Menopausal Bleeding

I have been bleeding for about 4 weeks now.  Sometimes toooo heavy.  I had a biospy of the uterus wall came back normal.  I am to go for an ultra sound next week.  I was put on protersrone (?) but was getting migraines so I stopped taking it.  I was then put on the pill , one week now, and I have also gotten a migraine.  I am still taking it because I need the bleeding to stop.  I don't wan to get anemic. I am 54 and believe I am starting menopause.  Is the bleeding this long normal? What are some ways of stopping the bleeding.
Thank you,
I am getting worried.

[Keith Downing, MD]

Hello,

The proper work up for irregular bleeding in a woman who is thought to be perimenopausal (menopause being defined as the absence of menstruation for 12 months) would include ruling out pregnancy, checking for an endocrine abnormality (e.g., thyroid hormone changes), assessing for structural lesions within the uterus (like endometrial polyps/fibroids usually by office hysteroscopy--i.e., looking inside the uterus with a small camera--or sonohysterogram--instilling saline into the uterus while simultaneously performing an ultrasound), considering anovulation (not ovulating monthly reflective of perimenopause) and performing an endometrial biopsy to look for abnormal tissue inside the uterus (e.g., endometrial hyperplasia or cancer).  With those results proper treatment can be instituted.  

It seems like the underlying cause of your bleeding has yest to be definitively determined.  However, If hormonal therapy is failing, a dilation and curettage can ameliorate the bleeding.  Long-term therapies may include endometrial ablation or hysterectomy.

Best regards,

Dr. Downing