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By definition, postmenopausal bleeding is a discharge that occurs
following the firm diagnosis of menopause, which is at least six
months from the end of a woman's last menstrual cycle, but not to
be confused with infrequent or irregular periods occurring around
the time of menopause.
Vaginal bleeding can be a light brown discharge, or it can be heavy,
red bleeding, and it may or may not include clots. It is possible
that mucus may accompany any occurrence of bleeding, and the discharges
may often vary in length, frequency, and intensity. The most important
factor, though, is that there is bleeding taking place, not the
type or the characteristics of the discharge.
There are no preventive measures that can be taken to treat postmenopausal
bleeding. Taking frequent lukewarm baths can help to relieve some
of the discomfort associated with the bleeding and relax tense muscles,
and there is no limit to how many times you can sit in a tub of
water for ten to fifteen minutes -- or longer if so desired. A heating
pad or hot water bottle can also be used by placing it on the abdomen
or back while relaxing. However, none of these are treatments for
the underlying problem, and serve only to help temporarily alleviate
some of the pain until such time as the patient can see a health
care provider.
The use of HRT (Hormone Replacement Therapy) is the most common
cause of postmenopausal bleeding. The supplemental estrogen produced
by the use of HRT causes the uterine lining to grow and subsequently
shed, causing a bloody discharge each month. This side effect is
completely normal for women taking HRT and doesn't require treatment,
although sometimes it can be controlled by adjusting the dosage.
Again, any bloody discharge needs to be brought to the attention
of your doctor and not ignored.
Women who are seriously overweight run a high risk of postmenopausal
bleeding since fat cells take the estrogen produced by the adrenal
gland and convert it to androgens, or male hormones.
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are a variety of other symptoms that can trigger postmenopausal
bleeding. When estrogen production stops, the vagina dries out and
atrophies, which is the most common cause of bleeding in the lower
reproductive tract. The vulva can also develop lesions and cracks
which may bleed. Bleeding can often occur following sexual intercourse
due to these issues, and with or without any associated infections.
A small number of women (around five to ten percent) may have postmenopausal
bleeding due to endometrial cancer or an issue related to its early
stages, thus the urgency in seeing your doctor as soon as any bloody
discharge occurs.
The patient can help her doctor diagnose her postmenopausal bleeding
by tracking the times, duration, frequency and amount of her discharges,
plus by keeping accurate records of all medications and supplements
she takes -- including estrogens and steroids.
Your doctor will probably want to perform a pelvic examination and
a PAP test, examine the vagina and vulva for signs of atrophy, plus
determine if there are indications of uterine polyps. More extensive
tests may be needed once the results of this examination are completed.
Depending on the outcome of the tests, your doctor may determine
an invasive procedure is necessary. This could be either a dilation
and curettage (D & C) or an endometrial biopsy. In the endometrial
biopsy, a relatively simple procedure that can be done in the office,
small samples are taken from the uterine lining, and a cervical
biopsy may also be taken at the same time. A D&C is typically
required in order to make a firm diagnosis, and can be done under
a local or a general anesthesia. Once the doctor has the results
from one or both of these procedures, additional tests can be ordered
if it is believed there may be a tumor present.
Vaginal probe ultrasound, a non-invasive procedure, can also be
used to test postmenopausal women experiencing bleeding. This procedure
measures the thickness of the endometrium.
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The chances of cancer are very minimal -- less than one percent
-- if the lining stripe is less than five millimeters thick. The
downside to the vaginal probe ultrasound is that polyps and fibroids
do not usually show up on it.
Another non-invasive procedure is Saline Infusion Sonography (SIS).
The uterus is injected with a saline solution by way of a catheter,
and then a vaginal probe is inserted. Abnormalities in the uterus
are more readily detected by filling it with the liquid solution.
Although these two non-invasive procedures are not as uncomfortable,
the D&C is still the best diagnostic tool in testing for uterine
cancer.
Surgery is required if the diagnosis finds cancer, and depending
on the location may include removing the uterus, cervix, ovaries,
and fallopian tubes. Tumors located in other parts of the body that
are producing estrogen or androgen will also require surgical removal.
Any postmenopausal bleeding that is not occurring due to cancer
but uncontrollable by treatment will typically require a hysterectomy.
A great many women are treated for postmenopausal bleeding using
hormones. If other methods fail to solve the bleeding, the removal
of the uterus by hysterectomy is usually the best solution, though
not completely free of complications. A lot of factors are involved,
including the type of cancer and the stage at which it was discovered.
There is no way to completely prevent postmenopausal bleeding, but
a woman can lower her risk of it occurring by keeping her weight
at a healthy level.
Even though a lot of women may experience some postmenopausal bleeding,
it's not considered normal and could indicate a more serious medical
issue. It is imperative that all instances of postmenopausal bleeding
be reported at once to your health care practitioner.
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