I Have Spotting After Menopause On My Underwear What Do I Do
Dr. Jessie: Please call your doctor and make an appointment. As long as the bleeding is minimal, this is not an emergency, but I like to get patients in for this problem within the next week. While seeing your gynecologist is generally not as fun as, say, buying some new shoes , the work up for post-menopausal bleeding is pretty straight forward and can bring some peace of mind.
How Do Doctors Treat Abnormal Bleeding After Menopause
If you do not have cancer, doctors can use a variety of methods to treat your bleeding depending on the cause.
If bleeding is caused by polyps, doctors can remove them with surgery. If the lining of the uterus is too thin, medications can help. If the uterine lining is too thick, doctors might prescribe a synthetic hormone called progestin, which causes the lining to shed. Or, your doctor may treat a thick uterine lining with a D& C procedure.
Treating Post Menopause Bleeding
If you have postmenopausal bleeding it is important to have it investigated.
You will most likely be referred to a gynaecologist who may:
- ask you questions about the history of your health
- examine you
- do a blood test
- look at the inside of your vagina and cervix using special tongs . At the same time, they may take a tiny sample of your cervix for testing .
The kind of treatment you have will depend on what is causing the bleeding.
- Atrophic vaginitis and thinning of the endometrium are usually treated with drugs that work like the hormone oestrogen. These can come as a tablet, vaginal gel or creams, skin patches, or a soft flexible ring which is put inside your vagina and slowly releases the medication.
- Polyps are usually removed with surgery. Depending on their size and location, they may be removed in a day clinic using a local anaesthetic or you may need to go to hospital to have a general anaesthetic.
- Thickening of the endometrium is usually treated with medications that work like the hormone progesterone and/or surgery to remove the thickening.
Before treatment there are a number of tests and investigations your gynaecologist may recommend.
All treatments should be discussed with you so that you know why a particular treatment or test is being done over another.
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Bleeding After Menopause: Cause For Concern
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If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
If youre a woman over 50, youre probably familiar with the signs of menopause and perimenopause. You know that menopause is a natural part of agingbut do you know whats normal and what might signal a problem in this stage of life?
Menopause is associated with a significant shift in estrogen and progesterone levels. Though these hormonal changes are normal, extreme fluctuations can sometimes lead to abnormal symptoms, such as vaginal bleeding.
Although most likely not a serious situation, post-menopausal bleeding can sometimes be a warning sign of cancer or a pre-cancerous condition. If you have entered menopause, it is important to tell your doctor about any vaginal bleeding. Together, you can choose the best way to identify and treat the cause.
Generations Of Women Have Trusted Chapel Hill Obgyn
Often, several different diseases present similar symptoms. Thats why its so important to have a local gynecologist who understands your medical history and has been a partner in your care. Generations of women have entrusted their care to us for decades. If youre experiencing any bleeding after menopause, we encourage you to schedule an appointment with us today.
For more than 40 years, Chapel Hill OBGYN has served women in the Triangle area, sharing the joy of little miracles and supporting them during challenges. Our board-certified physicians and certified nurse midwives bring together the personal experience and convenience of a private practice with the state-of-the-art resources found at larger organizations. To schedule an appointment, please contact us for more information.
Harvard Medical School. Postmenopausal Bleeding: Dont Worry But Do Call Your Doctor. Online.
Mayo Clinic. Bleeding After Menopause: Is It Normal? Online.
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The Significance Of Bleeding After Menopause
Bleeding after menopause or “postmenopausal bleeding” can be defined as the resumption of vaginal bleeding at least 6 months after a woman experiences her last menstrual period. This assumes of course that she is indeed menopausal ie. in her late 40’s, perhaps having hot flashes and night sweats, mood swings, insomnia, perhaps experiencing some vaginal dryness.
Bleeding after menopause or “postmenopausal bleeding” can be defined as the resumption of vaginal bleeding at least 6 months after a woman experiences her last menstrual period. This assumes of course that she is indeed menopausal ie. in her late 40’s, perhaps having hot flashes and night sweats, mood swings, insomnia, perhaps experiencing some vaginal dryness. The bleeding pattern most women experience as they approach menopause is one where the periods become lighter, shorter in duration, and the interval between periods changes so that the periods are either somewhat closer together or intervals greater than her customary 28 days. Cycles may be missed entirely for a couple of months.
Polyps and fibroids are common benign growths that develop in the uterine cavity. The former is most often associated with irregular light spotting, staining or actual light bleeding. The latter may also present this way, but in fact may be associated with much heavier bleeding.
Cancer obviously requires a much more aggressive surgery, namely hysterectomy.
What Happens At Your Hospital Or Clinic Appointment
The specialist may do tests to help find out the cause of the bleeding and plan any treatment.
They’ll probably examine your pelvis and vagina. They may insert a speculum into your vagina to hold it open, to see the inside of the vagina and the cervix.
Your specialist may also press on your tummy and inside your vagina. This is to check for lumps, tenderness or other abnormalities.
Other tests may include a vaginal ultrasound scan. Your specialist places a small device in your vagina to scan for any problems.
You may need a hysteroscopy. You’ll have this under local or general anaesthetic.
Your specialist passes a thin, telescope-like camera into your vagina, through the cervix and into your womb. They can look for any problems in your womb. They’ll take a biopsy for testing.
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Im Experiencing Postmenopausal Bleeding What Should I Do
First and foremost, you should make an appointment with your health care practitioner. All bleeding after menopause is considered abnormal until evaluated its the old better safe than sorry adage at work. This standard of care is important early identification of abnormal uterine tissue, precancerous tissue, and especially uterine cancer is critical to saving lives.
Most abnormalities in the uterus can be easily treated with great success when identified early. And while some of these cases turn out to be very serious and require immediate consultation with a cancer specialist, that certainly isnt the reality in all cases of postmenopausal bleeding or discovery of abnormal tissue. Fear can be a powerful deterrent in seeking help, but a delayed evaluation due to the possibility of something serious happening could very well make a difference in the success of treatment. I certainly understand the reluctance to face a possible crisis particularly if you are already dealing with emotional trauma of some kind but I urge you to seek help promptly if you see bleeding or spotting after menopause.
What Is Vaginal Bleeding
Vaginal bleeding can have a variety of causes. These include normal menstrual cycles and postmenopausal bleeding. Other causes of vaginal bleeding include:
- trauma or assault
- cervical cancer
- infections, including urinary tract infections
If youre experiencing vaginal bleeding and are postmenopausal, your doctor will ask about the duration of the bleed, the amount of blood, any additional pain, or other symptoms that may be relevant.
Because abnormal vaginal bleeding can be a symptom of cervical, uterine, or endometrial cancer, you should get any abnormal bleeding evaluated by a doctor.
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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.
How Do You Know The Cause Of Postmenopausal Bleeding
- Identifying the cause of the bleeding can include the following:
- Exam by your provider of the vagina and cervix.
- Pap smear to check the cervical cells.
- Ultrasound, usually using a vaginal approach, which may include the use of saline to make it easier to see any uterine polyps.
- Biopsy of the endometrium or uterus. In this procedure, your healthcare provider gently slides a small, straw-like tube into the uterus to collect cells to see if they are abnormal. This is done in the office and can cause come cramping.
How To Treat Postmenopausal Bleeding
It is important to remember that bleeding at 60+ years old, bleeding after menopause bright red in color, having a period after menopause, and irregular spotting or vaginal bleeding after menopause are not normal occurrences and should be evaluated by your doctor. Depending on the cause of your spotting or bleeding, your doctor can assist in finding the right treatment or therapy for you or refer you to a gynecological oncologist.
Treatments may include:
The key to treating postmenopausal bleeding is preventative care and reducing your risk factors for the conditions that may cause it. For example, by treating endometrial atrophy early, you can prevent it from progressing into cancer, or you can have your doctor screen for conditions early before postmenopausal bleeding may even begin. University Park OBGYN recommends maintaining a healthy diet, regular exercise routine, and yearly visits to the doctor to prevent various health conditions and complications.
First Determine Whether Youve Actually Reached Menopause Could Your Bleeding Be Due To A Period
According to the American College of Obstetricians and Gynecologists, the average age that women in the United States have their last period is 51.
Usually , womens hormone levels and menstrual cycles begin to change in their mid-40s. The ovaries get smaller and make less estrogen. This is the perimenopause period. You may get hot flashes. And your menstrual cycle may not happen every month.
After youve lived a full year without having a period, we say youve reached menopause. The ovaries have stopped producing eggs. Its the natural end of menstruation and ovarian function, says Dr. Neeley.
Your doctor will try to determine when you hit menopause. Some doctors think that the longer its been, the greater need for testing to rule out serious medical issues if youre experiencing bleeding.
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Natural Treatment For Postmenopausal Endometriosis
Women looking to naturally treat their endometriosis after menopause should first turn to their nutrition.
Diet has proven to have a significant influence on the risk of pelvic endometriosis. Studies have shown that increased consumption of green vegetables and fresh fruits decreases the risk of endometriosis, while beef and other red meats increase the risk.5
Moreover, dietary fiber and whole grain intake promotes a healthy balance of gut bacteria, which is necessary to properly regulate circulating estrogens and reduce inflammation. Find them in raspberries, pears, green peas, broccoli, lentils, black beans, barley, quinoa, and more.
However, while natural treatments for postmenopausal endometriosis do include dietary changes as an instrumental step toward relief, other alternative options should not be forgotten, like melatonin supplements, which are scientifically proven to reduce endometriosis-related pelvic pain.6
It Might Be Worth Seeing A Specialist
Your gynecologist should be able to perform your initial evaluation. But, if he or she suspects that your bleeding might be related to cancer, its important to see a gynecologic oncologist, Mantia-Smaldone said.
Endometrial cancer is usually treated with surgery that includes a hysterectomy, which may be followed by radiation and/or chemotherapy. Because gynecologic oncologists deal with female reproductive cancers every day, they have more experience operating on cancers, staging them correctly, and determining the best course of therapy. And that can add up to a more successful treatment outcome.
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What Can Cause Vaginal Spotting 10 Years After Menopause
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Things To Know About Postmenopausal Bleeding
Spotting or light bleeding after menopause might not seem like a serious problem, but you should never ignore it or wait to bring it up with your doctor. After a womans periods have stopped, vaginal bleeding could be a sign of a health issueincluding endometrial cancer. Heres what every postmenopausal woman should know.
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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.
Vaginal Bleeding After Menopause
Vaginal bleeding or spotting after menopause should never be ignored, nor should you wait to bring it up with your doctor. Because you have no period after menopause, vaginal bleeding after menopause can signify a serious health issue that sometimes may be serious, like cancer. Here is what postmenopausal women need to know about vaginal bleeding after menopause and when to seek Gynecological care.
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If Bleeding After Menopause Is Caused By Cancer What Are My Options
If you have endometrial cancer, your doctor may suggest a hysterectomy, removing the cervix, uterus, ovaries and fallopian tubes. Your surgeon may also remove lymph nodes and other tissue to test and determine whether the cancer has spread. Depending on the stage of cancer, your doctor may suggest chemotherapy and radiation. Most endometrial cancer can be treated successfully if diagnosed early.
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.
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What Will The Doctor Do If I Tell Her I Have Post
Dr. Jessie: When you come in to the office for bleeding after menopause, your doctor will take a thorough history to get a better idea where the bleeding might be coming from. She will do a physical exam and inspect the vulva, vagina and cervix to look for a potential source of the bleeding. Shell also do a pelvic exam to see if the uterus feels enlarged or the ovaries feel abnormal.
Because PMB is a warning sign for pre-cancer or cancer of the lining of the uterus, even if she finds a likely cause during the exam, your doctor will do some sort of an evaluation of the lining of the uterus. This may be an ultrasound to determine the thickness of the lining or it may be a biopsy of the lining of the uterus.
When Should I Contact My Doctor
Contact your healthcare provider if you experience vaginal bleeding:
- More than a year after your last menstrual period.
- More than a year after starting hormone replacement therapy .
A note from Cleveland Clinic
Its normal to have irregular vaginal bleeding in the years leading up to menopause. But if you have bleeding more than a year after your last menstrual period, its time to see your healthcare provider. It could be the result of a simple infection or benign growths. But in rare cases, bleeding could be a sign of uterine cancer.
Last reviewed by a Cleveland Clinic medical professional on 05/26/2021.
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