Postmenopausal Bleeding Causes, Diagnosis, and Treatment

Understanding Postmenopausal Bleeding

Postmenopausal bleeding (PMB) is a condition that affects women who have already attained  menopause.

 It is defined as any vaginal bleeding occurring at least 12 months after a woman’s last menstrual period. 

While it may not always indicate a serious health issue, postmenopausal bleeding should never be ignored, as it can sometimes be a sign of underlying medical conditions, including uterine cancer.

What Causes Postmenopausal Bleeding?

1. Thinning of vaginal lining; This thin lining has thin blood vessels which break easily due to friction or pressure
2. Endometrial hyperplasia; here the inner uterine lining becomes thick; and can bleed after menopause .
3. Endometrial and cervical polyps; 95 to 99% of the polyps are benign; these growths in the uterus can cause bleeding. 
4. Uterine fibroids;  sometimes small fibroids can undergo degeneration and cause PMB.
5. Uterine prolapse; especially with stage 3 prolapse; when cervix or vaginal wall may get ulcerations that bleed on friction of pressure.  
6. Infections
7. Cancer; cancer of cervix or body of uterus

Other uncommon causes

1. When bleeding happens from urine or stool can be mistaken for vaginal bleeding.
2. Use of hormone replacement therapy
3. Injury

Thus postmenopausal bleeding can happen due to many benign conditions; but still it requires prompt evaluation by your gynecologist for further management.

When to See a Doctor for Postmenopausal Bleeding

Postmenopausal bleeding  may range from mild spotting; minimal staining or bleeding; heavy bleeding or blood stained white  discharge. 

Any such episode of vaginal bleeding after menopause must  be evaluated by a healthcare provider. Although the cause may be benign, it is important to rule out serious conditions like cancer. Seek immediate medical attention if you experience:

• Heavy bleeding or prolonged spotting
• Bleeding accompanied by pelvic pain
• Unexplained weight loss
• Pain during intercourse
• Chronic white discharge with blood stains. 

Diagnosis of Postmenopausal Bleeding

To determine the cause of postmenopausal bleeding, doctors may perform several diagnostic tests, including:

• Pelvic Exam: A physical examination of the pelvic organs to check for abnormalities. Senile vaginitis is accurately diagnosed by your gynecologist directly looking at the tissues. 
• Transvaginal Ultrasound: A detailed sonography to evaluate the thickness of the endometrium or to document the presence of polyps. 
• Endometrial Biopsy: A procedure to collect a small sample of uterine tissue for testing.
• Hysteroscopy: A minimally invasive procedure using a small camera to examine the uterus. This can be combined with D and C . 

Office hysteroscopy is another OPDprocedure to look inside the uteruswithout having the need to get admitted and undergo anesthesia. OPD based endometrial sample collection can also be done when apparent diagnosis requires minimal sampling . This saves time and admission. 

Treatment Options for Postmenopausal Bleeding

Treatment depends upon the cause.

1. Diagnose the cause by physical examination by your gynecologist. Do ultrasonography;   hysteroscopy and biopsy by D and C may be needed to find the cause.
2. If it has resulted due to thinning of vaginal  tissues; local estrogen creams may help in short term. Now a days non hormonal creams like iseren are  also available to control the symptoms.  
3. If endometrial hyperplasia s present; hysteroscopy and D and C are a must.
4. Polyps require removal best done using  hysteroscopy by direct visualization and minimal invasion. 
5. Presence of fibroids may require hysterectomy
6. Antibiotics can treat infection
7. Uterine cancer requires early intervention in the form of surgery; chemotherapy or radiotherapy.
8. Presence of prolapse may require surgery like hysterectomy and vaginal repair.
9. If the bleeding is due to hormonal imbalances, doctors may prescribe progesterone therapy.

3 Lifestyle and Preventive Measures

• Maintain a healthy weight to balance hormone levels.
• Avoid smoking and limit alcohol intake.
• Attend regular gynecological check-ups for early detection of potential issues.

Conclusion

Postmenopausal bleeding can be alarming, but early diagnosis and appropriate treatment can help manage the condition effectively. If you experience any unusual bleeding after menopause, consult a doctor promptly to rule out serious health concerns and get proper guidance for further management. . Your health and well-being should always be a top priority.

By staying informed and proactive, you can take control of your health ; prevent serious disease-progression and ensure timely medical care when needed.