menopause A natural milestone in every woman’s life. It marks the end of the menstrual cycle, which usually occurs between the ages of 45 and 55. In India, the average age of menopause is around 46 years. While this phase marks the end of menstruation, it is also a time when women should pay extra attention to their health, especially if there is any unexpected vaginal bleeding.

“Any Vaginal bleeding after menopausecalled bleeding after menopause (PMB), is never normal. Even if it is just a little spotting, it is important to consult a doctor without delay.

What is bleeding after menopause?

Postmenopausal bleeding refers to the bleeding that occurs after a woman has gone without menstruation for 12 consecutive months, marking the end of menopause. Although this may sound worrying, Dr. Paliwal assures that 9 out of 10 women with PMB do not develop cancer. However, in some cases, PMB may indicate something more serious, making it necessary to investigate the cause.

Common Causes of PMB

There can be many reasons for bleeding after menopause. While some are benign, others may require immediate medical attention.

After menopause, the lining of the uterus (endometrium) can become thin and fragile, sometimes leading to bleeding.

It occurs when the uterine lining becomes abnormally thick due to hormonal imbalance (too much estrogen and too little progesterone). In some cases, it can turn into endometrial cancer.

These are usually benign growths that develop in the uterus or cervix, but sometimes they can cause bleeding.

Noncancerous growths in the uterine muscles can also cause bleeding after menopause.

– cancer

Although less common, PMB may be an early warning sign of cancer of the uterus, cervix, or vagina. According to Dr. Paliwal, “Bleeding after menopause is a common symptom of uterine cancer. “About 1 in 10 women with PMB may have cancer cells in the lining of their uterus.”

Other causes may include infection, hormone therapy, or blood-thinning medications.

When should you see a doctor?

“Bleeding after menopause is never something to be ignored,” explains Dr. Paliwal. Even if it happens just once, you should immediately consult a gynecologist. Delaying diagnosis can lead to complications, especially if the underlying cause is cancer.

How is PMB diagnosed?

If you visit your gynecologist with concerns about bleeding after menopause, they may recommend the following:

A detailed internal examination occurs to check for abnormalities.

This is usually done using a small probe inserted into the vagina to get a clear view of the uterus.

A thin telescope is inserted into the uterus to directly examine the uterine lining. The procedure can be performed in an outpatient clinic or under general anesthesia.

A small sample of the uterine lining may be taken for analysis to rule out or confirm cancer.

What are the treatment options?

Treatment of PMB depends on its cause:

– If bleeding is caused by benign issues such as polyps or atrophy, simple treatment or monitoring may be sufficient.

– If endometrial hyperplasia or cancer is diagnosed, more advanced treatments such as surgery (hysterectomy) or radiation may be necessary.

Dr. Paliwal explains, “When bleeding after menopause is diagnosed as endometrial cancer, hysterectomy is often the first treatment. However, if the cancer has spread to the lymph nodes, additional procedures such as lymph node dissection may be needed.

Why consult a gynecological oncologist,

Dr. Paliwal strongly recommends meeting a gynecologist oncologist if cancer is suspected. These specialists are trained to perform precise surgeries, reducing the need for additional treatments or repeat procedures. “In many cases, early detection and specialized care can make treatment easier and significantly improve survival rates,” she says.

good news

Here’s some reassuring news: Most cases of bleeding after menopause are not linked to cancer. Even when cancer is diagnosed, it is often in the early stages, making it highly treatable.

“Education is key,” explains Dr. Paliwal. “Many women with advanced uterine or cervical cancer tell us they experienced postmenopausal bleeding for years, but didn’t think it was serious. We need to spread awareness about what is normal after menopause and encourage women to seek timely medical care.

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