Menopause—Period. by Dr. Pamela Dee^

Dr. Pamela Dee, OB/GYN, is a paid spokesperson for Estroven®. The information provided herein is for educational purposes only and is not intended to be construed as medical advice or to replace professional medical care. You should always seek the advice of a medical professional before starting any new medication or dietary supplement. The opinions stated herein are those solely of the writer and do not portray the opinions of the Estroven®brand, i- Health, Inc., or DSM.

Dr. Pamela Dee^ (Dr. Pam) is America’s leading menopause expert & OB/GYN, and she is on a mission to encourage honest dialogue about the physical and emotional symptoms that accompany menopause. Her goal is to de-stigmatize menopause and start the “Menopause Romance Revolution.” Her film, LOVE, SWEAT & TEARS, shares an empowering message of hope and action. Dr. Pam^ won’t rest until every woman knows the truth about menopause, that there is hope and that the third part of a woman’s life can be the best and most romantic.

A woman is officially “menopausal” when she has not had a menstrual period for 12 months. From this point on, she should consider vaginal bleeding an abnormality, one that necessitates a trip to the doctor. First and foremost, it’s vital that a woman’s healthcare provider screens for cancer in the vagina, cervix, uterus, fallopian tubes or ovaries to determine if the bleeding is symptomatic of a larger issue. Once that determination has been made, there are many options to treat this bleeding.

1. Oral Contraceptive Pills

One option for bleeding during menopause is to take oral contraceptive pills (OCPs, or birth control pills). If there are no contraindications, a woman may take birth control until her mid-50s. If they are taken continuously (meaning that the placebo pills are skipped), a woman may go many months without having a withdrawal bleed. While the risk of blood clots forming from birth control pills increases as a woman gets older,1 the pills used now are available in extremely small doses.

2. Progesterone Intrauterine Device

Not only is a progesterone intrauterine device (IUD) less expensive than birth control pills in the long run (over five years), the risk factor for blood clots is lower than with OCPs.1 The use of a progesterone IUD for abnormal uterine bleeding is considered an off-label use by the FDA, so as always, it is very important that a woman speak with her doctor before considering this option.

3. Endometrial Ablation

Endometrial ablation is a minor surgical procedure that works wonderfully in the menopausal age group. I personally prefer a woman to be 40 years of age or above to do an ablation. The procedure involves destroying the endometrium (the lining of the inside of the uterus), which usually reduces or prevents uterine bleeding. The body has a unique ability to heal, and sometimes the uterus “heals” and starts bleeding again. In my experience, the older the patient is, the less likely that she will start bleeding again.

4. Hysterectomy

Some women come in to my office requesting a hysterectomy. This could be an appropriate option if her uterus is full of benign fibroid tumors or if other methods have failed, but generally if a woman experiences bothersome peri-menopausal bleeding, she should explore conservative treatment options first: OCPs, progesterone IUD or ablation. A hysterectomy is major surgery with increased chances of risk, such as a bowel injury, blood loss or a bad infection. It is best to consider the aforementioned options before resorting to something serious. A woman should always consult with her healthcare provider about the available options best suited to her unique needs.

^Dr. Pamela Dee is a paid spokeswoman for Estroven®.