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.
What Are The Symptoms Of Perimenopause
Although menopause is a normal, healthy part of life for individuals with a uterus, it typically entails symptoms that can become unpleasant. Some individuals may not notice any significant changes, but many will likely experience one or more of the following:
- Hot flashes and night sweats = a sudden feeling of warmth that spreads over the body
- Breakthrough bleeding and spotting = bleeding when not on your period;
- Irregular periods = inconsistent timing and heaviness of periods;
- Headaches and/or migraines = pain that occurs in one or more regions of your head
- Mood swings = intense and sudden changes in mood;
- Insomnia = persistent difficulty falling or staying asleep;
- Urine urgency and/or leakage = constantly feeling the need to go pee;
- Vaginal dryness = lack of lubrication in the vagina;
- Acne = blemishes that pop up on the skin
- Fatigue = feeling more tired than usual;
- Breast tenderness = sore and/or swollen breasts;
- Lower sex drive = lack of desire to have sex and/or pain during sex
Sometimes, the symptoms of perimenopause can cause significant problems in day-to-day functioning. Fortunately, there are various treatments that can be implemented to help provide some relief.
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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How Can You Alleviate Perimenopausal Symptoms
Some women deal with the symptoms of perimenopause, and some women seek treatment for specific health concerns. Women with heavy bleeding, periods that last longer than seven days, spotting between periods or cycles that are less than 21 days should contact a doctor.
Typically, perimenopause is a gradual transition, and no particular test indicates what is happening to the body. Hormone therapy, vaginal estrogen treatments and antidepressants can help treat perimenopausal symptoms.
Start by identifying what’s bothering you most and then working with your doctor to address it. There are steps you can take to feel better. Lifestyle changes that can make a big impact in easing perimenopausal symptoms and improving your overall health include:
Should You Get Tested For Perimenopause
The short answer: No.
The blood tests that measure your ovarian reserve are rarely accurate during perimenopause. FSH and estrogen change by the day and throughout the day so they are generally not helpful.
We do consider testing these hormones if you experience perimenopausal symptoms under the age of 45. We generally will also check other pituitary hormones, like TSH and prolactin, if you are experiencing these symptoms prematurely.
Keeping a menstrual diary is generally the best test you can do. This will give you and your OBGYN insight into what your body is doing and for how long.
Any time you experience abnormal uterine bleeding , checking in with your doctor is a good idea to make sure it is normal and that no other work-up is needed.
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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.
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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Menopause And Birth Control: When Is It Time To Quit
Menopause can be a distressing, confusing time for many women. Its a natural part of life, but the timeline may vary between individuals with a uterus. You may have several questions about what this process entails, which is totally normal! The following article will provide some insight, particularly in terms of how to manage birth control use as you approach menopause.
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
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Fibroids And Menopause: Do I Have To Get Fibroids Removed
In the past, the only fibroid treatment available was surgery. This would remove either part or all of a womans uterus. This influenced a lot of women to do the watch and wait method. Its important to remember that fibroids will not go away without treatment. When left untreated, they will continue to cause uncomfortable or painful symptoms. Over time, this chronic pain may decrease from fibroids after menopause, but this is not a guarantee.With the recent development of new technologies, removal of fibroids is unnecessary for symptom relief. Hysterectomy is still the only true cure for fibroids, however it is now only used for very serious, rare cases.Uterine Fibroid Embolization is a treatment method that uses x-ray technology to deliver a medical agent to the uterus and fibroids. This blocks the blood flow to the fibroids and eventually causes them to shrink. UFE is done as an outpatient procedure, does not require a long recovery, and allows for preservation of fertility.
Could It Be Hypothyroidism
Menstrual abnormalities, particularly menorrhagia, can be one of the first noticeable symptoms of thyroid abnormalities, particularly hypothyroidism.10 The incidence increases with age and thyroid dysfunction can be masked by menopausal symptoms.
The physiology behind menorrhagia in hypothyroidism is anovulation due to thyroid hormone deficiency. Correct levels of thyroid hormone levels are required to produce luteinising hormone which is needed to trigger ovulation. If the balance is disturbed, there can be a delay in LH production. Hypothyroidism can also alter coagulation factors which are required for blood to clot effectively, and therefore this can result in excessive bleeding.11
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How Does Menopause Change Fibroid Symptoms
After menopause, fibroids cause similar symptoms to pre-menopausal fibroids. Since women dont have periods after menopause, they dont experience the intense menstrual cycles associated with fibroids. However, they can experience intermittent bleeding, cramps, a protruding belly, and frequent urination. If you have post-menopausal fibroids, you could also have symptoms like:
- Inability to empty bladder fully
- Pain during intercourse
Other Causes For Period Changes
The regular monthly period is not the only reason why people may bleed.
Because a persons periods are often irregular during perimenopause, they should pay extra attention for any abnormal symptoms particularly as some uterus-related conditions are more common during and after perimenopause.
People may bleed because of:
- Endometrial atrophy. Low estrogen in perimenopause and menopause can cause the tissue of the uterus to get very thin, which can cause irregular bleeding.
- Uterine polyps. These are benign growths that can grow inside the uterus and cervix. Polyps do not always cause symptoms, but some people notice bleeding after sex.
- Endometrial hyperplasia. Hormonal shifts can cause the lining of the uterus to thicken in perimenopause. When the body has too much estrogen without enough progesterone, this thickness may cause bleeding. Bleeding is its most common symptom. Endometrial hyperplasia is treatable but can increase a persons risk of cancer.
- Uterine Cancer. Uterine cancer happens when abnormal or atypical cells progress into cancer. Though rare, it generally presents with heavy bleeding or postmenopausal bleeding.
Perimenopause is not a disease and does not require treatment. It can, however, increase peoples risk of developing certain diseases. Moreover, the menstrual cycle can change for reasons other than perimenopause.
Anyone experiencing changes in their menstrual cycle should see a doctor for a diagnosis.
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What Happens After Menopause
As you wind down from the menopause, your body continues to go through a lot of changes. While your hormone levels adjust to a new normal, you can face changes to different parts of your body, and your health.
Common post menopause symptoms:
1. Your hot flushes will stop – eventually
As your hormones settle down, so will perimenopausal symptoms like hot flushes. Hurrah! However, they may continue for up to 8 years – and things might get worse before they get better. “Leading up to menopause, your oestrogen levels fluctuate. When they’re high, you don’t have symptoms,” gynaecologist Dr. Kevin Audlin explains. “But when you go into menopause and there’s a complete lack of oestrogen, you start to notice those symptoms more.”
2. Your breasts may look different
Postmenopausal breasts may shrink, change shape, lose firmness and become more prone to lumps. This is because weight can fluctuate during the menopause, meaning your breasts lose their elasticity. Time to go for that bra fitting.
3. Your weight distribution will change
Fat is less likely to settle on the hips and thighs post menopause – but more likely to settle on the waistline. It’s thought that the body attempts to hoard’ oestrogen in fat cells around the belly area, but experts warn that this kind of fat has been associated with diabetes, heart disease, stroke and even some cancers. Discover our tips to help you deal with menopause weight gain here, if you are concerned.
4. Sex may become more painful
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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A Pocket Guide To Uterine Fibroids And Menopause
Can you have fibroids after 50? While they may shrink once you enter menopause, they can also continue to cause symptoms. Learn more about menopause and fibroids as well as discover your treatment options below.
Fibroids are very unpredictable, which makes it very difficult to prevent and determine the cause, especially when it comes to information regarding uterine fibroids and menopause. However, research suggests that fibroid growth is linked to hormones specifically estrogen and progesterone.
For many women, fibroids grow during times when hormone levels are high, such as during pregnancy. On the other hand, fibroids tend to shrink when hormone levels are reduced, such as after menopause. Therefore, the risk of getting fibroids after menopause decreases.
Menstrual Bleeding During Perimenopause What Can It Be Like
During perimenopause, irregular periods are common. This is often normal and is rarely any cause for concern. It is linked to changing hormone levels during the menopausal transition.2 During perimenopause, the regular pattern in the rise and fall of oestrogen and progesterone is disrupted and there is now an unpredictable fluctuation in hormones during the menstrual cycle. As a result there are a variety of different menstrual changes that may occur. Cycles may be shorter than usual or bleeding can be days to weeks late. Periods can be heavier, or lighter, or vary a lot between each cycle.
Short menstrual cycles occur when there is a very low oestrogen level compared with progesterone. This is because oestrogen helps cause the womb lining to thicken, so when the levels are low, there is less lining to shed, hence the periods become short or scant. When there are more fluctuations in oestrogen and progesterone levels with lots of peaks and troughs, periods may be more frequent.
When menstrual cycles are prolonged, this is due to high oestrogen levels compared to progesterone levels. If ovulation does not occur, progesterone is not produced, so there is subsequently no sharp drop in progesterone, the trigger for the womb lining to be shed. Therefore you may experience a missed period, only for your period to be particularly heavy when it does arrive.
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How Does Birth Control Affect Perimenopause Symptoms
Hormonal birth control can help prevent pregnancy and eliminate period symptoms. Similarly, using birth control during perimenopause can help alleviate unpleasant symptoms and even decrease the likelihood of negative health conditions. For instance, the process of menopause may lead to osteoporosis and other bone-related issues, and implementing birth control can help reduce this risk. Additionally, because birth control regulates hormone levels, it can further minimize some of the effects associated with perimenopause such as hot flashes, acne, and vaginal dryness.
It is important to note, however, that hormonal contraceptives can mask perimenopause symptoms. Furthermore, those who take birth control may not recognize when they have reached the perimenopause stage. For this reason, it is crucial to communicate with a doctor in order to better understand what is going on in your body.
Perimenopausal Bleeding Or Spotting
Perimenopause is the period that leads to menopause. Its usually characterized by menopausal symptoms and irregular periods. Perimenopause can last up to 10 years. During perimenopause, its normal to experience heavier periods or irregular spotting due to hormonal changes.
Talk to your doctor if your perimenopausal bleeding:
- lasts longer or is heavier than expected
- occurs more often than normal
- occurs after intercourse
There are many conditions that can cause bleeding after menopause. Here weve listed the most common causes of postmenopausal bleeding.
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Causes Of Abnormal Bleeding
There are a number of possible culprits if you’re experiencing abnormalities in your bleeding habits.
For women who have already gone through menopause , vaginal bleeding could indicate cancer of the endometrium or cervix. Studies show that more than 90% of women with endometrial cancer experience bleeding after menopause.
During perimenopause, though, heavy bleeding may be caused by:
- Uterine fibroids or polyps
- Certain medications, such as blood thinners
- Pelvic infection;
- Most commonly, anovulation
Anovulation is when the ovary releases estrogen normally but doesn’t release an egg. It makes the uterine lining thicken and shed in an unpredictable manner, which causes irregular and/or heavy bleeding.
A number of simple diagnostic tests, many of which are non-invasive, can determine the cause of abnormal bleeding. These include:
- Vaginal ultrasound
- Endometrial biopsy
Additionally, if your doctor suspects your heavy bleeding is due to a bleeding disorder or is causing anemia, they may order blood tests.
Can Women Get Pregnant Even If Theyre Perimenopausal
Despite declines in fertility during perimenopause, ;it is still possible to become pregnant. Even when periods become less frequent, the body may be releasing more eggs. Furthermore, if a person with a uterus is currently taking birth control, they should continue to do so during perimenopause. If they are not on birth control, they should use an additional form of contraception for protection. It is also necessary to keep track of menstrual cycles in order to determine when it has been 12 months since the last cycle. Scheduling regular gynecological visits is a great way to help ensure that any rogue pregnancies will be detected early.
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