Many women consider post menopausal bleeding (vaginal bleeding after menopause) to be normal. However, the condition can be extremely dangerous and would need to be checked by a qualified physician immediately to rule out harmful medical anomalies like endometrial cancer. Almost all cases of post menopausal bleeding are considered to be endometrial cancer until proved otherwise.
Post menopausal bleeding is a condition that is characterized by vaginal bleeding after a year of attaining menopause. For ex: if you have gone without periods for more than a year and then experience vaginal bleeding all of a sudden, you may be suffering from postmenopausal bleeding.
And while there may not be a specific reason for a woman to get post menopausal bleeding, she may be more prone to the condition if she has PCOS (polycystic ovarian syndrome) or colorectal carcinoma (non polyposis in nature); is obese or takes medications like tamoxifen, oral contraceptives and exogenous estrogens etc. on a regular basis.
Common Causes for Post Menopausal Bleeding
A woman may suffer from post menopausal bleeding due to one or more of the following reasons.
Hormonal imbalances are very common during menopause. The changes in the hormonal levels in the body can trigger unexpected vaginal bleeding. In certain cases, women who reduce or stop hormone replacement therapies would also experience hormonal imbalances which could lead to shedding of the existing endometrial lining. This is considered perfectly normal in most cases.
Usually non-cancerous, uterine (or) endometrial polyps are small growths that attach to the inner uterine or vaginal wall. In certain cases, these polyps may detach from these areas and cause bleeding as they move out of the body.
In this case, the endometrial lining would become very thick (usually due to the presence of excess estrogen and the absence of sufficient progesterone) and would cause bleeding if it detaches itself from the uterus. In rare cases, endometrial hyperplasia could lead to endometrial cancer.
As opposed to endometrial hyperplasia, endometrial atrophy is said to occur when the endometrial lining becomes too thin to hold onto the uterus. This can lead to shedding which in turn can lead to post menopausal bleeding.
Sudden Weight Loss
Sudden weight loss triggered by normal or surgical means can lead to post menopausal bleeding in certain cases. When a woman loses weight suddenly, the estrogen present in the fat stores gets liberated into the blood stream. This may cause unexpected vaginal bleeding. In certain cases, sudden weight loss can shift the estrogen-progesterone balance in the body, leading to vaginal bleeding after menopause as well.
Women who are insulin resistant would tend to have more estrogen in their body. This would lead to a shift in the estrogen-progesterone ratio in the body. And this would usually lead to conditions like post menopausal bleeding.
Some of the other common causes for post menopausal bleeding would include uterine (or) cervical infections, blood thinning medications, uterine (or) vaginal bleeding disorders, uterine/ovarian/vaginal/cervical/vulvar carcinoma, uterine sarcoma, trauma, emotional stress or endometrial cancer.
Diagnosis of Post Menopausal Bleeding
Post menopausal bleeding (and the reason for the condition) can be diagnosed with one or more of the following tests. In most cases, these tests would be followed by questions pertaining to the patient’s medical history and existing physical symptoms. A physical examination would also be conducted before commencing the other tests.
The Tests Include
A transvaginal ultrasound is carried out by inserting a special wand like device into the vagina and uterus. The tip of the wand would disperse HF sound waves which would relay back images of the pelvic organs (including the uterine walls, fallopian tubes and the ovaries etc.).
The images would be displayed on a computer screen and would help the doctor check for medical abnormalities if any in the region that could be causing the condition.
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A hysteroscopy would involve the use of a device called the hysteroscope which would resemble a thin tube with a tiny light and camera attached to the tip. The device is inserted into the uterus via the vagina and relays back images of the uterine walls and cavity to the doctor who can check for possible problems causing the bleeding.
In this method, a thin straw like tube with a loop at the end is inserted into the uterus via the vagina. The loop at the end of the device is used to scrape the uterine wall for a small sample of the endometrial lining. The biopsy device is usually used in conjunction with a hysteroscope which would aid the doctor in choosing the best spot inside the uterus to get a sample. Retrieved samples are then sent to the lab for clinical evaluation and diagnosis.
Dilation and Curettage (D&C)
A D&C would involve the removal of a part of the tissue from the endometrial lining. This test is usually preferred when the doctor needs more than just a small sample of the uterine lining.
A D&C would mostly be performed at a surgical center or hospital. And the retrieved tissue would be sent to a medical lab for diagnosis.
Treatment options for Post Menopausal Bleeding
Much of the treatment for post menopausal bleeding lies in finding out the exact cause of the condition. If the bleeding is caused by conditions like endometrial atrophy or endometrial hyperplasia, the doctor would recommend medications to treat the condition. In the case of endometrial hyperplasia, the doctor may also recommend hormone replacement therapies like progesterone therapy or surgical removal of the thickened uterine lining. Both endometrial atrophy and endometrial hyperplasia would require frequent monitoring by the doctor to check for progress (reduced vaginal bleeding).
If the cause for post menopausal bleeding is attributed to uterine polyps, the doctor would recommend medications to reduce the polyps or surgery to remove them completely. In case the bleeding is attributed to a more serious condition like endometrial cancer, the doctor would recommend a hysterectomy to remove all or part of the uterus (including the ovaries, fallopian tubes, vagina and cervix) in order to prevent the disease from spreading to other parts of the body. In certain cases, some lymph nodes present near the uterus would also be removed. This is usually followed by radiation, chemotherapy and hormone therapy sessions in case the condition is very severe.
You may experience post menopausal bleeding due to a miniscule problem like uterine polyps. However, you can also experience post menopausal bleeding due to a serious condition like endometrial cancer. A quick diagnosis and treatment would ensure that you successfully prevent post menopausal bleeding and the condition causing it. So don’t be negligent if you experience bleeding after menopause. Rush to the doctor immediately to have it checked out and treated. This way, you can recover from the condition quicker and better.
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