How Do Doctors Diagnose Bleeding After Menopause
To find the cause of abnormal vaginal bleeding, your doctor will perform a physical exam and ask about your family and health history. He or she may also order a transvaginal ultrasound or an endometrial biopsy.
Transvaginal ultrasonography allows your doctor to assess your uterine cavity and endometrial thickness. He or she can also examine your fallopian tubes and ovaries. During this procedure, your doctor or an ultrasound technician will place an instrument into the vagina to examine the uterine cavity and endometrial lining. This instrument will emit sound waves that bounce off the pelvic organs. These sound waves get sent to a nearby computer and create a picture called a sonogram.
Endometrial biopsy, or endometrial sampling, involves removing a small piece of the endometrial lining. After taking the sample, the doctor will send it to the lab. There, the scientists will look for anything abnormal, including signs of infection or cancer.
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What Is Postmenopausal Bleeding
Postmenopausal bleeding is bleeding that occurs after menopause. Menopause is a stage in a womans life when reproductive hormones drop and her monthly menstrual periods stop. Vaginal bleeding that occurs more than a year after a womans last period isnt normal. The bleeding can be light or heavy.
Postmenopausal bleeding is usually due to benign gynecological conditions such as endometrial polyps. But for about 10% of women, bleeding after menopause is a sign of uterine cancer . Uterine cancer is the most common type of reproductive cancer Talk to your healthcare provider if you experience any bleeding after menopause.
Unusual Vaginal Bleeding Spotting Or Other Discharge
About 90% of women with endometrial cancer have abnormal vaginal bleeding. This might be a change in their periods, bleeding between periods, or bleeding after menopause. Non-cancer problems can also cause abnormal bleeding. But it’s important to have a doctor check out any irregular bleeding right away. If you’ve gone through menopause, its especially important to report any vaginal bleeding, spotting, or abnormal discharge to your doctor.
Non-bloody vaginal discharge may also be a sign of endometrial cancer. Even if you can’t see blood in the discharge, it doesn’t mean there’s no cancer. Any abnormal discharge should be checked out by a doctor.
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When Do I Need Medical Attention For Bleeding After Menopause
The issue of is bleeding after menopause always cancer is serious even if this hazardous ailment isnt diagnosed. You ought to obligatorily check-up with a specialist in this field. Turn to a doctor if bleeding:
- is longer than usual
- takes place too frequently
- takes place after sexual intercourse.
Youll have to pass several physical examinations. They are different and each has its benefits. Therefore, a professional will surely confirm or deny the probability of is bleeding after menopause always cancer. If you dont have cancer after menopause, youre very lucky and can enjoy your life to the fullest. Nevertheless, be cautious. If you bleed heavily and frequently, you should pass an examination to receive effective treatment.
Now you know the answer to an urgent question Is bleeding after menopause always cancer? You may suffer from this severe disease or not. Menopause is commonly followed by some spotting. Nonetheless, its not always true that youll have cancer when you bleed. Be reasonable and pass an examination to know for sure.
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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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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.
Bleeding After Menopause: How To Get A Diagnosis
No matter the cause of your postmenopausal bleeding, its important to visit the doctor. In most cases, this symptom is caused by a minor condition however, all possible causes must be ruled out. There are several different tests and/or procedures your doctor might recommend to discover the cause of postmenopausal bleeding.
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What Treatments Are Available To Help With Postmenopausal Bleeding
The treatments for bleeding after menopause vary depending on whatâs causing the issue, which is why itâs so important to get the right diagnosis.
- Doctors can remove polyps using a minimally invasive procedure called hysteroscopy.
- Medications and hormone replacement therapy can treat vaginal and endometrial atrophy.
- Progesterone hormone therapy is an effective treatment for endometrial hyperplasia.
- Dilation and curettage can also help with endometrial hyperplasia by removing the excess tissue from inside the uterus.
If cancer is responsible for the abnormal bleeding, your doctor can treat it with a hysterectomy. This surgical procedure involves removing the uterus. In some cases, your doctor may also recommend removing the cervix, fallopian tubes, and ovaries as part of the hysterectomy.
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Learn more about your postmenopausal health with the Everlywell at-home Postmenopause Test. This postmenopause test can help you to understand if your postmenopausal bleeding is caused by imbalanced hormone levels by allowing you to easily check your estradiol and progesterone levels from the comfort of home.
1. What Is Menopause?. National Institute of Aging. URL. Accessed March 25, 2021.
2. Bleeding after menopause: Is it normal?. Mayo Clinic. URL. Accessed March 25, 2021.
3. Bleeding after menopause: Get it checked out. Harvard Medical School. URL. Accessed March 25, 2021.
Postmenopausal Bleeding: An Overview
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 and menopause.
Because of this gradual change, many individuals are unsure when perimenopause ends and menopause begins. In medical terms, menopause is confirmed 12 months after your last period.
Bleeding after this point is called post-menopausal bleeding and it is considered abnormal bleeding.
Is It Normal To Bleed Years After Menopause
The short answer to this question is no. Postmenopausal women shouldnât experience bleeding because menopause is the end of a womanâs menstrual cycle. While some women do experience postmenopausal vaginal bleeding, this type of bleeding isnât normal. As a result, you should visit your doctor if youâre still bleeding as a postmenopausal woman.
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Dont Panic But Do See A Doctor
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.
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Why Does Menopause Hormone Therapy Cause Vaginal Bleeding
Answer From Shannon K. Laughlin-Tommaso, M.D. Some forms of menopause hormone therapy may cause monthly bleeding. This includes cyclic hormone therapy preparations that contain a combination of estrogen and progestin. Progestin helps protect the uterus from endometrial cancer if you have an intact uterus.
How Is Uterine Cancer Diagnosed
The ideal method for screening asymptomatic women has not yet been devised. If a woman has symptoms that suggest uterine cancer, her doctor may check general signs of health and may order blood and urine tests. The doctor also may perform one or more of the following exams or tests:
- Pelvic exam – the doctor checks the vagina, uterus, bladder and rectum for any lumps or changes in their shape or size. To see the upper part of the vagina and the cervix, the doctor inserts an instrument called a speculum into the vagina.
- Pap test – the doctor collects cells from the cervix and upper vagina. Because uterine cancer begins inside the uterus, it does not usually show up on a Pap test. However, postmenopausal women with endometrial cells on a Pap, particularly if they are atypical, need further evaluation.
- Transvaginal ultrasound – the doctor inserts an instrument into the vagina which aims high-frequency sound waves at the uterus. The pattern of the echoes creates a picture. If the endometrium looks too thick, the doctor can do a biopsy.
- Biopsy – the doctor removes a sample of tissue from the uterine lining. This usually can be done in the doctor’s office.
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Have You Had Unexplained Vaginal Bleeding And Are Wondering If Ovarian Cancer Can Be The Cause
Postmenopausal and unexplained premenopausal vaginal bleeding must always be investigated by your OBGYN so that a malignancy can be ruled out.
Though ovarian cancer is not a common condition, it is the deadliest of all gynecological cancers, as far as percentage of patients who are still alive after five years, relative to number of diagnoses.
Ovarian cancer is an insidious disease because it often does not present until it is in the more advanced stages, says Karen Patrusky, a board certified OBGYN and F.A.C.O.G. in private practice for 20+ years.
The most typical presenting symptoms of ovarian cancer are abdominal bloating, early satiety after a meal, changes in bowel habits and urinary pressure.
This disease is far more common in postmenopausal women, though it can definitely occur in premenopausal women. See the statistics chart below for age brackets and occurrence.
How Much Bleeding Is Normal After Menopause
You may think you have reached menopause if you have not had a period for a few months. However, it is still possible to have a period up to a year after your last one. After 12 months without a period, any bleeding at all is not normal.
Up to 1 in 10 women experience bleeding or spotting after their menopause. In most cases the bleeding is not serious and a cause may not be found. However, it needs to be checked because sometimes it can be a sign of cervical or uterine cancer, so it is always important to see a doctor if you notice any vaginal bleeding after menopause.
Does It Matter How Far After Menopause You Are Say Six Months Post
Dr. Jessie: It doesnt. Post-menopausal bleeding can be an indicator for abnormal cells in the uterine lining at any point after menopause. While there are probably more benign conditions that can cause some vaginal bleeding the closer you are to menopause , if you have gone a full year without a period, you need to get in to see your doctor.
How Is It Diagnosed
To find the cause of your bleeding, the doctor will do a physical exam and review your medical history. You may need one or more of the following tests:
Transvaginal ultrasound: This image helps your doctor check for growths and look at the thickness of your endometrium. Theyâll place a small probe into your vagina. It sends off sound waves to create a picture of the inside of your body.
Endometrial biopsy: The doctor uses a thin tube to take a small sample of the tissue that lines your uterus. Theyâll send it to a lab where scientists will look for anything unusual, like an infection or cancerous cells.
Sonohysterography: Your doctor may use this test to measure the size of a polyp. Theyâll put a saltwater solution inside your uterus to create a clearer ultrasound image.
Hysteroscopy: When the doctor needs to look inside your uterus, theyâll use a hysteroscope. This thin, lighted tube has a camera on one end.
D& C : During this procedure, the doctor opens 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 .
Ultrasound and biopsy are usually done in your doctorâs office. Hysteroscopy and D& C require anesthesia on one part of or your whole body. Youâll either go to a hospital or an outpatient surgical center.
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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.
Yes It Can Be A Polyp
Polyps inside the uterus or cervical canal are fairly common, but the amount of blood they cause can be scary, especially after menopause. As your uterine lining thins due to the drop in estrogen, these polyps also grow thin, and your body may shed the surface of the polypcausing the bleeding. Its usually light spotting or staining, but at times it can be surprisingly heavy. Your doctor will run a series of tests including a sonogram to locate the polyp and likely remove it to make sure its not cancerous.
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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.
Causes Of Postmenopausal Bleeding
A variety of conditions can cause postmenopausal bleeding, including hormone therapy, infection, or the use of medications such as blood thinners.Some of the most common causes of postmenopausal bleeding are:
- Cancer: Postmenopausal bleeding is a common symptom of endometrial cancer, but it also can be caused by cervical and vulvar cancer.
- Endometrial atrophy: The tissue that lines the uterus can become very thin after menopause. As the lining thins, bleeding may occur.
- Endometrial hyperplasia: Sometimes the lining of the uterus becomes thick, usually because of too much estrogen and too little progesterone. This is considered a precursor to endometrial cancer.
- Fibroids: These growths develop in the uterine muscle tissue.
- Polyps: These usually noncancerous growths can develop in the lining of the uterus.
- Endometrial biopsy: A thin tube is inserted into the uterus and a tiny sample of the lining is removed. The sample is sent to the lab for examination.
- Transvaginal ultrasound: An imaging device is inserted into the vagina to examine the pelvic organs.
- Hysteroscopy: An instrument with a light and camera at the end, called a hysteroscope, is inserted into the vagina and through the cervix to examine the uterus.
- Dilation and curettage : After enlarging the cervix, tissue is scraped from the lining of the uterus to be examined in a lab.
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Is Bleeding During Perimenopause Normal
The years before menopause are called perimenopause. During this time, your hormones shift. Your period may be heavier or lighter than usual. You may also have spotting. Thatâs normal. But if your bleeding is heavy or lasts longer than usual, talk to your doctor. You should also get checked out if you bleed after sex or more often than every 3 weeks.
Ming Tsai, MD, associate professor, obstetrics and gynecology, NYU School of Medicine chief of service, obstetrics and gynecology, NYU Lutheran, New York City.
American College of Obstetricians and Gynecologists: âEndometrial Biopsy,â âEndometrial Cancer,â âEndometrial Hyperplasia,â âHysterectomy,â âPerimenopausal Bleeding and Bleeding After Menopause,â âSonohysterography.â
Mayo Clinic: âBleeding After Menopause: Is It Normal?â âDilation and curettage ,â âDiseases and Conditions: Menopause,â âVaginal Atrophy.â
Journal of Midwifery and Womenâs Health: âAbnormal Uterine Bleeding.â
Cleveland Clinic: âWhat is Hysteroscopy?â
Obstetrics & Gynecology: âManagement of Endometrial Precancers.â
Current Testing Practices Supported
Although people tend to think of biopsies as invasive and frightening, an endometrial biopsy is a simple procedure similar to a Pap smear, Dr. Chu explained. Like a Pap smear, it can be done in the doctors office and doesnt require anesthesia.
In their study, the researchers ran simulations in which they estimated how many women with postmenopausal bleeding would need to undergo additional testing to detect one case of endometrial cancer, based on varied levels of risk and different testing strategies. Assuming a 10% risk of endometrial cancer and that women underwent subsequent testing with ultrasound, they estimated that 7 women would need to have a biopsy to find 1 cancer.
Before sending a woman for testing, doctors should ask themselves: If she has postmenopausal bleeding, how high is her risk of cancer?” explained Dr. Wentzensen. “Our estimate of 10% supports the current practice of further evaluating these women.”
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