Postmenopausal Bleeding

If you’re done with those bleeding, painful periods then congratulations and welcome to menopause. Menopause is the phase where women enter a pain-free and bleed-free stage which also means they become infertile. Menopause means a woman has not had menstruation for more than a year, which means absolutely no bleeding down there for more than a year. So, if any woman experiences even slight spotting or bleeding post menopause, ladies it is a serious issue and you need to consult a doctor immediately. This condition is termed in medical language as postmenopausal spotting or postmenopausal bleeding and can be triggered by numerous health related problems or issues, some of which can be deemed very serious.

In this article, let us have a look at some of the most common causes that can lead to postmenopausal spotting.

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  1. Polyps: appear as outgrowths in the uterus, inside cervical canal, or on the cervix which are usually non-cancerous and might be the reason for bleeding. Polyps account for 2-12 per cent for postmenopausal bleeding occurrences.
  2. Endometrial Atrophy: endometrium or the tissues lining the uterus sometimes becomes very thing post menopause due to lower estrogen levels. This may lead to unexpected bleeding. Endometrial atrophy along with vaginal and urogenital atrophies accounts for 60- 80% of all the causes of postmenopausal bleeding.
  3. Endometrial Hyperplasia: this is opposite of atrophy. In this case, endometrial lining becomes thick post menopause and becomes the cause of postmenopausal bleeding. Obesity can be a major culprit in causing endometrial hyperplasia. In some women with endometrial hyperplasia, abnormal cells tend to develop in the endometrium which can become cancerous leading to endometrial cancer. Endometrial hyperplasia accounts for 10% of postmenopausal bleeding cases.
  4. Endometrial cancer and cervical cancer: spotting or bleeding post menopause can be early indications of endometrial cancer or cervical cancer. Endometrial cancer account for 10% while cervical cancer accounts for 1% of postmenopausal bleeding cases.
  5. Other causes include hormone therapies, infection of the cervix of uterus, use of some types of medications like blood thinners, exogenous estrogen accounting for 15-25 per cent of cases, and other factors like anti-coagulants, vaginal trauma, and bleeding from non-gynecological areas.

 

Figuring out the Causes of postmenopausal bleeding

Women having postmenopausal bleeding must immediately consult a doctor. The doctor can find out what is the cause of such bleeding by looking into the patient’s medical history and conducting a physical exam coupled with few tests. Such tests may include:

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  1. Transvaginal ultrasound: this is an initial investigation which includes pelvic ultrasound to help assess endometrial thickness and evaluate pelvic pathology. It can be of two types- external ultrasound or internal ultrasound. In external one, the doctor uses a tiny hand held device named ‘transducer’ and moves it over the patient’s belly to examine her organs. An internal ultrasound is an imaging device which is inserted inside the women’s vagina to help the doctor look into her pelvic organs including the cervix, endometrium, uterus, and ovaries; and see if anything unusual is present. A 4-5mm thick endometrium is normal but if it increases to 20mm, it may pose a risk of endometrial cancer.
  2. Endometrial biopsy: this test is considered – gold standard for evaluating postmenopausal bleeding. The test is done using a thin tube or pipelle called endometrial pipelle, which is inserted into the uterus followed by removal of a small sample of the endometrial lining. This sample is then sent to a lab for examining purposes. This test is considered to be a rather sensitive device for identifying cancer or hyperplasia as compared to other testing devices.
  3. Saline-infused sonogram: salt solution is placed inside the uterus going through the cervix aided by a tiny, thin tube. The doctor looks inside the uterus with the help of sonogram to see for any masses or outgrowths within the endometrial lining. Saline-infused sonogram is often performed together with endometrial biopsy.
  4. Hysteroscopy: this takes photos of the patient’s endometrium, cervix, and uterus. A biopsy or sample of her endometrium might also be taken to carry out tests. The test involves putting a camera like device, which is narrow, long and called as a hysteroscope into the uterus through the vagina to take pictures. This method is done by administering general or local anesthesia.
  5. D&C or Dilation and Curettage: Dilation is made and a curette is used to scrape off parts of the woman’s endometrium to look for abnormalities and carry out analysis in a lab. This is done administering general anesthesia.

Ultrasound and biopsy tests can be done in a doctor’s chamber while D&C and hysteroscopy are generally performed in an outpatient surgical center or in a hospital.

 

How can Postmenopausal Bleeding be treated?

Treatment of postmenstrual bleeding highly depends on what is causing it.

If polyps are the culprit, then surgery is required to remove them whereas medication alone can treat endometrial atrophy.

 

Endometrial hyperplasia is treated with medicinal drugs like progestin otherwise progesterone therapy. Also, surgery can be done to do away with thickened parts of endometrium. Patients having endometrial hyperplasia need to get checked on regular basis.

  1. Polyps: appear as outgrowths in the uterus, inside cervical canal, or on the cervix which are usually non-cancerous and might be the reason for bleeding. Polyps account for 2-12 per cent for postmenopausal bleeding occurrences.
  2. Endometrial Atrophy: endometrium or the tissues lining the uterus sometimes becomes very thing post menopause due to lower estrogen levels. This may lead to unexpected bleeding. Endometrial atrophy along with vaginal and urogenital atrophies accounts for 60- 80% of all the causes of postmenopausal bleeding.
  3. Endometrial Hyperplasia: this is opposite of atrophy. In this case, endometrial lining becomes thick post menopause and becomes the cause of postmenopausal bleeding. Obesity can be a major culprit in causing endometrial hyperplasia. In some women with endometrial hyperplasia, abnormal cells tend to develop in the endometrium which can become cancerous leading to endometrial cancer. Endometrial hyperplasia accounts for 10% of postmenopausal bleeding cases.
  4. Endometrial cancer and cervical cancer: spotting or bleeding post menopause can be early indications of endometrial cancer or cervical cancer. Endometrial cancer account for 10% while cervical cancer accounts for 1% of postmenopausal bleeding cases.
  5. Other causes include hormone therapies, infection of the cervix of uterus, use of some types of medications like blood thinners, exogenous estrogen accounting for 15-25 per cent of cases, and other factors like anti-coagulants, vaginal trauma, and bleeding from non-gynecological areas.
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