Bleeding after menopause: It’s not normal

 Matthew Carlson, M.D.
Matthew Carlson, M.D.

Too often I see women with advanced endometrial cancer (uterine cancer) who tell me they experienced postmenopausal bleeding for years but didn’t think anything of it. This shows we need to do a better job educating our patients about what to expect after menopause.

Women need to know postmenopausal bleeding is never normal, and it may be an early symptom of endometrial cancer. Any bleeding, even spotting, should trigger a visit to your doctor as soon as possible. Don’t wait to make an appointment until after the holidays or even next week. Do it today.

Why you shouldn’t ignore postmenopausal bleeding

A woman is considered to be in menopause after 12 consecutive months without a period. You may experience irregular bleeding leading up to menopause, a stage known as perimenopause. But once you’re in menopause, all vaginal bleeding should stop.

There are benign causes of postmenopausal bleeding. For 10 percent of women, however, the cause is endometrial cancer.

Early diagnosis offers the best chance to beat endometrial cancer. I urge women to treat postmenopausal bleeding as cancer until proven to be something else. I don’t say this to scare people, but a healthy amount of worry in this situation is warranted.

Causes of postmenopausal bleeding

A variety of conditions can cause postmenopausal bleeding, including hormone therapy, infection, or the use of medications such as blood thinners.

Some of the most common causes of postmenopausal bleeding are:

  • Cancer: Postmenopausal bleeding is a common symptom of endometrial cancer, but it also can be caused by cervical and vulvar cancer.
  • Endometrial atrophy: The tissue that lines the uterus can become very thin after menopause. As the lining thins, bleeding may occur.
  • Endometrial hyperplasia: Sometimes the lining of the uterus becomes thick, usually because of too much estrogen and too little progesterone. This is considered a precursor to endometrial cancer.
  • Fibroids: These growths develop in the uterine muscle tissue.
  • Polyps: These usually noncancerous growths can develop in the lining of the uterus.

To diagnose the cause of your postmenopausal bleeding, the doctor will perform a physical exam and may order one or more of the following tests:

  • Endometrial biopsy: A thin tube is inserted into the uterus and a tiny sample of the lining is removed. The sample is sent to the lab for examination.
  • Transvaginal ultrasound: An imaging device is inserted into the vagina to examine the pelvic organs.
  • Hysteroscopy: An instrument with a light and camera at the end, called a hysteroscope, is inserted into the vagina and through the cervix to examine the uterus.
  • Dilation and curettage (D&C): After enlarging the cervix, tissue is scraped from the lining of the uterus to be examined in a lab.

Treatment for postmenopausal bleeding depends on its cause. For example, if you have polyps, simply removing them may correct the problem. But if the diagnosis is cancer, you should seek care from a gynecologic oncologist.

Why you should see a gynecologic oncologist

When postmenopausal bleeding is diagnosed as endometrial cancer, most cases can be cured with a hysterectomy. However, because endometrial cancer can spread into the lymph nodes, many patients also should have a lymph node dissection at the time of hysterectomy. Gynecologic oncologists are specifically trained to perform this procedure when it is indicated.

If only a hysterectomy is performed and it turns out the lymph nodes are at risk, we’re left with difficult decisions. Should the patient start radiation therapy, or should she go back into the operating room to perform the lymph node dissection? Seeing a gynecologic oncologist immediately after diagnosis can avoid these complications, simplifying care and improving the chance of survival.

It’s not always easy to travel to a gynecologic oncologist’s office. Dallas-Fort Worth residents are lucky in this respect, as there are a number of us in the area. I have patients who come from several hours away because we’re the closest available clinic. While making the trip to see a gynecologic oncologist may be inconvenient, it’s important for your care.

Make your health a priority

Women are known to focus on their families first and put their own health second. But you can’t care for loved ones if you’re not healthy yourself. Listen to your body. Alert your doctor to any changes or abnormal issues – such as postmenopausal bleeding – as soon as possible.

Don’t stop seeing your general gynecologist for an annual exam when you hit menopause. Just because your reproductive years have ended doesn’t mean those body parts go away! Your cancer risk increases as you age, and your gynecologist can screen for the disease and help you manage any conditions caused by hormone changes.

If you’re experiencing postmenopausal bleeding or have any concerns about your gynecologic health, request an appointment online or by calling 214-645-8300.

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