Birth Control During Menopause

Hard to believe we're already in October! What an awesome time of year! Beautiful warm days & cool nights - we've even had some rain thunderstorms. I know, I know, but hey it's a real luxury here in the southwest. We actually go outside when it rains so we can feel the rain on our skin smell it as it moistens the dry, desert air.

We've been talking a little bit about menopause and hormone changes, which brings us to the next question that many of you are concerned about.

Do I have to take birth control even though I have started menopause?

As a reminder, menopause is that time in a woman's life when, for the first time since puberty, her entire female reproductive system is shutting down. Age 50 - 54 are the most common times for menopause, when menstrual cycles will stop, the ovaries stop ovulating they stop producing estrogen progesterone.

It is also during this time that women may go through hot flashes, night sweats, fatigue, emotional ups; downs and lack of sexual desire. Go see your doctor to verify that your symptoms are truly the result of menopause. Once your cycles have been absent for more than 6 months, and your blood tests confirm that you are in menopause, only then you can be sure you are no longer ovulating and do not need to use birth control.

The mistake many women make is that they believe that once they are in their forties, they are too old to get pregnant, and they become less careful about using birth control. I cannot tell you how many surprise babies I've delivered for my 40-plus year-old patients who though they couldn't conceive any longer. So it’s best not to assume. If you are having regular cycles, chances are you are still ovulating, no matter what symptoms you are having.

So menopause means no more periods, no more ovulating, and no need for birth control. But before you stop taking birth control, be sure you visit your doctor to verify with a blood test that your ovaries are not functioning, so there are no surprises.

I hope this helps you and answers your question this week. Keep your questions coming, have fun and be safe.

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What Does Spotting After Menopause Mean?

Many women use their menstrual cycle as a way to determine the overall health of their bodies. If a woman is used to having very regular periods and then they become irregular, it can be very upsetting and may cause her to come in for a check-up. Also, if she has always had irregular, unpredictable menstrual cycles she may imagine something is wrong with her and seek medical help to find out the cause and treatment for the "problem".

Menopause is when a woman’s menstrual cycles naturally stop altogether. When a women stops having her cycles for a year or more and is sure she is in menopause, it can be alarming to wake up or use the bathroom and notice she is spotting or bleeding.

So what is the first thing we do when something like this happens to us? Go to the Internet, right? I know you out there! And what is the first thing that is says when you look it up? Cancer, right? And so you rush into my office like your house is on fire, so fast that your shoes are mis-matched, moving like a New York taxi driver with an attitude to match. But hold on, it's the Internet, the doctor’s archenemy, the bearer of generic, one-size fits-all, non-individualized information. If I can stress anything to you right now it is that YOU are NOT a car or a mechanical device!! I wish medicine was so easy that anyone could just pick up a textbook or surf the web and become an honorary doctor. The one thing they emphasize to us in medical school is, DON'T be your own doctor; it's just too hard to be objective.

Yes, it could be cancer, everything and anything can be cancer, and that is the #1 thing most of us worry about and want to make sure we don't have. Fortunately, cancer is rarely the case, but you probably missed all those other things it said after cancer mainly because they are not as scary and possibly because you don't know what they are.

Some of the more common reasons for post-menopausal bleeding are things like hormone replacement, stress, rapid weight loss, insulin resistance, degenerating fibroids, polyps, atrophic endometrium (from lack of hormones), atrophic vaginitis (from lack of hormones), endometrial hyperplasia, and yes, cancer (cervical or uterine). See all those you missed on the way to cancer?

Cancer is no joke. I know it is a legitimate concern, and it is definitely the first thing I will check for. I want you healthy and informed. I want you to come in as soon as you can, so if it were to be cancer or pre-cancer, we have the best chance for cure. Bleeding caused by uterine cancer is heavier and longer than that of a normal period. It is not spotting.

Menopause is a time of shifting hormones, so the normal rise and fall is out of synchronization. This causes a majority of the irregular bleeding cycles and spotting. Some of you are on hormone replacement to help with symptoms and to control bleeding, but even that can take time and create bleeding problems.

Stress releases many hormones like cortisol into our bloodstream. This can have a profound affect on our thyroid and female hormone system and throw our bodies completely out of balance. I know any of you who have experienced extreme stress have felt this.

Rapid weight loss will release estrogens that are stored in the fatty tissue, thus raising estrogen levels in the blood. Once this happens the estrogen can have the affect of thickening the lining of the uterus, (endometrium) causing abnormal uterine bleeding.

Insulin resistance is a blood sugar abnormality that not only increases insulin but estrogen and other hormones. The increase in estrogen, as I stated above, can have an affect of thickening the endometrium and causing abnormal bleeding.

Anatomic defects like degenerating fibroids and polyps cause spotting and bleeding and can be easily detected with ultrasound or by endoscopic procedures.

Atrophy is a term used after menopause when the vaginal and uterine tissues are depleted of hormones. They become very pale, thin and easily torn or damaged. The tiny vessels in the vagina and uterine lining become fragile, causing more spotting.

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Postmenopausal Bleeding

Lately, we have been discussing menopause and its associated hormone imbalance, vaginal atrophy, vaginal dryness and irregular bleeding and spotting. This can be really upsetting, as it ruins clothing/panties because it comes when we don't expect it. For those of you who have not had a period for a while, it can be scary, because there is so much information about abnormal or post-menopausal bleeding and cancer.

If you have been in menopause for a while and gone without a period for more than one year, you should not experience any menstrual bleeding. Even a little spotting is not normal after menopause unless you are on hormones.

Hormones can cause the lining of the uterus to thicken, and this can occasionally cause a small period and spotting. No matter what the cause of bleeding, it is important to see your doctor and have it checked out.

There are several health conditions that can cause postmenopausal bleeding, like polyps, which are growths in the uterus that are usually noncancerous. They can develop in the uterus or the cervical canal.

Endometrial atrophy (thinning of the endometrium) is when the endometrium, the tissue that lines the uterus, becomes very thin after menopause because of diminished estrogen levels. This can cause unexpected bleeding.

The opposite is Endometrial hyperplasia, which is a condition where the lining of the uterus becomes thickened - usually as a result of hormone imbalance.

Other bleeding causes besides hormone therapy can be things like uterine or cervical infections or use of certain medications, such as blood thinners.

Transvaginal ultrasound, endometrial biopsy, hysteroscopy, or a D&C (dilation and curette) can be done to help aid diagnosis.

Treatment depends on what is causing the bleeding. The most important thing is, whether you are very young or nearing menopause or even in menopause, find out what is happening and go talk to your doctor about it.

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Vaginal Discharge and Menopause

Women get used to how our bodies function: when to expect our cycles, how much discharge we have, how discharge changes during the month - including its consistency and odor. So, if something changes, we are aware of it right away. Many woman come in to see me after being in menopause with no hormones for many years - so they have become used to vaginal dryness and lack of discharge. So it is alarming to them, or a bother to some, to wake up and see discharge on the toilet paper or in their panties. Women in menopause on hormones will have less dryness and more normal discharge.

Menopause brings hormonal imbalances that signal the end of fertility. Vaginal fluids decrease with the body’s loss of estrogen and progesterone (the two main female hormones that are produced by the ovaries). This decrease in hormones and vaginal discharge can make it extremely difficult to maintain a proper pH balance. The pH balance, as we have discussed in previous writings, is important to prevent vaginal odor, abnormal vaginal discharge, and yeast or bacterial infections. Lack of hormones can even cause an increase in bladder and kidney infections.

Where does discharge normally come from? There are mucus membranes in the vagina and cervix that create fluids daily. During sexual stimulation, breast-feeding, ovulation, and hormonal changes, vaginal discharge helps women to maintain reproductive health. Reproductive organs contain healthy bacteria, hormones, and acids that control the temperature, pH balance, and exact chemical environment for egg and sperm fertilization. Once menopause comes, a women's ovaries stop functioning normally and no longer make our female hormones and actually completely dry up. This causes our periods and ovulation to stop. Because we are no longer in need of this exact balance, the body’s chemistry changes abruptly.

Women can lose 80 to 90 percent of their estrogen and progesterone stores during menopause. These hormones control body temperature, mood, sleep patterns, energy levels, weight management, fluid maintenance, sex drive, and can cause bodily aches and pains. Vaginal discharge during this life change can exist alongside vaginal dryness. But, this vaginal discharge does not maintain moisture in the vagina. It is a chemical reaction resulting from shrinking vaginal walls and waning hormone levels - this is called atrophic vaginitis. Again, vaginal moisture and elasticity comes from hormone balance when our ovaries are functioning. Estrogen is the most important hormone in this process.

Of course, if the vaginal discharge during menopause is oddly colored, such as brown, light pink, or bloody, it can be a sign of other problems. This should definitely be checked out by your doctor, as it could be a sign of by polyps, fibroids, or even cancer.

No matter what, vaginal discharge is a normal process and women should avoid perfume sprays, powders, lotions, douching and other hygiene products, because they can create yeast and bacterial infections and lots of vaginal irritation. Let your vagina clean itself, as it is so good at doing. Use only mild soap on the outside around your vagina and labia and try WaterWorks if you have stubborn recurrent vaginal odor or just want to feel good about having a safe, FDA-cleared way of cleaning inside your vagina.

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Vaginal Atrophy

Today I think we need to talk about vaginal atrophy, also called atrophic vaginitis, which I know most of you have never heard of. What happens with vaginal atrophy is that the vaginal walls begin thinning and drying out, which causes inflammation. It is due to your body having less estrogen as well as other hormone changes. Hormone changes can occur for many reasons as our bodies age or go through illness or disease.

The most common cause of vaginal atrophy is menopause, but it can also develop during breast-feeding or at any other time your body's estrogen production declines. It can make sex very painful — and if sex hurts, our interest & desire for sex will decrease. Luckily, effective treatments for vaginal atrophy are available, so it can be reversed.

Painful sex (dysparunea - wow, what a name!) is only one of the problems that lack of estrogen and vaginal atrophy causes. Women can also experience vaginal burning, vaginal discharge or extreme vaginal dryness (from lack of discharge), genital itching, not making it to the bathroom on time (whether from urine or your bowels), more urinary tract infections, light bleeding after sex, decreased vaginal lubrication during sexual activity, shortening and tightening of the vaginal canal.

So what's the deal anyway? What is the cause of all these changes? As if we need one more thing to change in our womanly bodies! It has to do with hormone changes, especially estrogen. Remember we have 3 main hormones that are produced by our ovaries; estrogen, progesterone, and testosterone. Hormone changes can occur after menopause, during the years leading up to menopause (called perimenopause), after giving birth and during breast-feeding, after surgical removal of both ovaries or as a side effect of any cancer treatment that requires chemotherapy or radiation.

In addition to hormone changes, habits like cigarette smoking affect your blood circulation, resulting in the vagina and other tissues not getting enough oxygen. So smoking can also reduce the effects of naturally occurring estrogens in your body no matter how old or young you are. In addition, women who smoke typically experience an earlier menopause.

Women who have given birth through c-section and have never given birth vaginally are more likely to develop vaginal atrophy than women who have had vaginal deliveries - possibly due to the effects that the stretching has on the function of the vaginal muscles. It is also known that women who remain sexually active with or without a partner have less trouble with vaginal atrophy as sexual activity and orgasm increases blood flow and makes your tissues more stretchy and elastic.

Lack of estrogen and hormone imbalance causing vaginal atrophy increases your risk of vaginal infections and urinary problems like bladder prolapse (falling out) and incontinence. It can also cause changes to the acid balance of your vagina, making you more likely to get a vaginal infection (vaginitis), and feel constant irritation and burning.

When you have your annual exam with your gynecologist, is easy to tell if this is what is going on, as the vaginal tissues are pale and lack ability to stretch - which makes the pelvic exam painful. It is also easy to see if you have signs of pelvic organ prolapse — indicated by bulges in your vaginal walls as your bladder or rectum try to fall out through the vaginal vault. Or, the cervix may be sitting much lower at the vaginal opening instead of at the top of the vagina.

To treat vaginal atrophy you can try vaginal moisturizers to restore some moisture to your vaginal area or use lubricants during sex. Use a water-based lubricant and try to avoid petroleum jelly or other petroleum-based products, especially if you're using condoms. Petroleum can break down latex condoms on contact. Petroleum will also coat the vagina and can cause yeast and bacteria to cling to the vaginal walls and cause more infections and irritation.

There are also prescription vaginal estrogen treatments which come in cream or tablet forms and will directly restore and nourish the vaginal tissues. Because menopause and hormone imbalance with lack of estrogen is associated with other symptoms such as moderate or severe hot flashes, night sweats, muscle aches and pains, fatigue, brain fog, trouble sleeping, and moodiness, most women choose to take natural estrogen pills, patches or topical creams and gels. These will treat the vaginal atrophy and help with all these other symptoms.

So, if you are experiencing vaginal atrophy symptoms, go see your doctor, as there is so much that can help it.

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What are the Signs and Symptoms of Perimenopause?

Menopause, which is the complete cessation of ovarian function usually happens around 51-52 years of age. The stage of a woman’s life leading up to menopause is called 'perimenopause', and it can begin in the late 30's, 10-15 years before menopause. Perimenopause can come and go until menopause begins, lasting from months to years in some women. It represents a decline of ovarian function and therefore, hormone imbalance.

Symptoms can vary in severity and range, with some women experiencing physical symptoms like hot flashes, night sweats, feeling warm all the time and irregular periods. Some women experience sleeping disturbances, including difficulty falling asleep, staying asleep or multiple awakenings due to increased urination frequency that can occur due to decreased estrogen.

Perimenopause can also cause mood changes similar to what we see in PMS, only much more severe, with women suffering from anxiety, depression, irritability and fatigue. Hair loss, dry skin, decreased libido and vaginal dryness (causing pain with sex), can also occur.

With perimenopause, the symptoms of hormone imbalance can come and go for months or years. It can be very frustrating for women to experience many symptoms, have them go away, only to return again. The similarity of symptoms in perimenopause and menopause can be confusing, and therefore women usually seek out their for answers.

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Vulvovaginal Atrophy & Menopause

Vaginal atrophy (atrophic vaginitis) is the thinning and inflammation of the vaginal walls due to a decline in estrogen. Vaginal atrophy occurs most often after menopause, but it can also develop during breast-feeding or at any time that your body's estrogen production is low, like during times of stress. Less circulating estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.

Vaginal atrophy due to menopause may begin to bother you during the years leading up to menopause (perimenopause), or it may not become a problem until several years into menopause. Regular sexual activity, with or without a partner, helps you maintain healthy vaginal tissues and can decrease problems associated with vaginal atrophy, as sexual activity enhances blood flow to your vagina.

There are some known factors that can accelerate vaginal atrophy due to their affect on hormone production and vaginal health. Cigarette smoking impairs blood circulation, depriving the vagina and other tissues of oxygen. Decreased blood flow to your vagina contributes to atrophic changes. Smoking also reduces the effects of naturally occurring estrogens in the body. In addition, women who smoke can have an earlier menopause. Also, women who never give birth vaginally are more prone to vaginal atrophy, as many hormones are released in response to vaginal stretching.

The risk of vaginal infections (vaginitis) can increase with vaginal atrophy. Atrophy leads to a change in the acidic environment of your vagina, making you more susceptible to infection from bacteria, yeast or other organisms.

Atrophic vaginal changes are also associated with changes in your urinary system, which can contribute to urinary problems. You might experience increased frequency, urgency or burning with urination. Some women experience more urinary tract infections or incontinence. Although stress incontinence is common among menopausal women, it doesn't appear to be caused by vaginal atrophy.

The symptoms can be varied, and some women have only one or two mild symptoms, while others can have many, sometimes more severe, symptoms. These can worsen the longer the body is estrogen-deficient. The most common symptoms include vaginal dryness and burning, spotting or even light bleeding after sex, discomfort and pain with sex, shortening of the vaginal canal and thinning of the vaginal walls, frequent urinary tract infections or urinary incontinence with burning and urgency.

Many of you may put off getting help because you feel you are experiencing a "natural" part of aging, and there is nothing that can be done about it. And some of you may be embarrassed about the changes that atrophy can cause, including uterine or bladder prolapse - which is where they begin to fall out of the vagina. Even though this is quite common and very uncomfortable, it's too embarrassing for some women to reach out for help.

Usually a simple pelvic exam and pap smear at your doctor's office is all that is needed to evaluate and diagnose vaginal atrophy or prolapse. If symptoms are bothersome, either vaginal or oral estrogen is effective in relieving vaginal dryness and itchiness, and improving vaginal elasticity. Vaginal estrogen may provide more direct relief of symptoms. You should experience noticeable improvements after a few weeks of estrogen therapy.

If you're experiencing vaginal dryness or irritation, adding back moisture with Replense, K-Y or Astroglide can help. The same is true for dryness with sex, so it is important to use a water-based lubricant, such as Astroglide or K-Y, to reduce discomfort during intercourse. Oils or petroleum-based products can make you more prone to infection.

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What Is Causing My Pain ‘Down There’?

Imagine vaginal burning and pain so severe you can’t sit comfortably, wear tight clothing or have sex. That’s the reality women with vulvodynia face, and although many of us would like to have a push-button answer to the problem, the human body does not function this way.

Why so many women suffer from pelvic pain during their cycles, during sex and some almost every day has puzzled many researchers and clinicians for years. There are a wide variety of reasons women can experience pain and problems.

Vulvodynia is a debilitating, difficult to treat, often incurable problem that causes extreme sensitivity of the vulva and vaginal labia. Possible contributors include injury to nerves in the vulva, hypersensitivity to candida (yeast) or other fungal and bacterial infections At times, the pelvic floor muscles spasm, causing throbbing and sensitivity to the slightest touch or pressure.

Some partially successful treatments have included the use of tricyclic antidepressants (to block pain receptors in the vulva), topical estrogen or lidocaine gel, and even surgery. Surgery is an extremely radical approach and requires removal of vulvar tissue in hopes the grafted tissue will cure the pain Capsaicin cream is a newer treatment that has to be specially compounded (and which contains the active ingredient in chili peppers), but has been shown to dramatically reduce symptoms.

If a woman’s condition is flared by a candida (yeast) hypersensitivity -- to which even a slight imbalance can cause itching and burning -- weekly doses of an oral antifungal medication over several weeks or months can help alleviate symptoms.

Some treatments for painful sex in women do not require medical intervention and can be treated safely at home - by using personal lubricants with intercourse, allowing injuries & surgical incisions to heal completely after surgery or childbirth, and simple patience and rest. Sometimes with vaginal pain due to menopause, excessive dryness after childbirth, or infections like yeast or bacteria, it may require a prescription from your physician. And, there are actually physical therapists that specialize in pelvic floor muscles that can help to alleviate the pain of pelvic organ prolapse.

Another condition, vaginitis, is caused from a disruption in the natural balance of bacteria that live in every healthy vagina. Vaginitis usually refers to bacterial vaginosis and yeast infections that can cause unbearable itching, burning, pain and/or odor for many women. It can re-occur several times per year.

There is no single cause for vaginitis, and it is not considered sexually transmitted. Common causes may include hormonal changes due to birth control, menopause or pregnancy, as well as chronic medical conditions, such as HIV and diabetes, which weaken the immune system. Frequent sex can also be a big cause of recurrent vaginitis, due to the sugary, alkaline solution surrounding the sperm which disrupts the acidic environment of the vagina. This creates a perfect environment for bacteria and yeast to flourish. Recurrent infections can cause chronic pain in women. Treatment is painless and easy - most women simply insert a prescribed cream at night or take a prescription oral antifungal or antibacterial.

Atrophic vaginitis is thought to be a problem of menopause. The term describes the dryness, vaginal wall thinning and shrinkage, and paleness of tissue due to lack of estrogen. Urinary incontinence can go hand in hand with this. Many of you have experienced this with childbirth and breastfeeding, due to the hormone changes which are similar to menopause. This condition can feel like an infection, with burning, itching, and pain, but no active fungus or bacteria is found. Treatments such as estrogen creams or oral estrogen therapy can help.

Some women suffer from another condition called lichen dermatoses, which is a condition that can lighten and stiffen the tissue in the vulva and can cause severe itching and scar formation. A mix of topical steroids with a tiny dab of estrogen can help heal the damage to the vulvar tissue and decrease symptoms.

Vaginismus is a rare condition (affecting fewer than 2% of women in the United States) in which the muscles surrounding the vagina involuntarily spasm so tightly that you can’t have sexual intercourse or even insert a tampon. The specific cause of vaginismus is unknown, but, as with vulvodynia, physical therapy can be a successful treatment.

Physical therapists who specialize in pelvic floor disorders can correct structural abnormalities and design a manual therapy and exercise program that will retrain pelvic muscles that are too tight or too weak, depending on the condition. Their efforts can dramatically reduce symptoms without the side effects of medication. They also teach women the proper way to perform techniques at home, with dilators and their own fingers, to gently stretch and massage the muscles. If a woman’s symptoms persist despite physical therapy, a doctor can inject Botox to paralyze muscles and prevent the spasms for up to six months. Other (older) treatments that have been successful for vaginismus include sex therapy medications such as Valium and hypnotherapy.

Fibroids affect about 77% of women, but most don’t realize they have them. In some cases, there are no symptoms, but some women can develop cramping, excessive bleeding during menstruation, and painful intercourse. The growth and development of these uterine tumors are rarely cancerous, in fact less than 0.01% of the time. Fibroids may shrink naturally after menopause. Treatment options vary and usually have a lot to do with a woman's age and desire for future childbearing.

Hysterectomy is one option, but if you have a desire for future fertility, it is possible to have only the fibroids removed, leaving the uterus and ovaries intact. There is also a procedure called uterine artery embolization, which cuts off the blood supply and forces the fibroid to shrink, however this may compromise future ability to have children, as it compromises blood flow to the uterus.

Genital Herpes is a disease caused by the herpes simplex virus (HSV), of which there are two types. Type 1 (HSV-1) usually causes oral herpes, an infection of the lips and mouth. Symptoms are commonly known as cold sores or fever blisters. In the past, HSV-1 was not known to cause genital lesions, but that is changing, and we now know oral herpes can be passed to the genital area via oral sex. Genital herpes is caused by the second type of herpes virus (HSV-2) and reoccurs more often - causing more distress to the person who has it. Chronic herpes infections can be a cause of persistent pelvic pain and painful intercourse.

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Will My Sex Drive Disappear When I Go Through Menopause?

Menopause can be an extremely difficult time for women as they begin experiencing so many physical and mental changes. There can be hot flashes, night sweats, insomnia, weight gain, and mood changes which can affect relationships and a woman's self esteem. Sex drive will be affected due to a lack of confidence many women have about their appearance, and the worry that their partner will still desire them as they journey through these changes. Sex drive may also be diminished due to a decline in overall physical health or side effects caused by many medications.

Menopause is a time of extreme hormonal change and imbalances linked to the ovaries’ inability to maintain production of estrogen, progesterone and testosterone as they did before. It is the complete loss of estrogen, the main female hormone that diminishes sexual desire and genital sensitivity. This lack of hormones can also cause vaginal dryness and pain during intercourse, which many women fear could mean an end to sexual intimacy with their partners. Testosterone, the male hormone, also plays a big role in vaginal lubrication and libido.

Many women choose to take some form of hormone therapy, if only for a few years, to help transition into this next stage of life. They find it can block weight gain by increasing metabolism, with a secondary benefit of increased energy levels and a return of outside interests (“libido for life”). A good diet and exercise is also important to maintain health and vitality during this stage.

About 70% of couples actually report an improvement in their intimacy levels and romance as they transition though their later years and menopause. They report that they no longer have the worries of a family to raise, and are much more comfortable with themselves and their partners sexually. This is good news.

Some reports suggest it is ovulation in our youthful years that increases sex drive in women, (all in the name of reproduction) Other studies are showing that decreasing estrogen plays only a small role in lowering sexual desire in later years.

We do know that intimacy seems to grow and become more important/deeper with age. So, there is hope for a healthy sex drive for our entire lives. Let's all hope for a wonderful partner to spend those years with.

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Post-Menopausal Bleeding

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.

-Liz

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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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