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Post menopausal bleeding is defined as any bleeding or spotting that occurs after a year of cessation of menstrual cycles (periods). The normal age of menopause can vary from 40-55 years of age in the Indian population, and is largely dependent on one’s genetic makeup.

According to Dr Geeth Monnappa, consultant obstetrician and gynaecologist, Fortis La Femme Hospital, Richmond Road, Bengaluru, spotting or bleeding is a big cause for concern after menopause. “Any amount of bleeding after menopause needs a complete evaluation by a gynecologist,” she says.

So, does it mean that every woman with post menopausal spotting/bleeding has cancer?

“No. Cancerous cells are detected in 1 in 10 women with post menopausal bleeding or spotting. Most often, post menopausal bleeding occurs due to thinning of the inner lining of the uterus due to a lack of female hormones post menopause (atrophic endometrium), or due to a thin vagina (atrophic vagina) that bleeds post intercourse,” says Dr Monnappa.

Other causes of postmenopausal bleeding include:

1. Endometrial/cervical polyps: Growth of non-cancerous or cancerous tissue within the uterus that needs to be removed for further evaluation.
2. Hormone replacement therapy.
3. Thickened endometrium.
4. Cancer of the pelvic organs.
5. Blood thinners. Patients on blood thinners for various medical conditions may have episodes of post menopausal spotting or bleeding.

What are the factors that increase the likelihood of a woman with post-menopausal bleeding having cancer?

* Overweight and obesity: These women are more likely to have a thick endometrium and cancer.
* Hormone replacement therapy.
* Oral estrogen therapy.
* Family history of uterine, ovarian and breast cancers.

“As cancers do occur in women despite the absence of risk factors, it is important that every woman with post menopausal bleeding meets with her gynecologist for further evaluation,” the doctor advises.

What can one expect at a gynecologist’s consultation?

The patient may be asked to share a detailed history regarding the symptoms and medications, followed by a clinical examination.

– Pap smear: This is a test, where a doctor inserts an instrument in your vagina in order to visualise the cervix, and takes a swab that is further sent for microscopic evaluation for the detection of cancerous cells.

– Transvaginal ultrasound: A probe is inserted into the vagina for better visualisation of the uterus and the ovaries. The endometrial thickness is noted, which is expected to be less than 4mm post menopause.

If the ultrasound shows a thickened endometrium, further evaluation with an endometrial sampling in the outpatient clinic or a hysteroscopic evaluation in the outpatient clinic or under anaesthesia with an endometrial sampling will be suggested by your gynecologist, says the doctor.

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By William Regal

Used to think I was a tad indecisive, but now I’m not quite sure.

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