Abnormal Bleeding

Kelly Anne Spratt, D.O., Director of Women's Cardiovascular Health at the University of Pennsylvania Presbyterian Medical Center, answers your questions.

Q. I am nearly 41 years old, and I have been experiencing vaginal bleeding (sometimes heavily and sometimes not) for approximately 6 weeks. I called my ob-gyn nurse and she told me that if I had had an irregular ovulation that I would bleed abnormally until my system got back on track. I have been the most regular person I know since I first started my periods! The first appointment that I could get is still a few weeks off, and I wondered if I should be more concerned about my situation.

A. I am glad that you will soon be seeing your doctor and that you realized that it is important to report any unusual bleeding to your doctor at once. There are many reasons why women have abnormal or heavy bleeding, especially as women approach their 40s and may begin to be perimenopausal -- which is the most likely cause of your new irregularity. Perimenopause is the transition stage leading up to menopause (when your periods stop altogether) and can last a few years.

The perimenopause is characterized by many changes, including erratic, sometimes heavy, vaginal bleeding or months of no bleeding -- think of it as puberty in reverse with all the irregularity that most women experience, even if you did not. Given the abnormal bleeding, your doctor will perform a complete exam and may do tests such as an ultrasound of your endometrium or blood tests to check levels of your hormones. Keep the appointment and do not worry until then.