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Causes and treatments for postmenopausal bleeding

Menopause does not have a start and end date. It occurs in stages. The first stage is called perimenopause, which can last for a few years depending on the individual. It is then followed by menopause. Once a woman has missed her period for 12 consecutive months, she is in the menopausal stage. From there on post menopause comenses.

Menopause takes place as a consequence of your hormones declining typically in your 40s and 50s. Menopause basically means your periods have stopped for a long period of time, at least a year. So ideally there must be no bleeding. However, there might be instances where you might go through vaginal bleeding. If you’re already in menopause, you might want to visit your doctor and get it checked out. It could be abnormal bleeding caused due to a variety of reasons.

While spotting is not cause for concern, heavy bleeding or bleeding that starts right after you have had sex, might indicate you should get it checked out by a professional. More often than not, it could be caused by factors other than your periods, in which case the source of the problem must be identified to remedy it.

Causes

There can be several causes for postmenopausal bleeding. Some of these reasons might include:

Endometrial atrophy 


Menopause starts when the hormones secreted in your uterus begin to decline. These hormones usually consist of oestrogen and progesterone. When the level of oestrogen in your body starts to fall, it not only triggers the beginning of menopause, but it might also cause your endometrial lining to become thin. This could lead the lining of your endometrium to bleed which could result in postmenopausal bleeding. 

Endometrial hyperplasia


If you’re affected by this condition, the lining of your uterus could gradually become thicker instead of thinning, which could lead to irregular or quite heavy bleeding. Menopause is known to cause a hormonal imbalance. In case the level of oestrogen in your body exceeds its counterpart, progesterone, it might lead to the development of this condition. There have been cases reported of endometrial hyperplasia developing into endometrial cancer. So if you do experience bleeding, especially on the heavy side, you might want to get it looked at by a doctor immediately. 

Endometrial cancer


It is a form of cancer that takes place in your endometrial lining. Research shows approximately 10 percent of women experiencing heavy postmenopausal bleeding might be caused by endometrial cancer. 

Polyps


Development of growths on your uterus lining are known as polyps. While they might not often lead to the development of cancer, they can cause heavy or unusual bleeding. The cervical canal can at times witness these growths. Bleeding after sex is usually caused by polyps. 

There are other possible causes that might trigger postmenopausal beeding. Although the likelihood of their occurrence is statistically rare. These include bleeding from your urinary tract, problems in clotting, pelvic trauma and thyroid disorders. It might also be caused by an infection developing in the lining of your uterus, which is called endometritis.


Tamoxifen, a hormone medicine can have side effects that includes postmenpausal bleeding. Hormone replacement therapy can cause similar bleeding instances in postmenopausal women, esepcially during the initial 6 months. 


Even though the cause of your postmenopausal bleeding does not turn out to be severe, it is still in your best interest to visit a doctor once you start experiencing it. The doctor could not only help you curb the bleeding, but also catch any ailments you might be suffering from. 

Diagnosis

You should keep a note of all the symptoms you might be experiencing, as your doctor will first want to know them before starting an examination for the cause of your postmenopausal bleeding. The questions your doctor might have for you can include the timeline when you first started to notice these symptoms. The amount of bleeding and if your family history includes postmenopausal bleeding, can be some of the questions the doctor might need answered before making a diagnosis.


After taking into account the symptoms you are suffering from, the doctor might recommend some follow up tests.

A few of the tests your doctor might suggest to confirm the cause of your postmenopausal bleeding include:

Dilation and curettage


Your cervix is widened or dilated so as to get a tissue sample of large proportion. Hysteroscope, a tool specially designed for this purpose is inserted to take a look inside your uterus. This can be very beneficial in spotting any growths that could potentially be dangerous. 

Endometrial biopsy


A sample of the lining tissue of your uterus is obtained by inserting a thin and tiny tube through your vagina in order to reach the cervix. The tissue is then tested to identify any abnormal growth that could be cancerous cells. 

Hysteroscopy


The inside of your uterus along with its lining is examined using a very thin and lighted camera that is attached to a tool which a doctor inserts into your vagina. It is greatly beneficial in identifying abnormal growths as well as polyps. 

Sonohysterography


This test includes injecting fluid into your uterus through your vagina. An ultrasound machine will then be used to get a visual of your uterus. An ultrasound machine differentiates between various types of tissues using sound waves. This procedure is called transabdominal ultrasound. It is an efficient way for your doctor to determine if the lining of your uterus is more on the thinner or thicker side. 

Transvaginal ultrasound


An ultrasound probe designed especially for such purposes is inserted into the vagina. Doing this helps the doctor get a good picture of your uterus from its bottom, instead of from the position of your lower abdomen. 

Your doctor might have the tools and facilities to conduct most of these tests right at the clinic. 

However there are a few tests like the D and C that might require you to pay a visit to a surgery center or a hospital.

Treatment options

There is no fixed treatment that can be considered a cure all. Treatments might vary based on the cause that is leading to your postmenopausal bleeding.


The information your doctor gleans from your tests can help chart the best treatment plan to help with your specific condition. 

Some of these treatments can include: 

Polyps


Your doctor might suggest you to get your polyps surgically removed as a treatment to curb postmenopausal bleeding. 

Endometrial cancer


The usual course of treatment to treat endometrial cancer is to perform a procedure called hysterectomy. It involves the removal of your entire uterus along with any lymph nodes that might have grown nearby to which the cancer could have spread. If the cancer is widespread, a round of chemotherapy or radiation treatments can also be recommended by the doctor. 

Endometrial hyperplasia


Progestins are the medications prescribed if you have been suffering from this condition. They avoid your endometrial lining from thickening. There is a possibility that your doctor might ask you to get tested for cancerous cells within the uterus to rule out the possibility of endometrial cancer. These types of tests might have to be regular to make sure you’re healthy. 

If the cause of your vaginal bleeding is the result of your endometrial tissue thinning, you might be recommended vagianl oestrogen by your doctor. This course of treatment is known to minimise the side effects of your tissues thinning, which include postmenpausal bleeding.

Approximately 4 to11 percent are a victim to vaginal bleeding once menopause has passed. While it is fairly common to experience vaginal bleeding before menopause commences, especially during perimenopause, it is highly unusual and could be cause for concern in the postmenopausal stage. While it might not always be caused by something serious like endometrial cancer, you might still want to pay your doctor a visit and get it checked out. 

The diagnosis does not have to be made through invasive tests. Usually they can perform tests during your regular visit to the doctor. It can help map out a treatment plan that is customised for the needs of your body and can help you get better faster.

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