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.
Prolonged And Heavy Bleeding During Menopause Is Common
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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.
What Is A Typical Postmenopausal Bleeding Workup
Routine interventions include a bimanual pelvic examination, a pap smear if you are due, and an ultrasound for the evaluation of the lining of the uterus. And then often an endometrial biopsy is recommended, as quickly as possible. Through these procedures, a practitioner might discover on occasion that the bleeding is the result of a tear in the vaginal wall or from the urethra instead of the uterus. The ultrasound can evaluate the thickness of the uterine wall and lining, and confirm that the ovaries and fallopian tubes look the way they should. What does that all mean? While you are probably familiar with what a pelvic exam, pap smear and even ultrasound are, an endometrial biopsy might sound alarming but it shouldnt scare you. Lets take a look at whats involved.
The word biopsy can strike fear in your heart but remember that a biopsy is often one of the best ways to evaluate a situation. In this case, your provider needs to look at the intrauterine tissue to determine the cause of postmenopausal bleeding. The procedure isnt terribly complicated; often it can be performed right at your gynecologists office. Sometimes, an endometrial biopsy is also used after a particular type of abnormal Pap test, if there are endometrial cells on the pap, for example.
How is an endometrial biopsy done and how can I prepare for one?
What happens after the biopsy?
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.
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
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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.
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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What Is Vaginal Bleeding After Menopause
Bleeding after Menopause is also called as Post-Menopausal Bleeding . After reaching your menopausal stage, in rare cases you begin to bleed again. It may be confusing in a womans point of view and somehow frightening because of its occurrence.
If a woman already reached her menopausal stage, it is expected that the regular menstruation will stop. But in some cases, bleeding after menopause occurs due to certain underlying factors.
Why Am I Bleeding Again Common Causes And Treatments For Postmenopausal Bleeding
Imagine making it through menopause a whole year without a period then suddenly start bleeding again. You may find that surprising, but postmenopausal bleeding happens more often than you might think.
I have many women come to me confused and frightened understandably so. They feel that something serious might be wrong. After all, how could this happen if theyve gone through menopause already?
Heres an important note: if youve had a period within the past year you arent through menopause yet, no matter how infrequently those periods come. But if you begin to spot or get what feels like a period after more than a year with no bleeding, theres no need to panic.
Be sure to see your health care provider as soon as possible to calm your fears about this sudden bleeding. However, as I will go over in this article, quite often there is a reasonable explanation for this postmenopausal bleeding.
This time of life can bring a host of symptoms directly related to lifestyle issues, and postmenopausal bleeding is no exception. Sudden bleeding or spotting is often a message from your body; its asking you to slow down and take a closer look at your life, and how you are taking care of yourself. Lets examine some things that cause bleeding after menopause, and talk about what you should do if it happens to you.
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Preventing Bleeding After Sex
Determining how to prevent postcoital bleeding depends on what has caused bleeding for you in the past.
For most people, using water- or silicone-based lubricants will help prevent bleeding caused by vaginal dryness and friction during sex. If youre using condoms, an oil-based lubricant can damage it. Water-based lubricants are recommended.
It may also help to take sex slowly and to stop if you feel pain. Using vaginal moisturizers regularly can help keep the area moist and make you feel comfortable.
If your symptoms of postcoital bleeding are related to a medical condition, you can talk to your doctor about the best options to prevent future episodes.
What Can Cause Vaginal Spotting 10 Years After Menopause
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Is Vaginal Bleeding An Early Sign Of Pregnancy
No, vaginal bleeding is not an early sign of normal pregnancy. If you are pregnant and experience vaginal bleeding, you should visit your OBGYN for evaluation. Vaginal bleeding can be caused by many things other than pregnancy, including sexually transmitted infections, uterine growths called fibroids, and certain types of cancers.
Learn More About Post
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Dr Rebecca Grainger
Rheumatologist & researcher, University of Otago, Wellington
I was really impressed because health is covered in its entirety. Its a very useful site for clinicians or anyone interested in gaining knowledge around the current status of indigenous wellbeing here in Aotearoa.
Health Navigator is an excellent ‘go-to’ site for New Zealanders. The articles are well written and very clear to understand. They provide enough information to make an informed choice as to where to go next. An excellent resource.
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What You Can Do
Consider keeping a journal to track your periods. Include information such as:
- when they start
- whether you have any in-between spotting
You can also log this information in an app, like Eve.
Worried about leaks and stains? Consider wearing panty liners. Disposable panty liners are available at most drugstores. They come in a variety of lengths and materials.
You can even buy reusable liners that are made of fabric and can be washed over and over again.
A skipped period can also cause the lining to build up, leading to heavy bleeding.
Bleeding is considered heavy if it:
- soaks through one tampon or pad an hour for several hours
- requires double protection such as a tampon and pad to control menstrual flow
- causes you to interrupt your sleep to change your pad or tampon
- lasts longer than 7 days
When bleeding is heavy, it may last longer, disrupting your everyday life. You may find it uncomfortable to exercise or carry on with your normal tasks.
Heavy bleeding can also cause fatigue and increase your risk for other health concerns, such as anemia.
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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What Does The Color Mean
Although the vagina has less moisture after menopause, you might still have some discharge. This is perfectly normal.
A thinner vaginal lining is more easily irritated and more vulnerable to infection. One clue that you have an infection is a thick, yellow-white discharge.
Fresh blood looks bright red, but older blood turns brown or black. If you notice spots of brown or black in your underwear, its most likely blood. The discharge may be lighter in color if you also have yellow or white discharge due to infection.
A variety of things might cause brown spotting after menopause.
How Can I Prevent Postmenopausal Bleeding
In some circumstances, there is nothing a woman can do to prevent bleeding after menopause. It can be a crucial message your body is sending that something just isnt right. But often, there are steps you can take to avoid the conditions that cause these bleeding events.
Maintaining hormonal balance
When hormones are at play, there are some relatively simple lifestyle changes that can keep your hormones balanced, thus avoiding one of the most common conditions that leads to bleeding after menopause:
- Eat as well as you can. Make sure your body is getting the nutrients it needs by choosing fresh vegetables, lean protein, and healthy fats.
- Get up and move. Staying active can be instrumental in keeping your body balanced and healthy.
- Relax. Taking time for self-care is crucial. Find ways to relieve the stress of everyday life. Yoga, meditation, deep breathing, or regularly indulging in activities you love can go a long way towards stress reduction.
- Supplementation. You can prevent on overabundance of estrogen by giving your body some natural endocrine support.
- Minimize exposure to xenoestrogens. Pay attention to how often you expose your body to chemicals that can wreak havoc on your hormones. Perfumes, cleaning products, even cash register receipts may impact your hormonal balance, so go natural any chance you can.
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Prevention Of Bleeding After Menopause
In order to prevent bleeding after menopause, the best way is to reduce the risk factors that lead to it. The other preventive methods are:
- Use of pads and regular change of pads during menstruation which reduce the chances of infection.
- Safe and hygienic sexual intercourse and use of condoms to avoid sexually transmitted diseases that can cause bleeding after menopause
- Constantly watching over vaginal dryness and maintaining accurate pH levels
- Maintaining a healthy body to avoid obesity by exercise and healthy diet
- Regular checkups with gynecologists to ensure a healthy uterus
- Treatment for Postmenopausal bleeding should be done early to prevent cancer.
Can Fibroids Cause Bleeding After Menopause
Dr. Jessie: Yes, although this is unusual. Most fibroids shrink after menopause and become less symptomatic than they were prior to menopause.
Fibroids that are pushing in to the cavity of the uterus can certainly cause post-menopausal bleeding, but I usually see this in patients who are in their early 50s; they think they are not menopausal because they continue to bleed, but the bleeding is actually coming from the fibroid and not a hormonal cycle.
I dont usually see bleeding from fibroids starting up when a woman is already well in to menopause. If you know you have fibroids and are having bleeding after menopause, I would definitely recommend a visit to your doctor rather than writing the symptoms off as coming from the fibroids. Very rarely, women can develop a fibroid-related uterine cancer called a sarcoma.
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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.
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.
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