Doc: Menstruating after menopause is a serious concern
Dear Dr. Roach: Do women who have their ovaries and uterus ever stop ovulating? I am 70 and have begun having menses regularly again. I do know when I ovulate, and always have. My periods did not begin to cease until I was about 57.
Dear A.S.: Yes, women stop ovulating, and they stop having periods. The age when this process begins varies, but it’s most commonly at about 51. This is referred to as menopause (literally meaning “the cessation of menses”). It is common for women to have irregular periods beforehand, usually with longer-than-normal periods for a while before stopping. Women sometimes think they are finished and then get one or two more periods, but it is menopause when there have been no periods for a year.
When women have vaginal bleeding after menopause, it traditionally has been termed “dysfunctional uterine bleeding” and is a serious concern. There are many causes, but, like most physicians, I have been taught to immediately consider uterine cancer, even though 90 percent of the time it is something less concerning, such as bleeding from atrophy, polyps or fibroids (a type of benign tumor of the uterus).
A women’s-health specialist will perform a careful history and do a physical exam, usually with an ultrasound. Depending on the results, an endometrial biopsy may be recommended (the endometrium is the lining of the uterus). You should go to a gynecologist or other expert in women’s health; this includes advance practice nurses and some family medicine and internal medicine doctors.
Dear Dr. Roach: In a recent column on secondhand marijuana smoke, you said, “… current regulations make high-quality research on marijuana and its effects very difficult to do in this country.” What kind of regulations are these? Where does the Centers for Disease Control and Prevention stand on this issue? If the CDC lacks funding, couldn’t a university study this? I don’t understand how any reasonable medical topic cannot be studied. Can you please add some clarification?
Dear M.L.: Mostly, the regulations come from the federal government, which, in the Controlled Substances Act of 1970, categorized marijuana as a Schedule 1 drug, like heroin. Drugs in this category are considered by the U.S. government as having no accepted medical use, and thus have very tight regulations on study. Moreover, research has to be done with marijuana obtained via a federal research supplier, and news reports indicate that this is another obstacle to performing research.
I spoke with a researcher, Dr. Matt Springer, who said that changing laws at the state level “does not enable researchers at federally funded universities to study marijuana that isn’t approved by the Drug Enforcement Agency, because the universities are federal contractors by virtue of getting federal funding, and need to comply with federal regulations.”
Funding for the research is not necessarily the problem, as there are many backers for marijuana research: It’s the legal and administrative obstacles that are creating the issue. As someone who believes in the power of research and who relies on evidence (when I can) to make recommendations, I would like to see more high-quality research done, as it has become abundantly clear that it is likely that marijuana may have beneficial effects in several areas.
In the previously mentioned study on marijuana, the authors compared inhaled secondhand smoke from marijuana against inhaled secondhand smoke from tobacco, and found that blood vessels were damaged more by the marijuana than by the tobacco. The way I wrote in the column was not clear. I appreciate the note from the author of the study, and apologize for the confusion.
Email questions to ToYourGoodHealth@med.cornell.edu.