abnormal bleeding

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Postmenopausal Bleeding

Thursday, April 17th, 2014

Once you have gone through menopause (and it has been a year since you’ve had a period), you should not be bleeding. More conservative doctors consider bleeding after six months of not bleeding to be a potentially worrisome sign. Not even spotting is considered normal after menopause, and should be evaluated by your doctor as soon as possible. Some of the conditions that can be responsible for postmenopausal bleeding include:

Polyps: These typically benign growths can develop on the cervix or in the uterus and can cause bleeding.

Endometrial atrophy: This is the thinning of the tissue lining the uterus, the endometrium. After menopause, lower estrogen levels are responsible for this condition, which can be a cause of unexpected bleeding.

Endometrial hyperplasia: Sometimes, when too much estrogen and too little progesterone are present, the endometrium can thicken, and this can cause bleeding.

Endometrial cancer: Endometrial or uterine cancer can cause bleeding. This is most common between the ages of 65 and 75.

Other potential causes for postmenopausal bleeding include infection, hormone therapy, certain medications (blood thinners, for example), and other types of cancer besides endometrial.

In order to find the reason for your bleeding, your doctor will want to take your medical history, perform a physical examination, and perform some tests. These tests may include a transvaginal ultrasound, a biopsy, a hysteroscopy (in which the inside of your uterus is examined with a small camera), a sonohysterogram (which is a transvaginal sonogram with saline solution instilled into the uterine cavity) or a D&C (dilation and curettage; during this test, uterine tissue is removed and sent to a lab to be analyzed).

Which treatment your doctor recommends will depend on the cause of the bleeding. If you have polyps, surgery may be necessary to remove them. Medication is typically used for endometrial atrophy; endometrial hyperplasia may call for both medication and surgery aimed at the removal of the thickened endometrial tissue.

What If It’s Cancer?

If it is determined that you have endometrial cancer, your doctor will probably want to perform a total hysterectomy, a surgical procedure in which your uterus and cervix are removed. Other parts that might need to be removed include the ovaries, fallopian tubes, part of the vagina, or nearby lymph nodes. You may also need radiation, chemotherapy, or hormone therapy.

Just keep in mind that while irregular bleeding during perimenopause can be normal, bleeding after menopause isn’t. Even if it’s very light, postmenopausal bleeding warrants an immediate call to your doctor to have it checked out. Chances are good that the bleeding is being caused by a minor problem, but there is always the chance that it could be something more serious. And if it is cancer, the earlier it is treated, the better, so don’t ignore even very light postmenopausal bleeding.

Read more about the menopause and other natural changes in your body in my health book, “Inside information for Women”.

– Yvonne S. Thornton, M. D., M. P. H

What Is Endometrial Ablation?

Monday, March 31st, 2014

Endometrial ablation is a procedure in which a layer of the uterine lining is permanently removed in order to reduce or stop abnormal bleeding. The procedure is performed only on women who do not wish to have any more children. In some cases, it is performed in place of a hysterectomy.

The techniques used to perform endometrial ablation vary and include electrocautery, radiofrequency, cryoablation, and hydrothermal procedures, among others. The procedure is performed on women who are experiencing abnormal bleeding (bleeding between periods) or menorrhagia (prolonged or extremely heavy periods). Abnormal bleeding can be so severe in some cases that daily life is interrupted and some women may even develop anemia.

Reasons for abnormal bleeding and menorrhagia include hormone disorders or imbalances, fibroid tumors, polyps, or endometrial cancer. However, as stated earlier, the lining of the uterus is destroyed during ablation and is no longer able to function normally; therefore, bleeding is significantly lessened or even stopped entirely, and it is important to know that the woman also will no longer be able to become pregnant.

Endometrial ablation carries the same risks as any surgical procedure, including infection, bleeding, perforation of the uterine wall, or complications due to medication sensitivities the patient is not aware of (or neglects to inform the doctor of). In addition, women with certain medical conditions should not have this procedure, and these include vaginal infections, cervical infections, pelvic inflammatory disease, weakness of the uterine muscle, abnormal shape or structure of the uterus, and having an IUD in place, among others. In my health book, “Inside Information for Women”, I discuss this technique under “Resectoscopy”.  Endometrial ablation with cautery via a resectoscope or any other modality is a little tricky if the patient ultimately is found to have uterine cancer.  Why?  Because all the evidence regarding the extent of the disease (cancer) is burned away and the physician will have difficulty in staging the cancer, which is important in formulating the best management for a patient with uterine cancer. 

If your doctor and you decide that endometrial ablation may be right for you, your doctor should explain the procedure to you thoroughly and give you a chance to ask any questions you have. If you are to have a procedure that requires general anesthesia, you will be asked not to eat or drink before the procedure, most likely for at least eight hours or after midnight the night before. Be sure to tell your doctor if you may be pregnant, are allergic to any medications, or are taking any prescription drugs or herbal supplements.

Your procedure may take place in a hospital or in your doctor’s office on an outpatient basis. Recovery will depend on the type of anesthesia and the type of ablation used. In general, you can expect to need to wear a sanitary pad for a few days after the procedure, as bleeding during this time is normal. Also for the first few days, you may experience cramping, frequent urination, nausea, and/or vomiting.

Your doctor will probably instruct you not to use tampons, douche, or have sex for at least a few days. Usually restrictions on other activities are also necessary, such as heavy lifting and strenuous exercise. Let your doctor know if you experience fever, chills, severe pain, difficulty urinating, excessive bleeding, or foul-smelling discharge.

This information applies in general to most ablation procedures, but because each woman and situation is unique, the most important thing to remember is to follow your doctor’s specific instructions, and ask any questions you may have.

– Yvonne S. Thornton, M. D., M. P. H.