Vaginal bleeding or postmenopausal bleeding is an important issue for woman. It occurs in approximately 4 to 11 percent of postmenopausal women.
Menopause is defined as one year after your last menstrual cycle. Any bleeding, even a little spotting, after menopause is considered abnormal and should be reported to your primary physician or OB/GYN. Many women underestimate a little spotting and delay reporting this abnormality.
The causes of postmenopausal bleeding are vast. They can range from benign causes to cancer. Benign causes include hormone replacement therapy, growths in the uterus such as polyps or fibroids, endometrial atrophy or thinning of the lining of the uterus, endometrial hyperplasia or thickening of the lining of the uterus. Postmenopausal bleeding can also occur from medications such as blood thinners, herbal or dietary supplements, infection and other cancers.
Uterine cancer accounts for about 10 percent of the cases of postmenopausal bleeding. According to the Centers for Disease Control and Prevention, uterine cancer is the fourth most common cancer in women. It is the most common cancer of the gynecological cancers. Approximately 45,000 women in the United States are diagnosed with uterine cancer each year, and about 4,800 of these women will die.
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When you see your physician, she will take a detailed history on the bleeding. Expect to be asked when it started, if there’s a pattern, are there any other associated symptoms, what medications including herbal supplements you are taking and if there is any family history of cancers. If you haven’t had a recent pap smear, this test should be performed. You might also get an ultrasound to check the lining of the uterus and to see if there are any tumors or masses. Another test that is often performed is an endometrial biopsy. During this test, a sample of the lining of the uterus is sent off to the lab to be evaluated for cancerous changes.
Treatment of postmenopausal bleeding will be determined by the cause of the bleeding. Polyps and fibroids can be removed with surgery. Endometrial atrophy and endometrial hyperplasia can be treated with certain medications. In the case of medications being the cause, the medication can be changed or adjusted. If the cause of the bleeding is determined to be cancer, you will be referred to a gynecologist or gynecologic oncologist. A complete hysterectomy, or removal of the uterus, cervix and ovaries, will be scheduled. Patients with more advanced cancer may also require radiation or chemotherapy.
There is no way to determine who will get uterine cancer, but there are some factors that put a woman at risk. These factors include age over 50, obesity, trouble getting pregnant, having fewer than five periods a year, taking estrogen alone in a woman who still has her uterus, taking Tamoxifen or having a family history of uterine or ovarian cancer.
Vaginal bleeding after menopause is not normal. Any bleeding, regardless of how light, should be reported to your doctor. It is very possible that there is a benign reason for the bleeding. If it is determined to be cancer, the sooner you report the bleeding and receive treatment, the more likely you are to have a complete recovery.
Kristen Ewy, PA-C, specializes in internal medicine with Kansas Physician Group.