Perimenopausal Bleeding: When Do I Worry
Women in their forties often experience changes in the amount and/or frequency of their menstrual flow. This can affect lifestyle by causing fatigue and limiting activity. Some women must remain confined to home or at least within immediate proximity to a bathroom for days at a time. A womans mother or aunt may have had a hysterectomy for similar bleedingraising concerns that surgery might also be in her future. We are often asked, When do I get concerned?
In general, menstrual cycles tend to shorten as menopause approaches. This is a slow process occurring over the course of several years. They usually stay regular during this transitionevery 23 or 24 days versus every 28-30 days previously. As the ovaries age and become less efficient, ovulation occurs less frequently. This is reflected in the menstrual cycle as a more pronounced irregularity for example, cycles that will vary from 14-40 days or more in length. These patterns are generally hormonal and therefore benign.
Here Are The Most Common Causes Of Postmenopausal Bleeding:
Polyps These are growths, usually noncancerous, that can develop in the uterus, on the cervix, or inside the cervical canal. They might cause bleeding.
Endometrial atrophy The endometrium, the tissue that lines the uterus, can become very thin after menopause because of lower estrogen levels. This may cause unexpected bleeding.
Endometrial hyperplasia In this condition, the lining of the uterus becomes thick, and bleeding may occur as a result. Obesity may be the cause of the problem. Some people with endometrial hyperplasia may have abnormal cells that can lead to endometrial cancer .
Endometrial cancer Bleeding after menopause can be a sign of endometrial cancer.
Other causes Hormone therapy, infection of the uterus or cervix, use of certain medications such as blood thinners, and other types of cancer can cause postmenopausal bleeding.
How Do I Manage Bleeding After Menopause
Your doctor will want to do some investigations to find the cause of your bleeding. Let them know if you have noticed any changes going to the toilet, whether you have pain, have lost weight or whether you are on HRT. You may also want to check whether you need a cervical screening test.
Some women may need to have an ultrasound, blood test or may be referred to a gynaecologist for further tests.
Treatment will depend on what is causing the bleeding. It may involve medicines to control problems with the lining of the uterus, or surgery to remove polyps.
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Q: What Causes Ovarian Cysts
A: The most common causes include:
- Hormones. Drugs that help with ovulation can cause cysts. Hormonal problems can trigger them too. Most hormone-related cysts go away on their own.
- Pregnancy. A cyst usually develops early in pregnancy. Its there to help support the pregnancy before the placenta forms.
- Endometriosis. Women with this condition can develop cysts called endometriomas. This type of cyst can cause pain during menstruation and sex.
- Severe pelvic infection. Cysts can form when infections spread to the ovaries and fallopian tubes.
Do I Still Need A Pap Smear Now That I Am Menopausal
Even if you are menopausal or postmenopausal, you should continue to have Pap or HPV tests. Women who have had a total hysterectomy for a noncancerous condition and have not had a previous history of precancerous Pap tests may be able to stop Pap screening depending on their medical history and risk of contracting human papilloma virus . Screening may also be discontinued at ages 65 or 70 if women have had at least three normal Pap tests in a row and no abnormal Pap tests in the previous 10 years.
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Postmenopausal Bleeding Is Never Normal
Whether its 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. Mantia-Smaldone, MD, 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.
Why Am I Still Spotting After My Period Ends
Continuous bleeding after a period can be caused by a many things. Most commonly, an abnormally long period may have no discernible cause. If it does not recur, it may require no further investigation. Continuous spotting may be a sign of a disorder in coagulation caused by either medication or a genetic disorder. It may also be a sign of infection of the vagina or cervix.
Bleeding After Menopause: Its Not Normal
Too often I see women with advanced endometrial cancer who tell me they experienced postmenopausal bleeding for years but didnt think anything of it. This shows we need to do a better job educating our patients about what to expect after menopause.
Women need to know postmenopausal bleeding is never normal, and it may be an early symptom of endometrial cancer. Any bleeding, even spotting, should trigger a visit to your doctor as soon as possible. Dont wait to make an appointment until after the holidays or even next week. Do it today.
Living With Abnormal Uterine Bleeding
Abnormal uterine bleeding can impact your life in a negative way. Not being able to predict when bleeding will begin can cause you to be anxious all the time. Also, heavy menstrual bleeding may limit your daily activities during your period. For some women, it even prevents them from leaving the house.
If you have heavy menstrual bleeding, try taking ibuprofen during your period . Ibuprofen is a nonsteroidal anti-inflammatory drug . NSAIDs can work to reduce the bleeding during your period.
You also should make sure that you are getting enough iron in your diet. Your doctor may prescribe an iron supplement to ensure that you dont become anemic.
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Why You Shouldnt Ignore Postmenopausal Bleeding
A woman is considered to be in menopause after 12 consecutive months without a period. You may experience irregular bleeding leading up to menopause, a stage known as perimenopause. But once youre in menopause, all vaginal bleeding should stop.There are benign causes of postmenopausal bleeding. For 10 percent of women, however, the cause is endometrial cancer.Early diagnosis offers the best chance to beat endometrial cancer. I urge women to treat postmenopausal bleeding as cancer until proven to be something else. I dont say this to scare people, but a healthy amount of worry in this situation is warranted.
Should You Be Worried About Postmenopausal Bleeding
You’ve endured the hot flushes and the mood swings. You’ve survived the heavy, irregular bleeding. Once you come out the other side, maybe the menopause isn’t so bad – after all, you don’t have to put up with periods every month. But then you start bleeding again, and you’re not sure if it’s normal.
Reviewed byDr Hayley Willacy
17-Apr-18·3 mins read
Sound familiar? If it does, you’re in good company. Bleeding after the menopause is remarkably common, and accounts for 1 in 20 of all referrals to gynaecologists.
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Causes Of Uterine Fibroids Appearance
Currently, scientists are forced to admit defeat the causes of myomatous nodes are unknown. There are two main theories, but none of them has strong evidence:
- Embryonic theory suggests that abnormalities occur during fetal development. The smooth muscle cells of the uterus of the embryo do not finish their development for a long time, until the 38th week of pregnancy, and are in an unstable state , due to which there is a higher risk occurrence of defects in them.
- Based on the traumatic theory, a defect in the cells of the myometrium occurs due to repeatedly repeated menstrual cycles, inflammatory processes, abortions, curettage of the uterus, the inaccurate performance of obstetric manual methods during childbirth, and a small number of pregnancies.
The uterine fibroids after menopause nods always arise from a single cell. Due to damage, this cell begins to divide and forms a node.
Uterine fibroids are a disease that no woman is safe. Since the causes of the occurrence are unknown, effective methods of prevention do not exist, except for regular visits to the gynecologist twice a year. The doctor may pay attention to nonspecific signs and schedule an examination.
There Are Several Potential Causes But Some Are More Serious Than Others
In most cases, postmenopausal bleeding is caused by issues such as endometrial atrophy , vaginal atrophy, fibroids, or endometrial polyps. The bleeding could also be a sign of endometrial cancera malignancy of the uterine lining, but only in a small number of cases. A 2018 study by the National Cancer Institute found that only about 9 percent of postmenopausal women who saw a doctor for bleeding later received a diagnosis of endometrial cancer.
Still, we want the option to intervene early if it is cancer, since treating it sooner leads to better outcomes, Mantia-Smaldone said.
If endometrial cancer is found early, a woman has a 95 percent chance of surviving the cancer for at least 5 years.
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Bleeding After Menopause Dont Ignore It
Before you reach menopause, chances are youll experience some irregular bleeding patterns. After menopause, any bleeding is reason to see your healthcare provider. Heres why.
Bleeding after menopause or postmenopausal bleeding is when vaginal bleeding resumes at least six months after a woman experiences her last menstrual period. If it happens to you, see your healthcare provider to determine the cause, since bleeding in post-menopausal women can sometimes be a sign of endometrial cancercancer in the lining of the uterusand its critical to catch it early.
Causes of bleedingNot all post-menopausal bleeding signals cancer. Still, if you experience it, see your healthcare provider, who will review your health history, do an exam and perform tests to explore all the potential causes of bleeding, including:
- PolypsUsually noncancerous growths that attach to the uterine wall or develop on theuterine lining. Polyps can also grow on the cervix the narrow end of the uterus that protrudes into the vagina and may cause bleeding after sex.
- Endometrial hyperplasiaExcess estrogen without enough progesterone can lead to a thickening of the uterine wall that can also cause bleeding. In some cases, the cells of the lining become abnormal and can lead to cancer of the uterus.
- Endometrial atrophyLower estrogen levels can result in uterine wall thinning that can cause bleeding.
What Causes Bleeding After Menopause
Bleeding after menopause is rarely cause for concern. It does need to be investigated, however, because in very few cases it will be an indicator of something more serious.
In about 90 per cent of cases, a particular cause for bleeding after menopause will not be found. This is not a cause for alarm, if there is a serious problem it will be identified through investigations. Most of the time, postmenopausal bleeding is caused by:
- inflammation and thinning of the lining of your vagina
- thinning of the lining of your uterus
- growths in the cervix or uterus which are usually not cancerous
- thickened endometrium often because of hormone replacement therapy
- abnormalities in the cervix or uterus.
These are generally not serious problems and can be cured relatively easily.
However, about 10 per cent of the time, post-menopausal bleeding is linked to cancer of the cervix or uterus and so it is very important to have it investigated.
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Genitourinary Syndrome Of Menopause
As you get older, especially when your menstrual periods stop, your body produces less estrogen. Estrogen is the hormone responsible for regulating your reproductive system.
When your estrogen levels are lower, several things happen to your vagina.
Your body produces less vaginal lubrication, so your vagina can become dry and inflamed.
Lower estrogen levels also reduce the elasticity of your vagina. Vaginal tissues become more fragile, get less blood flow, and are more susceptible to tearing and irritation. This can lead to discomfort, pain, and bleeding during sex.
Can Abnormal Uterine Bleeding Be Prevented Or Avoided
If your abnormal uterine bleeding is caused by hormonal changes, you will not be able to prevent it. But if your hormonal changes are caused by being overweight, losing weight could help. Your weight affects your hormone production. Maintaining a healthy weight can help prevent abnormal uterine bleeding.
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Determining The Cause Of Postmenopausal Bleeding
Possible testing may include:
Transvaginal ultrasound: During this test, an imaging device is inserted inside the vagina so the pelvic organs can be viewed to look for anything unusual.
Endometrial biopsy: A thin tube is inserted into your uterus, and a tiny sample of the uterine lining is removed. Its sent to a lab to look for anything unusual.
Saline-infused sonogram: Saline is placed in the uterus through the cervix with a small, thin tube to see if there are any masses within the uterine lining.
Hysteroscopy: During this test, Dr. Portera uses an instrument with a light and small camera to examine the inside of the uterus and look for problems.
D& C : This is a surgical procedure that allows Dr. Portera to remove tissue from the uterus lining, so it can be sent to a lab for analysis.
Cervical And Uterine Cancer
Vaginal bleeding, including bleeding after sex, can be a symptom of cervical and uterine cancers. These cancers are most common in people over age 50 or those whove experienced menopause.
In addition to age, other risk factors include a family history of one of these cancers, excess weight , or cigarette smoking. Getting the human papilloma virus is another risk factor for cervical cancer.
If you experience postcoital bleeding and have gone through menopause, see your doctor to identify or rule out cervical and uterine cancers.
As with other types of cancer, treatment is most effective when the cancer is found and treated early.
Serious complications from postcoital bleeding arent common, unless the cause is cancer or an untreated condition. Following are some possible complications.
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What Can Cause Bleeding After Menopause
There can be several causes for vaginal bleeding after menopause, including:
- inflammation and thinning of the lining of the vagina
- thinning of the lining of the uterus
- thickening of the lining of the uterus, often caused by hormone replacement therapy
- polyps or other abnormalities in the cervix or uterus
Postmenstrual Bleeding Treatment Options
Treatment options for postmenopausal bleeding will largely depend on whats causing your symptoms. Estrogen therapy can be used to treat conditions such as vaginal and endometrial atrophy. Progestin therapy, on the other hand, is used to treat endometrial hyperplasia.
Polyps can be removed during a hysteroscopy, or they might require surgery. Cancer and severe cases of endometrial hyperplasia can require a hysterectomy. If youre diagnosed with cancer, your doctor will discuss several options with you, including chemotherapy, radiotherapy, and hormonal treatments.
As with most other conditions, the most important step when it comes to postmenopausal bleeding is to get an early diagnosis. Once you know whats causing your symptoms, you and your doctor will be able to discuss treatment options and decide on the best course of action for your individual case.
Discovering that youre bleeding after menopause can be scary, but in most cases, the underlying condition can be treated with simple therapeutic options. Ensuring your wellbeing and overall health should always be your main concern.
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What Is Vaginal Atrophy
After menopause, your body makes less estrogen. As a result, you may have vaginal atrophy, which is the thinning, drying and inflammation of the vaginal walls. It can cause problems with urination such as:
- Recurring urinary tract infections
In addition, vaginal atrophy can make sex painful. Treatments include topical estrogen, vaginal moisturizers and water-based lubricants to make intercourse more comfortable.
What are uterine fibroids?
These tumors, which are almost always benign, develop within the uterine muscle tissue and often dont cause any symptoms. They are very common, and between 20 and 80 percent will develop fibroids before the age of 50.
When fibroid tumors do cause symptoms, they include:
- Painful intercourse
- Longer periods
- Abdominal or lower back pain
Only 1 in 1,000 fibroids are cancerous. While there is no one definitive cause for fibroids, researchers believe they can be influenced by hormones or genetics. .
Vaginal And Vulvar Atrophy
Postmenopausal atrophic vaginitis, or vaginal and vulvar atrophy , is the thinning of the walls of the vagina caused by decreased estrogen levels during menopause. As a result, the lining of the vagina may be more likely to bleed.
Vaginal and vulvar atrophy is caused by cellular changes during menopause. Changes in estrogen levels also cause a decrease in blood flow to the vaginal area, which further contributes to vaginal dryness and discomfort. Spotting during and after intercourse is a common symptom of VVA.
At least half of those who enter menopause have signs and symptoms of VVA, but only 20% to 25% seek medical attention from their doctor.
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How Does The Perimenopause Impact Your Periods
In your peak reproductive years, levels of your reproductive hormones oestrogen and progesterone rise and fall somewhat consistently throughout your menstrual cycle. When you enter the perimenopause, however, your ovaries stop ovulating regularly.Since ovulation is more infrequent than before, circulating levels of oestrogen and progesterone become unpredictable and erratic, which can result in unusual bleeding patterns.
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The Reassuring News On Postmenopausal Bleeding
The analysis found that most post-menopausal bleeding is caused by a noncancerous condition, such as vaginal atrophy, uterine fibroids, or polyps. That information doesnt really differ from what doctors have historically thought about the incidence of endometrial cancer and bleeding, says Dr. Berkowitz. But it does finally put solid data behind those figures, which was missing in the past, he says. The researchers who conducted this study were looking for clues about postmenopausal bleeding and how it relates to endometrial cancer.