What to do if you have postmenopausal bleeding?

Postmenopausal bleeding is defined as any bleeding or spotting that occurs after one year of stopping menstrual cycles (periods). The normal age of menopause can vary from 40 to 55 years in the Indian population and is largely dependent on genetic makeup.

According to Dr. Geeth Monnappa, consultant obstetrician and gynecologist, Fortis La Femme Hospital, Richmond Road, Bengaluru, spotting or bleeding is a big concern after menopause. “Any amount of bleeding after menopause requires a full evaluation by a gynecologist,” she says.

So, does this mean that all women with postmenopausal bleeding have cancer?

“No. Cancer cells are detected in 1 in 10 women with postmenopausal bleeding or spotting. Most often, postmenopausal bleeding occurs due to the thinning of the inner lining of the uterus due to ‘a lack of female hormones after menopause (atrophic endometrium), or due to a thin vagina (atrophic vagina) that bleeds after sex, ”says Dr Monnappa.

Other causes of postmenopausal bleeding include:

1. Endometrial / cervical polyps: growth of non-cancerous or cancerous tissue in the uterus that must be removed for further evaluation.
2. Hormone replacement therapy.
3. Endometrium thickened.
4. Cancer of the pelvic organs.
5. Anticoagulants. Patients taking blood thinners for various medical conditions may have episodes of postmenopausal spotting or bleeding.

What factors increase the likelihood that a woman with postmenopausal bleeding will develop cancer?

* Overweight and Obesity: These women are more likely to have a thick endometrium and cancer.
* Hormone replacement therapy.
* Oral estrogen therapy.
* Family history of uterine, ovarian and breast cancer.

“As cancers occur in women despite the absence of risk factors, it is important that every woman with postmenopausal bleeding meets with her gynecologist for further evaluation,” advises the doctor.

What can you expect during a consultation with a gynecologist?

The patient may be asked to share a detailed history regarding symptoms and medications, followed by a physical examination.

– smear: This is a test where a doctor inserts an instrument into your vagina to view the cervix and takes a swab which is then sent for microscopic evaluation for the detection of cancer cells.

– Transvaginal ultrasound: A probe is inserted into the vagina for better visualization of the uterus and ovaries. The thickness of the endometrium is noted, which should be less than 4 mm after menopause.

If the ultrasound shows a thickened endometrium, further evaluation with an endometrial sample on an outpatient basis or a hysteroscopic assessment on an outpatient basis or under anesthesia with an endometrial sample will be suggested by your gynecologist, specifies the doctor.

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