As women enter menopause, ovarian function begins to decline. First, there is a progressive decline in luteal function, with follicles developing to a certain extent and then self-atrophying without ovulation. Without luteal formation, there is a decline in reproductive function. However, in the early stages of ovarian function decline, follicle-stimulating hormone (FSH) secretion increases, and luteinizing hormone levels remain normal. Due to the body's self-adjusting function, FSH can reach normal levels, resulting in ovulatory menstrual cycles. Therefore, occasionally, women who have been infertile for many years suddenly become pregnant in the perimenopausal period. With age, ovarian function transitions from instability to decline, resulting in hormonal imbalance. This often manifests as abnormal menstruation, irregular menstrual cycles, prolonged periods, and excessive bleeding. Symptoms such as premenstrual tension syndrome, cyclical breast swelling and pain, edema, and headaches disappear. Generally, there are three types of menstrual changes from ovarian function decline to menstrual cessation:
(1) Scanty menstruation
Menstrual cycles become longer, changing from the normal 20-30 days to 2-3 months or even longer between periods. The amount of menstrual flow may be normal or reduced compared to before, and the interval gradually extends to 4-5 months or half a year before menstruating once, and then completely stops.
(2) Irregular menstrual cycles
Menstrual cycles change from regular to irregular vaginal bleeding, sometimes with prolonged periods or continuous vaginal bleeding lasting for 1-2 years or even more. Heavy vaginal bleeding can also occur, leading to anemia, pale complexion, fatigue, palpitations, and shortness of breath. In severe cases, hemoglobin levels can significantly decrease. Some patients experience repeated bleeding, and after 1-2 years, menstruation completely stops. At this point, a detailed examination should be conducted to rule out bleeding caused by tumors. For women over the age of 40, a comprehensive examination or endometrial biopsy should be performed. After excluding tumors, treatment for menopausal menstrual disorders should be carried out. Menstrual cycle disorders before menopause are the most common. According to reports, among 282 premenopausal women observed, 181 showed signs of menstrual cycle disorders, accounting for 63.8%.
(3) Sudden menopause
A small number of women who previously had normal menstrual cycles and periods suddenly experience menopause. Others may have normal cycles, but their menstrual flow gradually decreases, and then menstruation suddenly stops. According to observations of 282 women who experienced natural menopause, 40 of them had sudden menopause, accounting for 14.1%. Therefore, the majority fall into the first two categories.
Another group of patients experience uterine bleeding after a period of amenorrhea, which lasts for 2-4 weeks. The amount of blood and duration are related to the duration and rate of withdrawal of estrogen.
The diagnosis of menopause can only be confirmed through retrospective review. Menstruation must be absent for at least 6 months to 1 year to establish the diagnosis.
