Menopause is defined as the absence of menses for one full year. For most women, this occurs between ages 45-55, with the average being 51 years old. Bleeding after menopause is never normal and should always be reported to your provider. In 95% of cases, the cause of bleeding is non-cancerous; however, postmenopausal bleeding is sometimes the first symptom of uterine cancer. Some causes of postmenopausal bleeding include the following:
- Endometrial or vaginal atrophy: This is when the lining of the uterus or vagina become so thin from lack of estrogen that it gets irritated and bleeds.
- Endometrial polyp: This is a non-cancerous growth that develops from tissue similar to the lining of the uterus. It can be attached to the uterus or in the cervix. If in the cervix, bleeding after intercourse is often a symptom.
- Fibroids: If there is a fibroid (a benign overgrowth of the uterine muscle) that grows into the lining of the uterus, then bleeding could occur.
- Hormonal effects: Use of estrogen with progesterone hormone replacement can sometimes lead to abnormal bleeding.
- Endometrial hyperplasia: This is an abnormal thickening of the uterine lining usually due to an excess of estrogen. This lining can sometimes become abnormal and eventually lead to cancer.
- Endometrial cancer
- Use of anticoagulation medications, like Coumadin, Lovenox or Heparin.
Anyone with postmenopausal bleeding should have an evaluation. Besides a pelvic examination, you can expect one or more of the following:
- Endometrial biopsy: A small sample of the lining of the uterus is taken using a small tube (like a very thin straw) that is inserted through the cervix. The sample is then thoroughly examined by a pathologist.
- Transvaginal ultrasound: Used to evaluate the uterus and ovaries
- Sonohysterogram: This is a special ultrasound where saline is injected into the uterus through a small tube to get an even clearer picture of the uterine lining.
- Hysteroscopy with D & C: This is an operation where a small camera is placed through your cervix in order to visualize the lining of the uterus. A sample of the lining is also usually obtained after dilating the cervix. You are under anesthesia for this procedure. Some patients even qualify for having this surgery done as an In Office Procedure at our Durant Road office.
Treatment for your abnormal bleeding is dependent on the cause and this can be discussed with your provider.