Postmenopausal bleeding

Postmenopausal bleeding is bleeding that occurs after menopause. menopause is a stage in a woman’s life (around age 45 and above) when reproductive hormones drop and her monthly menstrual periods stop. Vaginal bleeding that occurs more than a year after a woman’s last period isn’t normal. The bleeding can be light (spotting) or heavy.

Whether it’s light spotting or a heavier flow, vaginal bleeding after menopause can signal potential health problems.

“It should always be brought up with your provider,” said GINA . M, a gynecologic oncologist at Fox Chase Cancer Center. And the sooner, the better. Rather than waiting for your next planned checkup, give your gynecologist a call quickly to schedule an evaluation.

No matter your exact symptoms, you’ll want to get in touch with your ob-gyn right away if this happens to you.

Any evaluation should start with a detailed conversation, either in person or via telephone(a phone call or video chat). Your ob-gyn should ask questions such as:

• When did you go through menopause? The longer it’s been, the greater cause for concern and the more testing we might need to do.
• Are you taking any new medications? Some drugs, such as blood thinners and some mental health medications, can have vaginal bleeding as a side effect.
• What else is going on with your health? Other medical conditions could be relevant.

Causes of postmenopausal bleeding

A number of conditions could cause postmenopausal bleeding such as;

• Endometrial or Vaginal atrophy (thinning of the uterine lining):   The endometrium is the tissue that lines your uterus. It responds to hormones like estrogen and progesterone. When the hormone estrogen stops being produced due to menopause, a woman’s endometrial lining may start to become thinner. As a result, the lining of the endometrium may be more likely to bleed.
• Polyps : These tissue growths show up inside your uterus or cervical canal, or on your cervix. They’re usually not cancer, but they can cause spotting, heavy bleeding, or bleeding after sex.
• Endometrial hyperplasia : This condition causes the uterine lining to become thicker instead of thinner, giving rise to heavy or irregular bleeding. The cause of this condition is most commonly excess estrogen without the hormone progestrone to offset it. Endometrial hyperplasia can sometimes lead to the development of endometrial cancer.
• Endometrial cancer: This is cancer of the endometrial lining. An estimated 10 percentof postmenopausal women with uterine bleeding experience the bleeding due to endometrial cancer.
• Sexually transmitted diseases (STD) : Some sexually transmitted disease can cause bleeding such infections like chlamydia, gonorrheamay cause spotting and bleeding after sex. Also herpes can cause bleeding
• Medications :Hormone medications, such as tamoxifen, may also cause postmenopausal bleeding as a side effect. Many women will experience breakthrough bleeding as a result of taking hormone Replacement therapy in the first 6 months.

Other potential, but less likely, causes of postmenopausal bleeding include:

• clotting problems
• trauma to the pelvis
• bleeding from the urinary tract
• thyroid disorders

READ ALSO : WHAT CAUSES HEAVY BLEEDING

Diagnosis

A doctor will start an exam for postmenopausal bleeding by asking the woman about the symptoms she may be experiencing. A doctor will likely ask:

• when she first noticed her symptoms
• how much she bleeds
• if she has any family history of postmenopausal bleeding

Depending upon a woman’s symptoms, a doctor may recommend one or more of a number of tests.

1. Transvaginal ultrasound: This procedure involves inserting a special ultrasound probe into the vagina to allow a doctor to visualize the uterus from the bottom of the uterus, instead of from the lower abdomen.This image helps your doctor check for growths and look at the thickness of your endometrium.
2. Endometrial biopsy: The doctor uses a thin tube to take a small sample of the tissue that lines your uterus. They’ll send it to a lab where scientists will look for anything unusual, like an infection or cancerous cells.
3. Dilation and curettage (D&C):During this procedure, the doctor dilates your cervix. They use a thin tool to scrape or suck a sample of the uterus lining. They send this to a lab that will check for polyps, cancer, or a thickening of the uterine lining (endometrial hyperplasia).Ultrasound and biopsy are usually done in your doctor’s office. Hysteroscopy and D&C require anesthesia on one part of or your whole body. You’ll either go to a hospital or an outpatient surgical center.
4. Hysteroscopy:This procedure involves a doctor inserting a tool with a thin, lighted camera on the end to examine the inside of the uterus and its lining. The approach can help a doctor to identify polyps or abnormal growths.
5. Sonohysterography: This procedure involves injecting fluid through the vagina and into the uterus. A doctor will then use an ultrasound machine – which uses sound waves to identify differences in tissues – to visualize the uterus. This is known as a transabdominal ultrasound. The process can allow a doctor to determine whether the uterine lining is thicker or thinner than expected.

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Treatment

Treatments for postmenopausal bleeding often depend upon the underlying cause associated with the bleeding.

A doctor can consider the information gathered from the testing to work out the best course of treatment.

Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments.

Medication:

• Antibiotics : can treat most infections of the cervix or uterus.
• Estrogen : may help bleeding due to vaginal dryness. You can apply estrogen directly to your vagina as a cream, ring or insertable tablet. Systemic estrogen therapy may come as a pill or patch. When estrogen therapy is systemic, it means the hormone travels throughout the body.
• Progestin : is a synthetic form of the hormone progesterone. It can treat endometrial hyperplasia by triggering the uterus to shed its lining. You may receive progestin as a pill, shot, cream or intrauterine device (IUD).

Surgery: 

• Endometrial cancer: Often, the treatment for endometrial cancer is to remove the uterus as well as any nearby lymph nodes to which the cancer could have spread. This procedure is known as a hysterectomy. Depending upon the cancer’s spread, a woman may also need to undergo chemotherapy and radiation treatments.
• Endometrial hyperplasia: Women who have this condition may take medications known as progestins, which can help to prevent the endometrial lining from becoming too thick. However, a doctor may recommend regular testing for cancerous cells inside the uterus to ensure that they do not have endometrial cancer.
• D&C (dilation and curettage): In this surgery, the doctor opens your cervix. (You may hear them say they are going to dilate it). They use a thin tool to remove polyps or thickened areas of the uterine lining caused by endometrial hyperplasia.

Outlook

An estimated 5 to 10 of women experience vaginal bleeding after they go through menopause.

While women can expect to experience some irregular bleeding before they go through menopause – during a time period known as perimenopause – bleeding is not the norm afterward.

Although bleeding after menopause is not always cause for concern, a woman should always consult her doctor if she does have postmenopausal bleeding to rule out more serious causes, such as endometrial cancer.

Many postmenopausal bleeding diagnostic methods do not have to be invasive and can be done at a doctor’s office.