Post-menopausal bleeding

THE menopause for women is synonymous with the end of all vaginal bleeding, and when bleeding occurs after this period it can be a frightening experience. Consultant obstetrician-gynaecologist Dr Sean Parkinson said bleeding or even spotting after menopause could be a sign of serious health complications.

“It is important for women who are experiencing post-menopausal bleeding to get evaluated immediately so that the cause of the bleeding can be identified,” Dr Parkinson said.

He explained that post-menopausal bleeding is when women bleed from the genital tract having established menopause ­— not menstruating for at least a year.

“There are a number of reasons for post-menopausal bleeding, the most common being atrophic vaginitis. This is where the vagina gets thin and dry and may bleed easily. The condition is usually caused by reduced hormones or lack of hormones,” Dr Parkinson said.

He said another common reason for post-menopausal bleeding is cancer.

“The main type of cancer associated with post-menopausal bleeding is endometrial cancer which usually presents itself through bleeding, and consulting your gynaecologist early allows for an early diagnosis, and treatment will prevent spreading,” Dr Parkinson explained.

He said women should visit the gynaecologist for a thorough assessment to establish that the bleeding is not from other places such as the anus.

The doctor’s analysis will check:

• How long the bleeding has been going on for.

• How much blood is seen.

• Whether the woman is having symptoms of anaemia (headache, palpitations).

• If the bleeding is related to anything that could precipitate bleeding — sex, for example.

• To establish whether the woman is actually in menopause.

• A detailed drug history to see if she is on any medication that could precipitate bleeding (for example blood-thinning agents or herbal medication).

• If there are other abnormal discharges with bleeding or other features such as itching or odour.

• Family history (check for gynaecological-related cancer, breast, ovaries, endometrium).

“Ascertaining the cause of the bleeding will include a vaginal examination and depending on what is seen, for example, if suspicious masses are found, this should be thoroughly investigated and possibly biopsied. Another test is a pelvic ultrasound which is used to assess the organs of the genital tract. This exam is also used to measure the thickness of the endometrium. If this value exceeds four millimetres, then a biopsy of the womb lining would be required to check for endometrial cancer,” Dr Parkinson explained.

He underscored that treatment of post-menopausal bleeding would depend on the findings of the vaginal examination and the pelvic ultrasound.

“Atrophic vaginitis is generally treated with topical oestrogen gels and creams are prescribed, and in the case of cancer of the endometrium, surgical management is recommended,” Dr Parkinson said

He explained that surgical management usually involves the removal of the uterus, Fallopian tubes and ovaries. Aided by advanced technologies, patients are no longer required to do it as an open surgery since it can be achieved laparoscopically, leaving minimal scarring.