Question

I am 58 years old and I still get an occasional period. I have never had the symptoms of menopause. Recently I had two periods 29 days apart. For the last 7 years I have only had a period once every 3-5 months and then they were mostly very light. I must add that I am overweight, but I've been losing weight nicely on a diet. What can be done?

Answer

In the situation of a woman still having menstrual bleeding into the late 50s, a useful test would be a blood test for the amount of FSH, which stands for follicle stimulating hormone. This is a hormone produced in the pituitary gland, and is an indicator of whether one is actually in menopause. The results of this test would be useful in a situation like yours, because then the physician can get an idea of whether your bleeding is considered post menopausal bleeding or not. The approaches and treatments are different if one is felt to have post-menopausal bleeding, versus bleeding that is occurring in a woman who still has ovaries that are functioning.

In addition, you should discuss with your own gynecologist an endometrial biopsy, a sampling of the uterine lining, to rule out cancer or hyperplasia. The bleeding may certainly be from something harmless, but it would be a consideration to at least rule out a potentially serious cause.

Adipose, or fat, cells produce estrogen. This could stimulate the uterine lining, which could then bleed. Your weight problem might have contributed, therefore. An endometrial biopsy would be helpful in determining if this is the case as well.

As far as management of the bleeding, that would depend on the above test results; it could often be managed with hormone therapy; exactly what would be given would depend on the results of your evaluation. Please discuss this with your personal physician.