleeding and periods, it can be difficult to judge when you’ve reached menopause.
In medical terms, once you’ve gone 12 months without a period, your doctor will confirm you’re in menopause. Menopause usually happens between the average age of 45 and 55. Menopause that happens before the age of 40 is called premature menopause or early menopause.
At this stage, you are no longer fertile, so birth control is no longer required to prevent pregnancy.
Bleeding After Menopause Isn’t Considered Normal
If you are confirmed to be in menopause (i.e. you haven’t had a period for one year) and you experience bleeding there are a few different explanations.
While we strongly urge you to see a doctor to understand these symptoms, don’t panic. Not all explanations are serious. But you will want to have the more serious explanations ruled out quickly.
Here are some of the most common explanations:
Vaginal Atrophy (Thinning Tissue in the Vagina)
Vaginal or endometrial atrophy occurs in some women. The body produces less estrogen after menopause, which can lead to the thinning, drying and inflammation of the vaginal walls.
According to the Mayo Clinic, “Because the condition causes both vaginal and urinary symptoms, doctors use the term "genitourinary syndrome of menopause (GSM)" to describe vaginal atrophy and its accompanying symptoms.” You may also notice brown spotting or other bleeding.
Endometrial Atrophy or Endometrial Hyperplasia
The endometrium is tissue that lines your uterus. Fluctuating or irregular hormone levels during menopause can affect this tissue in two possible ways:
- Thinning of the Endometrium (Atrophy): According to the American College of Obstetricians and Gynaecologists, low estrogen levels can cause the tissue of the endometrium (or uterine lining) to thin, which can result in some bleeding.
- Thickening of the Endometrium (Hyperplasia): The uterine lining becomes thickened, most often due to increased estrogen and decreased progesterone. This condition can sometimes lead to cancer, though it may be prevented if detected early (source). Early indicators include unusual bleeding.
Polyps are usually benign, noncancerous growths in the uterus, cervical canal, or on your cervix. While they are not usually harmful, they can grow quite large, which can cause discomfort. Women with polyps can experience bleeding.
Sexually Transmitted Diseases (STIs) and other infections like Pelvic Inflammatory Disease (PID) can all be explanations of spotting.
Most infections are treatable. But infections can become more serious if ignored, so it’s worth getting routinely tested for STIs.
While exercise is essential for good all-round health, strenuous exercise after menopause can cause some bleeding (or perhaps brown spotting). Generally, this is not something to be concerned about. But if it happens for the first time, it’s good to seek reassurance from your doctor.
Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy is a form of hormone therapy used to treat symptoms of menopause, including:
- Hot flashes
- Vaginal atrophy
- Accelerated skin aging
- Vaginal dryness
- Bone loss
Side effects of HRT medications include unusual bleeding, though this is considered a less common side effect. More information about HRT can be found on the Mayo Clinic.
In addition to HRT, a side effect of other medications can include unusual bleeding. For example blood thinners may cause unusual postmenopausal spotting.
If you are on any medications you think might cause spotting, discuss this side effect with your doctor. She will help you determine if there’s any additional risk.
Cervical or Uterine Cancer
According to the Dana-Farber Cancer Institute, spotting in post-menopausal women can, in some cases, be an early sign of cancer and should always be investigated further.
“Any post-menopausal bleeding should warrant a visit to a gynecologist,” says Ursula Matulonis, MD, chief of the Division of Gynecologic Oncology at Dana-Farber Cancer Institute.
Perimenopause and menopause can be a challenging time for many women. As you approach the end of your reproductive years there may be at gamut of emotion to work through.
On top of this, there are physical changes to adjust to. If you experience symptoms that interfere with your life quality, it’s always worth seeing a doctor.
However, for the most part, it’s worth understanding that many of the menopausal symptoms and experiences are completely normal and expected at this stage of life.