Bleeding After Menopause Isnt Considered Normal
If you Google “vaginal bleeding after menopause”, the search results are likely to send you into a panic.
Please dont panic. There are many explanations for spotting after menopause. And despite what Dr. Google says, it does not automatically mean you have cancer.
According to this study published by JAMA Internal Medicine, postmenopausal bleeding occurs in approximately 90% of women with endometrial cancer; however, only 9% of women with postmenopausal bleeding were diagnosed with endometrial cancer.
So, why the urgency to see a doctor?;
Well, endometrial cancer cannot be screened for, which means it can go undetected if symptoms are ignored.;
So, even though postmenopausal bleeding can occur for a variety of reasons, understanding that it can allow for early detection of endometrial cancer means its always worth investigation.
Some People Are More Prone To Uterine Prolapse Than Others
Some women will lift heavy items most of their life and never have an issue with uterine prolapse, but there are others who have specific risk factors that make them more vulnerable to prolapse, including women who:
- are obese
- have had multiple births or given birth to a large infant
- have experienced a prior prolapse of the uterus
- are older or who have already gone through menopause
There are ways to mend a prolapsed uterus, most of which involve something like a surgically installed sling or stitches to hold the uterus in place. If left untreated, the entire uterus can collapse, but before that, painful symptoms can emerge like discomfort during sex and pelvic aching. If you believe you have a prolapsed uterus or have any more questions about how does heavy lifting affect your uterus, reach out to us at Avant Gynecology today and schedule an appointment.
How Is Postmenopausal Bleeding Treated
Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments.
- 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 .
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Treatment For Asymptomatic Bladder Prolapse
If you have no symptoms of bladder prolapse, you may not need treatment. This may be the case with stage 1 or stage 2 prolapse. In fact, you may not be aware of the bladder prolapse at all. It may be picked up by your GP during a routine examination, such as during a cervical screening test.
Lifestyle changes and physiotherapy are the key aspects of managing such cases. There are things you can do to help prevent the condition from getting worse, which may include:;
- weight loss
- correction of position when sitting on the toilet
- avoiding heavy lifting
- pelvic floor exercises, which have been proven to reduce the symptoms of an early stage bladder prolapse and prevent any worsening;
- seeking treatment and management for chronic cough and lung disease.
Seeing a pelvic floor physiotherapist is always recommended so that they can assess your pelvic floor function properly and show you the correct technique for doing pelvic floor exercises. The best published evidence supports supervised pelvic floor muscle exercises for the management of prolapse and urinary incontinence.
Are You Really In Menopause What Is Perimenopause
One possible explanation of a period in menopause is that youre not yet in menopause, but still in perimenopause.
During perimenopause , your menstrual cycles and periods gradually come to an end. The average length of perimenopause is four years and, during that time, your period can become irregular and there can be irregular bleeding between periods.
Just as periods maybe started out irregularly when you went through the changes of puberty, so they become irregular as you go through the changes of perimenopause. From a hormonal standpoint, perimenopause is characterized by irregular estrogen and progesterone levels.;
Because of this gradual change, many individuals are unsure when perimenopause ends and menopause begins. In medical terms, menopause is confirmed 12 months after women have their last period.
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Can Stress Cause Postmenopausal Bleeding
As we women age, our bodies go through some drastic and remarkable changes. After the childbearing years, the 40s and the 50s, the female body begins to change away from procreation as the production of reproductive hormones naturally begins to decline. This phase of a womans life is called menopause and is signaled by 12 continuous months since the last menstrual cycle.
The average age in the United States for women to start menopause is around 51 years of age. There are three phases of menopause that women typically go through and they are perimenopause , menopause, and then postmenopause .
Many questions surround this phase of female life, and for the purpose of this article, we are going to look at the postmenopause phase and a common question that arises often.;
What Will The Spotting Be Like
Whenever you change your routine, especially if you are exercising more vigorously, and if you have changed your diet, there is a good chance that you will see some occasional spotting. If you are spotting after exercise, and you are between your menstrual cycles, take note the color and quantity of the blood. The spotting should be brownish, as opposed to bright red, and it should be in a relatively small amount, unlike a regular flow. However, if you’re spotting frequently, and the bleeding is consistently light and brownish, you should consider lightening up a little. It is very likely the more vigorous exercising is over stressing your body.
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Symptoms Of Postmenopausal Bleeding
Many women who experience postmenopausal bleeding may not have other symptoms. But symptoms may be present. This can depend on the cause of bleeding.
Many symptoms that occur during menopause, like hot flashes, often begin to decrease during the postmenopausal time period. There are, however, other symptoms that postmenopausal women may experience.
Symptoms postmenopausal women may experience include:
- vaginal dryness
A doctor may conduct a physical exam and a medical history analysis. They may also conduct a Pap smear as part of a pelvic exam. This can screen for cervical cancer.
Doctors may use other procedures to view the inside of the vagina and the uterus.
Do You Have A Question
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What Symptoms Should I Watch For Between Pap Smears
Pre-cancerous conditions of the cervix seldom cause symptoms. For problems to be detected, a pelvic examination and a Pap smear are usually required.
When cancer is present in the cervix, the most common symptom is abnormal bleeding. Bleeding may start and stop between regular menstrual periods, or it may occur after sexual intercourse or douching . Abnormal vaginal discharge is another symptom. Pain is NOT an early warning sign of the disease. These symptoms can be caused by other conditions and are not sure signs of cancer; but be sure to see your doctor if any of these symptoms occur.
When To Seek Medical Help
You should consult your doctor any time you have abnormal vaginal bleeding. The cause of the bleeding could be serious and should be determined. See your doctor right away if youre pregnant and have vaginal bleeding.
If you have other serious symptoms in addition to bleeding, you may need emergency medical attention. These include:
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Can Stress Cause Vaginal Bleeding
No, stress cannot cause vaginal bleeding. Stress can, however, cause an earlier or later menstrual cycle and cause bleeding in-line with a new cycle. If you have new mid-cycle bleeding and have not consulted a clinician, you should seek medical evaluation. It may be a sign of anything from a sexually transmitted infection , to fibroids, to a pregnancy, or it may have no definable cause.
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.
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Bleeding After Menopause: Get It Checked Out
Bleeding after menopause can be disconcerting, but the good news is, more than 90% of the time its not caused by a serious condition, according to a study in JAMA Internal Medicine.;That said, the study also reinforces the idea that postmenopausal bleeding should always be checked out by your doctor to rule out endometrial cancer, a cancer of the uterine lining, says Dr. Ross Berkowitz, William H. Baker Professor of Gynecology at Harvard Medical School. This is because the study also found more than 90% of women who did have endometrial cancer had experienced postmenopausal bleeding. And screening all women who experience bleeding after menopause for endometrial cancer could potentially find as many as 90% of these cancers, which are highly curable if found early.
What Causes Cervical Cancer
Almost all cases of cervical cancer are caused by the human papilloma virus . HPV is a very common virus that can be passed on through any type of sexual contact with a man or a woman.
There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer.
Two strains of the HPV virus ;are known to be responsible for 70% of all cases of cervical cancer.;These types of HPV infection don’t have any symptoms, so many women won’t realise they have the infection.
However, it’s important to be aware that these infections are relatively common and most women who;have;them don’t develop cervical cancer.
Using;condoms during sex offers some protection against HPV, but it can’t always prevent infection, because the virus is also spread through skin-to-skin contact of the wider genital area.
Since 2008, a;HPV vaccine;has been routinely offered to girls aged 12 and 13.
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Ovulation Pain Or Midcycle Spotting
Mittelschmerz is a German word that translates as “middle pain.” It refers to the normal discomfort sometimes felt by women during ovulation, which is at the midpoint of the menstrual cycle.
Each month, one of the two ovaries forms a follicle that holds an egg cell. The pain occurs when the follicle ruptures and releases the egg.
This is a dull, cramping sensation that may begin suddenly in only one side of the lower abdomen. In a few cases, there may be vaginal spotting. Mittelschmerz occurs about 14 days before the start of the next menstrual period.
Actual Mittelschmerz is not associated with nausea, vomiting, fever, or severe pelvic pain. These symptoms should be evaluated by a medical provider since they can indicate a more serious condition.
Diagnosis is made through patient history.
Treatment requires only over-the-counter, nonsteroidal anti-inflammatory drugs to relieve the pain. An oral contraceptive will stop the symptoms, since it also stops ovulation.
Top Symptoms: abdominal pain , last period approximately 2 weeks ago, vaginal bleeding, bloody vaginal discharge, pelvis pain
Symptoms that always occur with ovulation pain or midcycle spotting: last period approximately 2 weeks ago
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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The Diagnostic Process May Involve Multiple Steps
Even though postmenopausal bleeding can have a number of different causes, your doctors first objective is to rule out potential cancers.
Well usually do a physical exam to look for blood or masses, such as fibroids, followed by an ultrasound to see how thick a patients uterine lining is, Mantia-Smaldone explained. A postmenopausal womans uterine lining should be quite thin, since she isnt menstruating.
Endometrial cancer can cause the lining of the uterus to thicken. If your uterine lining appears thicker than normal, your doctor will recommend a biopsy, in which a sample of your uterine lining is removed and examined under a microscope.
Treatment For Symptomatic Bladder Prolapse
If you have symptoms of bladder prolapse it is recommended that, as for people with no symptoms, you make the same lifestyle changes, do pelvic floor muscle training and treat any chronic cough. Make them part of your routine.
However, sometimes prolapse can be more severe and these measures may not be enough on their own to relieve symptoms.
For these cases, there can be two different approaches:
1. Non-surgical approach vaginal pessaries
A pessary is a device made mostly of silicone. It is inserted in the vagina to support the bladder prolapse and front vaginal wall. Pessaries come in different shapes and sizes.You do not need surgery to put in a pessary. It can be done in the rooms of a pelvic floor physiotherapist, continence nurse or your gynaecologist.
Some women may prefer this option if they wish to avoid or delay surgery, and it may be the safest option for women who are unfit for surgery.You will need regular check-ups with your healthcare professional if you are using a vaginal pessary long-term.
Suggestions may include:
- resting each day.;
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Risk Factors For Bladder Prolapse
Risk factors for bladder prolapse include anything that puts pressure on the pelvic floor and affects its function, such as:;
- pregnancy and childbirth
- regularly straining on the toilet to pass bowel motions or empty the bladder
- being overweight
- chronic cough secondary to smokers cough or chronic lung diseases
- repetitive lifting of children or heavy weights at work or in the gym, or any exercises where there is excessive downward pressure on the pelvic floor
- pelvic or gynaecological surgery
- strong family history
- connective tissue disease, in which the tissues in the body are not able to hold the weight of the organs
Postmenopausal women are more susceptible to bladder prolapse because they have reduced levels of oestrogen . Oestrogen helps to keep the vaginal tissues and muscles in good tone. When oestrogen levels drop after menopause, these tissues become thinner and less elastic, which may allow the bladder to bulge into the vagina.
Why Am I Experiencing Vaginal Bleeding After Menopause
Vaginal bleeding after menopause may be due to medications, hyperplasia of the uterus, or some types of uterine cancer. Certain medications containing estrogen or progesterone can cause either hyperplasia or an increase in the amount of tissue in the uterus, which may cause bleeding or an excess sloughing off of tissue both of which will be seen as vaginal bleeding.
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What Are Some Complications Caused By Uterine Fibroids
Sometimes uterine fibroids may cause more serious problems. Uterine fibroids can make menstrual bleeding heavy and full of clots. Heavy menstrual bleeding and fibroids that cause bleeding between periods can make a woman anemic. If youre feeling fatigued, visit your doctor to have a blood test to measure your level of red blood cells.
Other complications may include:
- Blockage of the urinary tract or bowels
- Deteriorating fibroids, which can cause severe, localized pain
- Development of cancerous fibroids, which is rare and less than one in 1,000
How Exercise Affects The Uterus
Then she switches gears a bit, and explains further. Your uterus is a muscle. It can sense dehydration. It can cramp like other muscles. When you do strenuous exercise, you can cause your uterus to cramp, and this causes the spotting. Wow. Im embarrassed that I hadnt known that the uterus was a muscle. Then again, I never had a health or science class cover this material – which would have been great to know, as a woman. But, I know this now, and am grateful.
Then Dr. Wright addresses the CrossFit. Take something like CrossFit. CrossFit is lots of motion, so even in that friction – that motion can result in some spotting. This makes sense. She continues, Other patients have cramping after exercise. That can just be a normal uterine muscle response.
The connection that I had noticed years ago is completely accurate, but not for the reasons I understood. Wright is able to help me see that strenuous exercise isnt making my endometriosis worse – exercise is not causing the endometriosis to grow faster or in greater amounts.
Rather, the exercise was simply putting a strain on the muscles of the uterus, which form a lining of blood and mucosal tissue every month. Agitation of those muscles disrupts that natural process.