Tips and Hints | Web Resources | "Will I Bleed Forever?" (other case histories)

This rant is under construction, and will be updated as I move through perimenopause.

I started having heavy periods and, more annoyingly, prolonged spotting/bleeding in the early 1990s. My old reliable gynecologist says, we can fix that, and for two hundred bucks he cauterizes my cervix with an electrosurgery apparatus right in his office. For two or three years the bleeding is lighter and the spotting stops.

Alas, he retires. I have to search for a new gynecologist at the same time the bleeding starts up again. (*Snarl.*) Here are the highlights, as I remember them:

• June-August 1996: new gynecologist (a young and fuzzy thing, maybe in his mid-30s) puts me on Provera for 12 days. That dries me right up, so well that I stop bleeding and have some hot flashes. Young and Fuzzy says, you're in menopause. He puts me on Premphase for my heart and bones (see rant).

• August-November 1996: twelve hours after taking my first estrogen tablet, I start to bleed. I continue to bleed, more or less, nonstop, through September and October. Sometimes it's run-down-your-legs-heavy, sometimes it's light. Sometimes there are clots the size of chicken livers. We tinker with the meds. In November I say enough already and stop taking them. I also start a bleeding log in November so that I can remember how much fun it's been.

• December 1996. Young and Fuzzy calls to tell me the next step will be an endometrial ablation (scraping off the uterine lining, a $XXXX procedure) and, p.s., he's moving to Baltimore.

• December 1996-May 1997. I make an appointment with another gynecologist in the same practice. I say I want to try less invasive, less expensive alternatives if there are any. He agrees. I go on 20 mg/day of Provera for some weeks (I think it was three), then drop back to 10/mg for a further several weeks, then to 5 mg. It's working; the bleeding, although still more or less spontaneous, is considerably lighter and shorter-duration overall. New guy gets transferred to the suburbs.

• June 1997. I'm tired of the revolving door at this practice, try an older gynecologist with an established single practice chosen from among the list provided by my internist. Since I was so happy with my original gynecologist, I think I may do better with someone less young and fuzzy. Well...

  Old Established listens with great impatience to my tale of gradual improvement on the Provera. I need a pelvic ultrasound, he announces, followed by a D&C. Somehow I wheedle a new prescription for Provera from him. I ask him how much this all will cost. He has no idea, he says grandly. So I ask the Office Ladies how much this ultrasound/D&C will cost: they make phone calls to the hospital and tell me $6,500. I fill the prescription and fire the gynecologist. My internist, hearing the story, says if I don't feel like shopping for another gynecologist for awhile he can do my Pap smears and write prescriptions for Provera. (Update: Of course, my internist retires in September 1998, at the ripe old age of 51. Sigh...)

• July-December 1997. I cut my own dosage back, to 2.5mg/day some time in the fall, and then right after Christmas I chuck the pills.

• January-August 1998. My periods aren't as heavy and they're more widely spaced. Sometimes I skip one entirely; other times they're 45 days apart; no more of this 10 day period every 20 days stuff. The last one I had was only four days long.

• (Full disclosure postscript: my weight has crept up about 15 lb during the summer vacation and some enforced couch-potatohood in fall 1998. My periods, while much more manageable than before, are creeping closer together and lasting longer. When I'm able to exercise again I'll post an update if appropriate. Jan. 1999 -- I lost 15 pounds but probably regained most of it during the holidays. Still, my last period, a mere 4-day event, started October 23. I'm keeping my fingers crossed. -- Update April 22, 1999 -- I had a six-day period in mid-March, and am now a week "late," so I am hoping for another several-month hiatus. I also gained back all my weight over the holidays and am still not bicycling enough to lose any.)

The scary thing about all this bleeding is that it's coming from someplace you can't see. You've been told all through your reproductive life that bleeding is a sign that something is seriously wrong. Anything you've read about menopause and "menstrual irregularities," unless you've read something very graphic, simply won't prepare you for the emotional impact of all that blood. If you're like me, a small terrified voice inside your head is screaming that you're rotting away inside -- you have incurable cancer and you're going to die. The odds are overwhelmingly that it's plain old perimenopause, but that doesn't mean much to that small terrified voice inside your head.

It's also a huge nuisance -- what a bother to have to think about changing pads once an hour or more, what an embarrassment to have serious leakage when you're standing up in front of a room full of people, what a drain on your physical body and your coping skills. For some of us, surgery will be necessary. But the heartening message I have to share is that for quite a few of us it's a passage that can be survived with less intrusive measures.

Exuberant bleeding is one of perimenopause's scariest symptoms. It's occasionally the sign that something is seriously amiss -- something that may require surgery, like cancer, intransigient fibroids, endometriosis, or Horrible Mystery Bleeds. More commonly, though, it's nothing more than garden-variety perimenopausal flooding, caused by your hormones acting up or perhaps by being a bit overweight, and it can be managed with less invasive measures. You can start with some simple lifestyle changes such as weight loss and food choices and move along the spectrum with hormones, D&C or endometrial ablation, or other relatively minor surgical procedures that stop short of hysterectomy.

In many cases, the bleeding may scare us to death but otherwise is not immediately life-threatening. For those of us who fall into that category, we have the luxury of seeking a second opinion or trying out the simpler treatments first. A relatively inexpensive test called an endometrial biopsy can rule out the possibility that malignancy is causing the bleeding. This test requires a little cervical dilation, which some folks find intensely painful; I found it uncomfortable (but not quite painful and certainly not unbearable) for about 30 seconds, and I had some wimpy crampy-thingies and a little spotting thereafter. If your cervix complains a lot about being dilated, consider asking for a muscle relaxant to take an hour beforehand.

Here's a collection of links to bleeding related issues (scroll up or down for other menopause-related issues):

https://members.tripod.com/menopause/index.html#bleeding

Several relatively simple lifestyle changes help many of us to avoid (or at least minimize) the Great Flood. Among them include avoiding the following while bleeding even a teeny bit:

• aspirin
• alcohol (bad!bad!bad!)
• soy products
• vigorous exercise

My personal experience was that any and all of these could take an existing bleed and turn it into The Red Tide. When I'm not bleeding -- or now that I seem to be out of the Flood Zone -- they don't bother me. (Alcohol was especially spectacular -- when I was bleeding or spotting, one lousy glass of something nice showed up as a flood within an hour. Now that my "periods" are few and far between, alcohol doesn't seem to make any difference.)

Stress makes a bad bleed worse. Ibuprofen helps tame a bad bleed -- so stock up on Advil or its generic or non-U.S. equivalent. Buying sanitary supplies in bulk and squirreling them everywhere helps counteract that sinking feeling of being out of Tampax. Naps are highly recommended, as many and as long as you can get away with. One of those good-sized incontinence bed pads buys nocturnal peace of mind, as does a waterproof mattress cover. I used to keep a wet washcloth (dark colored) in a baggie beside the bed for emergency mop-ups, too. I found that Spray n Wash gel was great for getting out bloodstains, even yucky dried-on ones. Smooth the applicator on the stain, toss the garment in the hamper, launder up to one week later. Another poster recommends soaking in ammonia.

Making a large bloody mess in front of one's significant other breeds a healthy respect for your predicament, and I highly recommend it, at least once. Why should you have all the fun?

If you're bleeding a lot and have that run-down feeling, think about eating lots of nice rare red meat, especially liver. (Click here for Joanna's absolutely fabulous liver casserole recipe.) If the mere thought makes you gag, look at other iron rich foods (I think there's a list on Tishy's web site) or even supplements. Now's a good time to pay particular attention to your nutrition generally -- heavy bleeding takes a lot out of you. In your nonbleeding phases, try to get some exercise.

Take care of yourself as much as you can, and don't be shy about asking those who live with you to take care of you a little. (If they resist, just bleed on them. They'll get the hint.)

Laura's bleeding rant
Updated April 22, 1999

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