Post-Menopausal Bleeding

>> Friday, December 10, 2010

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How is everyone this week? Hasn't it just been so exciting with everyone decorating for the holidays. To me, it just makes usual places look so cheery and welcoming. I recieved a really good question this week from one of my readers, and I know it is something that many of us women struggle with.
Dear KnowYourV,   I am 54 yrs old and have not had regular periods for 4 yrs and know that I have been told I am in menopause. I also have diabetes, high blood pressure (HTN), Irritable bowel syndrome (IBS), and high cholesterol all of which are now under control, and I have recently lost 28 pounds since August.
About a month ago, I had a bad episode of constipation which caused me to strain too hard and I even tried to help it by trying to pull my butt cheeks apart. Afterwards, I noticed I started spotting and have cramping and pressure for the past four weeks.

I did see my internist as my appointment with my gyn was a few weeks out. My internist checked to make sure I had no tears and that my labs were all normal but I left feeling very confused and scared. I felt like because I was menopausal the only answer he had for me was uterine cancer -- post-menopausal bleeding is cancer.

My dad's sister died of it at age 28 when I was very young, and all my mom can remember is she had very heavy bleeding. Now I'm so scared, and upset I don't know if you can help calm me down until I get to my gynecologist.

I read your bio and I noted that you are involved in church, so maybe as one believer to another you could help me.


Well, menopause is an extremely difficult time, and many women feel very different due to the hormone changes. The missing periods can make some women feel healthier but some say they miss their monthly cycles because they felt like their bodies functioned better with them. It may be the hormone changes, not the actual periods that are making them feel less than optimal.
Some feel a worsening of their health due to weight gain and hormone imbalance that lowers the metabolism. This can cause fatigue, constipation, IBS, sleeplessness, body aches, emotional up and downs, anxiety and other symptoms.

All the sudden changes can worsen health and existing medical illnesses like diabetes, high cholesterol, and hypertension.

This is one of the best times to take a proactive part in your health, and like Liz, work on losing weight and dietary changes, because everything we do now will just make the years ahead so much easier. Many women have seen improvements in their menopause symptoms, blood pressure, cholesterol, and diabetes with weight loss and a healthy diet. I know a lot of you already know this, so keep up the good work!

Constipation seems to be a lifelong problem for many women due to hormone changes we experience with our monthly cycles or during and after childbirth and also menopause. But constipation can also have a mechanical component due to weakness of the muscles between the rectum and vagina. This is found commonly as the pelvic floor muscles can be damaged during childbirth or due to aging and gravity . If this has happened, it can make it very difficult to push out your bowel movements. This is called a rectocele, and requires surgery to correct it, so it is something to be discussed with a gynecologist.

Post-menopausal bleeding can be very alarming and definitely needs to be evaluated by a doctor.

Uterine or endometrial cancer usually happens in post-menopausal women over aged 50. It is usually diagnosed very early as the symptoms are bleeding after menopause. Risk factors include diabetes, weight changes and family history. It is usually treated and cured by doing a hysterectomy and rarely requires radiation or chemotherapy.

Estrogen can thicken the lining of the uterus and when there are no periods or other hormones to oppose the estrogen to thin the lining or release it as a period, it can result in abnormal bleeding or spotting. This does not mean cancer just because there is bleeding, and that's why getting the proper tests is so important.

Sometimes cervical cancer will be confused with uterine cancer as the cervix is part of the uterus. However, cervical cancer is not passed through genetics; it is caused by HPV. Unlike endometrial cancer, cervical cancer cure rates are low and do require radiation and chemotherapy.

Now if a pap smear has been normal, and that's how cervical cancer is diagnosed, then that's good! So why all the spotting? Well, hormone imbalance during menopause can make spotting and bleeding happen now and then, and then just suddenly stop. If this becomes too frequent and tests have been done that have verified that there is no cancer, then this can be corrected with hormones or a procedure called an endometrial ablation.

Sometimes there are other conditions that can cause post-menopausal bleeding, like uterine fibroid or polyps, ovarian cysts and other pelvic cancers like ovarian, anal rectal or bladder cancer. If any test or ultrasounds point to these then they should be followed up.

Of course, any potential endometrial cancer should be discussed with a gynecologist for proper testing. Usually the tests are very simple and can be done in the office, like an endometrial biopsy or an ultrasound. Endometrial cancer causes very heavy bleeding, not just spotting -- soaking through tampons and 2-3 pads in an hour. But whether spotting or bleeding, it needs to be checked by a doctor.

I know there is so much more we could say on this subject. So let me hear from you if you have any questions or something on your mind.
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