Postmenopausal Bleeding Is Always A Symptom That Needs To Be Evaluated By A Healthcare Provider
Postmenopausal Bleeding Is Always a symptom that needs to be evaluated by a Healthcare Provider
Menopause is the time of a womans life when she stops menstruating permanently. It is confirmed by missing your period for 12 months. The average age of menopause is 51 years, but the normal range is 45 years to 55 years. Bleeding or spotting after this point is called postmenopausal bleeding . Postmenopausal bleeding always needs to be check out by a healthcare provider. Many times it can be due to a minor health issue but it can also be a sign of more serious disease like cancer in the uterus or vagina. If found early many of these cancers can be successfully treated.
The years leading up to this point are called perimenopause. This is the time that leads up to menopause. This phase can last for up to 7-10 years. During perimenopause, shifts in hormone levels can affect ovulation and cause changes in the menstrual cycle . Bleeding less than 21 days from the beginning of one cycle until the beginning of the next, bleeding longer than 8 days at a time, bleeding through a pad and hour, or bleeding after sex are also problems that need a medical evaluation- but these are not the intended focus of this article.
Causes of Postmenopausal bleeding
Most of the time, postmenopausal bleeding is caused by noncancerous conditions:
These are generally not serious problems and can be cured relatively easily.
What will happen at the appointment when I am evaluated for PMB?
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.
Causes Of Postmenopausal Bleeding
There can be several causes of postmenopausal bleeding.
The most common causes are:
- inflammation and thinning of the vaginal lining or womb lining caused by lower oestrogen levels
- cervical or womb polyps growths that are usually non-cancerous
- a thickened womb lining this can be caused by hormone replacement therapy , high levels of oestrogen or being overweight, and can lead to womb cancer
Less commonly, postmenopausal bleeding is caused by cancer, such as ovarian and womb cancer.
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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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Prolonged And Heavy Bleeding During Menopause Is Common
ANN ARBORWomen going through menopause most likely think of it as the time for an end to predictable monthly periods. Researchers at the University of Michigan say its normal, however, for the majority of them to experience an increase in the amount and duration of bleeding episodes, which may occur at various times throughout the menopausal transition.
The researchers from the U-M School of Public Health and U-M Health System offer the first long-term study of bleeding patterns in women of multiple race/ethnicities who were going through menopause. They say the results could impact patient care and alleviate undue concern about what to expect during this life stage that can last anywhere from 2-to-10 years.
For most women in their 30s, menstrual periods are highly predictable. With the onset of the menopausal transition in their 40s, womens menstrual periods can change dramatically. These dramatic changes can be disconcerting and often provoke questions about whether something is wrong, said Sioban Harlow, U-M professor of epidemiology.
Women need more descriptive information about the bleeding changes they can expect. We need clear guidance to help women understand what changes in bleeding patterns do and do not require medical attention.
The study, Menstruation and the Menopausal Transition, is reported in the current issue of BJOG: An International Journal of Obstetrics and Gynaecology.
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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.
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.
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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
What Causes Ovarian Cancer
When cells multiply and divide in an unregulated way, it is referred to as cancer. When this is found in the ovary, it is ovarian cancer. The exact reason this happens is unclear. These risks can increase the chance of getting the symptoms of ovarian cancer after menopause.
Your Family History
Those who have relatives whove had breast or ovarian cancer are at a higher risk of getting ovarian cancer than other women. Genetic testing can be done to screen out genes associated with the risk.
Many cases of ovarian cancer happen after a woman goes through menopause. This can be especially true for those over 63 but is less common before 40.
Those who have had a pregnancy or more that went full-term are at a lower risk. This is especially true for those that were pregnant before 26 and your risk decreases the more pregnancies you have. Breastfeeding will also decrease your risk.
If you have used the pill for a minimum of three months, your risk may be reduced. The longer youve been on the pill, the lower the risk can be. Risk is decreased further if the birth control has been the Depo-shot and its been used for more than three years.
Fertility Treatment or Infertility
If a woman has been diagnosed with breast cancer, she has an increased risk of getting diagnosed with ovarian cancer. This is why those who test positive for BRCA2 or the BRCA1 gene may decide on oophorectomy for preventative measures.
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What Are The Treatment Options For Postmenopausal Bleeding
The treatment offered will depend on the cause of the bleeding. For those with polyps, removal of the growths will need to be carried out by a specialist. Our Consultants are experts in removing those polyps under local anaesthetic.
Depending on the severity and type of endometrial hyperplasia, patients will either require hormone medications or a hysterectomy.
There are many different vaginal atrophy treatment options, including topical oestrogen, hormone replacement therapy and new, laser treatment therapies. If HRT is causing the bleeding, your GP may recommend you change your treatment or stop altogether.
Patients who have been tested and diagnosed with a sexually transmitted infection will be given antibiotics or other medications depending on the type of infection.
Common Causes For Post Menopausal Bleeding
What is post menopausal bleeding?What is the concern with post menopausal bleeding?What are the general causes of post menopausal bleeding -PMB?
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Heavy Bleeding During Menopause Is Not Normal Under Any Circumstances And Could Actually Mean Cancer Certain Cancers Can Cause Heavy Bleeding
Menopause means that you are no longer menstruating. So if youre bleedingone of two things is going on:
#1. Youre menstruating and are not going through menopause. Somehow, you mistakenly came to believe that you were undergoing the change. Menopause means no period. So if youre bleeding, youd better find out why.
Dr. Gino Tutera says that heavy bleeding during menopause is not normal, but adds that this would mean that a woman is entirely into menopause as evidenced by testing or having no menstruation for 12 months.
Dr. Gino Tutera is an OB/GYN and specialist in bioidentical hormone replacement therapy, and I interviewed him for this topic.
If you havent had lab testing, then its likely youve assumed that youre menopausal because youve missed several periods in a row.
But then some heavy bleeding occurs: menstruation. Or is it?
Why You Should See A Gynecologic Oncologist
When postmenopausal bleeding is diagnosed as endometrial cancer, most cases can be cured with a hysterectomy. However, because endometrial cancer can spread into the lymph nodes, many patients also should have a lymph node dissection at the time of hysterectomy. Gynecologic oncologists are specifically trained to perform this procedure when it is indicated.If only a hysterectomy is performed and it turns out the lymph nodes are at risk, were left with difficult decisions. Should the patient start radiation therapy, or should she go back into the operating room to perform the lymph node dissection? Seeing a gynecologic oncologist immediately after diagnosis can avoid these complications, simplifying care and improving the chance of survival.Its not always easy to travel to a gynecologic oncologists office. Dallas-Fort Worth residents are lucky in this respect, as there are a number of us in the area. I have patients who come from several hours away because were the closest available clinic. While making the trip to see a gynecologic oncologist may be inconvenient, its important for your care.
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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.
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Rare Causes Of Postmenopausal Spotting
Other potential causes of postmenopausal bleeding include:
- Infection of the uterine lining, known as endometritis
- Injury to the vagina from the insertion of foreign objects or sexual trauma
- Some medications, such as tamoxifen for breast cancer or blood-thinning medications
- Sexually transmitted infections such as chlamydia, gonorrhea, and herpes can cause postmenopausal bleeding.
- Menopausal hormone replacement therapy
- In some cases, cancer of the cervix and vagina can also cause postmenopausal spotting.
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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What Happens At Your Gp Appointment
The GP should refer you to hospital or a special postmenopausal bleeding clinic. You should not have to wait more than 2 weeks to see a specialist.
What happens at your hospital or clinic appointment
A specialist, who may be a nurse, will offer you tests to help find out what’s causing the bleeding and plan any necessary treatment.
The tests may include:
- a small device being placed in your vagina to scan for any problems
- an examination of your pelvis and vagina a speculum may be inserted into your vagina to hold it open, so the inside of the vagina and the cervix can be seen
- a thin, telescope-like camera being passed up your vagina, through the cervix and into your womb to look for any problems and to take a tissue sample for testing under local or general anaesthetic
- the specialist may press on your tummy and inside your vagina to check for lumps, tenderness or other abnormalities
What Are Some Risk Factors For Uterine Cancer
Women who get this disease are more likely than other women to have certain risk factors. A risk factor is something that increases the chance of developing the disease. Risk factors for uterine cancer include:
- being older than 50 years of age
- having endometrial hyperplasia an increase in the number of cells in the lining of the uterus
- using estrogen without progesterone
- being obese or having related conditions, such as diabetes or high blood pressure
- using tamoxifen to prevent or treat breast cancer
- having an inherited form of colorectal cancer
- having a history of endometrial polyps or other benign growths of the uterine lining
- never being pregnant or being infertile
- starting menstruation before age 12
- starting menopause after age 50
Other risk factors relate to how long a womans body is exposed to estrogen. Women who have no children, begin menstruation at a young age, or enter menopause late in life are exposed to estrogen longer and have a higher risk. The endometrium can be stimulated by the increased estrogen levels related to obesity, liver disease or other sources such as postmenopausal estrogen.
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