Postmenopausal hemorrhage | Definition and education of the patient



What is menopausal hemorrhage?


Postmenopausal bleeding occurs in a woman's vagina after she has gone through menopause. Once a woman has spent 12 months without a period, she is considered to be in menopause.


To rule out serious medical problems, women with postmenopausal bleeding should always see a doctor.


What is vaginal bleeding?


Vaginal bleeding can have a variety of causes. These include normal menstrual cycles and postmenopausal bleeding. Other causes of vaginal bleeding include:



  • trauma or assault

  • cervical cancer

  • infections, including urinary tract infections


If you experience vaginal bleeding and are postmenopausal, your doctor will ask about the duration of the bleeding, the amount of blood, any additional pain, or other symptoms that may be relevant.


Because abnormal vaginal bleeding can be a symptom of cervical, uterine or endometrial cancer, you should get any abnormal bleeding evaluated by a doctor.


What causes postmenopausal bleeding?


Bleeding can occur in postmenopausal women for several reasons. For example, women who take hormone replacement therapy may have vaginal bleeding for a few months after starting hormones. It is also possible that a woman who thought she was in menopause begins to ovulate. If this happens, bleeding may also occur.


There are a variety of other conditions that can cause postmenopausal bleeding.


Some common causes include: polyps, endometrial hyperplasia and endometrial atrophy.


Uterine polyps


Uterine polyps are non-cancerous growths. Although benign, some polyps can become cancerous. The only symptom that most patients with polyps will experience is irregular bleeding.


Uterine polyps are particularly common in women who have gone through menopause. However, younger women can also get them.


Endometrial hyperplasia


Endometrial hyperplasia is the thickening of the endometrium. It is a potential cause of postmenopausal bleeding. It often occurs when there is an excess of estrogen without enough progesterone. It occurs frequently in women after menopause.


Prolonged estrogen use may increase the risk of endometrial hyperplasia. Ultimately, it can lead to cancer of the uterus if left untreated.


Endometrial cancer


Endometrial cancer begins in the uterus. The endometrium is a layer of the uterus. In addition to abnormal bleeding, patients may experience pelvic pain.


This condition is often detected early. It causes abnormal bleeding, which is easily noticed. The uterus can be removed to treat cancer in many cases. About 10 percent of women who have postmenopausal bleeding have endometrial cancer.


Endometrial atrophy


This condition causes the lining of the endometrium to become too thin. It can occur in postmenopausal women. As the coating becomes thinner, bleeding may occur.


Cervical cancer


Bleeding after menopause is often harmless. However, it can also be a rare sign of cervical cancer. Cervical cancer tends to progress slowly. Doctors can sometimes identify these cells during a regular exam.


Annual visits to the gynecologist can help with early detection and even prevention of cervical cancer. This can be done by monitoring abnormal Pap tests.


Other symptoms of cervical cancer can include pain during intercourse or abnormal vaginal discharge, even in postmenopausal women.


Symptoms of postmenopausal bleeding.


Many women who experience postmenopausal bleeding may not have other symptoms. But the symptoms may be present. This may depend on the cause of the bleeding.


Many of the symptoms that occur during menopause, such as hot flashes, often begin to diminish during the postmenopausal period. However, there are other symptoms that postmenopausal women may experience.


The symptoms that postmenopausal women may experience include:



  • vaginal dryness

  • decreased libido

  • insomnia

  • stress incontinence

  • increase in urinary tract infections

  • weight gain


How is postmenopausal bleeding diagnosed?


A doctor can perform a physical examination and a medical history analysis. They can also perform a Pap test as part of a pelvic exam. This can detect cervical cancer.


Doctors can use other procedures to see inside the vagina and uterus.


Transvaginal ultrasound


This procedure allows doctors to see the ovaries, uterus and cervix. In this procedure, a technician inserts a probe into the vagina or asks the patient to insert it herself.


Hysteroscopy


This procedure shows endometrial tissue. A doctor inserts a fiber optic endoscope into the vagina and cervix. The doctor then pumps carbon dioxide gas through the scope. This helps to expand the uterus and makes the uterus easier to see.


How is postmenopausal bleeding treated?


Treatment depends on the cause of the bleeding, whether the bleeding is heavy and the presence of additional symptoms. In some cases, bleeding may not require treatment. In other situations where cancer has been ruled out, treatment may include the following:



  • Estrogen creams: your doctor may prescribe estrogen cream if your bleeding is due to thinning and atrophy of your vaginal tissues.

  • Removal of polyps: the removal of polyps is a surgical procedure.

  • Progestin: Progestin is a hormone replacement therapy. Your doctor may recommend it if your endometrial tissue is too full. Progestin can decrease excessive tissue growth and reduce bleeding.

  • Hysterectomy: bleeding that can not be treated less invasively may require a hysterectomy. During a hysterectomy, your doctor will remove the patient's uterus. The procedure can be performed laparoscopically or by conventional abdominal surgery.


If the bleeding is due to cancer, the treatment will depend on the type of cancer and its stage. Common treatment for endometrial or cervical cancer includes surgery, chemotherapy, and radiation therapy.


Prevention


Postmenopausal bleeding may be benign or may be the result of a more serious condition such as cancer. Although you may not be able to prevent abnormal vaginal bleeding, you can quickly seek help to get a diagnosis and treatment plan, no matter what the cause. When cancers are diagnosed early, the chances of survival are greater. To prevent abnormal postmenopausal bleeding, the best strategy is to reduce your risk factors for the conditions that could cause it.


What you can do



  • Treat early endometrial atrophy to prevent progression in cancer.

  • Visit your gynecologist for regular exams. This can help detect conditions before they become more problematic or cause postmenopausal bleeding

  • Maintain a healthy weight, follow a healthy diet and exercise regularly. This can only prevent a variety of complications and conditions throughout the body.

  • If your doctor recommends it, consider hormone replacement therapy. This can help prevent endometrial cancer. However, there are drawbacks that you should consult with your doctor.


What is the perspective for postmenopausal bleeding?


Postmenopausal bleeding is often treated successfully. If your bleeding is due to cancer, the prognosis depends on the type of cancer and the stage in which it was diagnosed. The five-year survival rate is around 82 percent.


Regardless of the cause of the bleeding, maintain a healthy lifestyle and continue to visit your gynecologist regularly. They can help detect any other condition from the beginning, including cancer.



Reference: https: //www.healthline.com/health/postmenopausal-bleeding






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