Bleeding After Menopause

So–you haven’t had a period for a year–the definition of menopause–and surprise–there’s blood in your undies—what the heck?!?!?

So—now you’re scared..and if you are like most women, the first thing you think is, “Oh no!  cancer?”

90% chance it is NOT cancer (take the Winnie the Pooh approach)—10% it is cancer (Eeyore approach).

What would increase your risk of it being a cancer?  Being “fluffy”, being diabetic, and if you have high blood pressure –so if all three there, you need to be seen pretty quickly!  Now–tell yourself–if you had to have a cancer anywhere in your body–the uterus is one of the best places to have it!  Nine times out of ten you can remove the uterus, and you’re likely cured.

Why do we get bleeding after menopause?   Well, when your ovaries are working, they are making TWO hormones–estrogen all month, and PROGESTERONE for the two weeks after an egg pops out of an ovarian cyst.  By the way, when you are having periods you have an  OVULATION CYST–called a FOLLICULAR CYST  in your ovaries EVERY MONTH!  This cyst is usually about 2-4 cm in size, and shrinks away after a couple of weeks–just to start all over again the next month.   It is the JOB of the ovary to make cysts–so don’t go making up your will the second you hear you have a cyst!

menstrualCycle

The progesterone level falls if you are not made pregnant, and the uterus gets rid of its lining–you have a period.

Now, when you go through the menopause your ovaries are not working, BUT (don’t you hate the “but?”) you continue to make estrogen in any fat that you have on your body–the more fat, the more you make.  This estrogen goes to your uterus and builds up a lining (a “period”), BUT you don’t get that ovulation, so no progesterone.  So the lining just keeps building up, and up, and eventually can turn into the “BIG C”.

So–what to do?   Usually two things.  An endometrial biopsy and a pelvic ultrasound.

To do an ENDOMETRIAL BIOPSY, you are undressed from waist down, and assume the old pap smear position—sigh.  Next that old duck billed speculum is inserted into the vagina.  You are cleaned with a little antiseptic (although that is not absolutley necessary), and a grasper (tenaculum), is used to hold your cervix steady.  This feels like a poker going into your pee hole—they used to tell us it feels like a period cramp in school–they lied!

Then a slender thing is put up into your uterus, and suction is applied, to try and suck some tissue out for the lab to analyse.

Bottom line is –everyone walks out!   It is unusual to have to be taken to the OR for this.  Take some Ibuprofen or Tylenol before you come in.   Just get it done–it’s over before you know it, and not doing it means you will keep worrying that something bad is happening.  Time to get the big girl panties on–and take care of yourself!  YOU are the most important person to your family–and you would make any family member get this done–so listen to your own advice.

ULTRASOUND TO CHECK endometrial stripe

The lining of your womb (uterus) should be nice and thin when you are in the menopause.  BEFORE menopause it will be thicker jsut before your period starts, and thin AFTER your period finishes.

You can see the outline of the uterus, and the stripe outlined inside of it.  If the stripe if equal to or under 4 mm, we don’t have to do anything more.  If over 4 mm, we need that biopsy.  Sometimes we do the biopsy, because we can get an answer faster than waiting 3 months for an ultrasound.uterus_stripe122_color_200x151

Do you see how that lining looks nice and thin and equal along the length?   LOVELY!

 

Now–here polypsis an example of an ultrasound showing growths in the cavity.

Here is a sample of a THICK lining!thick endometrium

If we cannot get the sample in the office, then you will be scheduled for a day surgery to get the biopsy with a HYSTEROSCOPY ( we LOOK inside the uterus), and a scraping of the uterine lining–or a biopsy of a particular spot we may see.

The lining of the uterus may be thick because of a polyp–see here?

http://www.oxfordgynaecology.com/Images/Investigations-Hysteroscopy-4.jpg

The LINING of the uterus is nice and normal looking–and we obviously cannot suck the polyp out in the office–it won’t fit in our tiny little suction tube.

Here is a hysteroscopy showing a cancer of the lining of the uterus—pretty shaggy and nasty looking

 

 

 

One Reply to “Bleeding After Menopause”

  1. WilliamBeX says:

    This is one awesome forum post. Keep writing. Saade

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