Most midlife women are ready to be done with tampons, pads, and periods. So when irregular bleeding happens after menopause, it’s common to ignore it. As a woman helping women, I am here to tell you not to ignore any postmenopausal bleeding, no matter how light or how annoying. Reporting postmenopausal bleeding to your healthcare provider could save your life.
What Is Postmenopausal Bleeding Anyways?
Postmenopausal bleeding is any bleeding that happens after menopause. A couple of brown blood spots on your underwear ten years after your last period – is postmenopausal bleeding. Weekly spotting for the past two months, two years out from menopause – is postmenopausal bleeding. A gush of blood after sexual intercourse five years after your last period- is postmenopausal bleeding.
How Do You Know If You Are Postmenopausal or Perimenopausal?
For many midlife women, this can be the million-dollar question. The transition time leading up to menopause is called perimenopause.
Perimenopause confuses many of us because it can be hard to know precisely when you have crossed the finish line into menopause. And it can be a marathon— you have not reached menopause until you have been without any bleeding at all for 12 consecutive months. If your period stops for six months, and suddenly you have some bleeding, you must start the clock over.
Don’t Lots of Women Have Irregular Bleeding During Perimenopause?
Yes. According to the Menopause Society, approximately 90% of women experience 4 to 8 years of menstrual cycle changes before going through natural menopause. Imagine if men experienced 4 to 8 years of erection changes—the world would grind to a screeching halt! According to the American College of Obstetricians and Gynecologists (ACOG) and NAMS, abnormal or irregular bleeding during perimenopause should still be evaluated.
The Link Between Postmenopausal Bleeding and Endometrial Cancer
Endometrial cancer is the elephant in the room that all women’s health providers worry about with irregular bleeding. Endometrial cancer starts in the lining of your uterus (womb), called the endometrium. It occurs most often after menopause in women in their 60s. Endometrial cancer is the most common cancer affecting the female reproductive organs, more common than ovarian or cervical cancer.
Perimenopausal and postmenopausal changes in estrogen and progesterone cause changes in the endometrium. When not balanced with progesterone, higher estrogen levels can cause excessive growth and thickening of your endometrial cells, sometimes becoming cancer. Women with larger bodies are at greater risk for endometrial cancer because fat tissue can also produce estrogen, resulting in more estrogen acting upon the endometrial lining.
As your lining thickens, it becomes unstable, meaning it can fall off or shed, coming out through your cervix and vagina just like it did with your periods. Ninety percent (9 out of every 10 women) with endometrial cancer reported having bleeding before their cancer diagnosis. Just remember that the reverse is not true. Not every woman with postmenopausal bleeding has endometrial cancer.
Postmenopausal Bleeding Can Be an Early Warning Sign for Endometrial Cancer
When discovered early (because a woman reports postmenopausal bleeding to her healthcare provider), removing the uterus surgically (hysterectomy) often cures endometrial cancer. With an early diagnosis, a woman has a 95% chance of surviving cancer for at least five years. That is why paying attention to irregular bleeding during perimenopause and menopause could save your life.
How Do Healthcare Providers Check to Make Sure Peri- or Postmenopausal Bleeding Is Normal?
If your bleeding pattern seems suspicious to your healthcare provider, they will most likely order a transvaginal ultrasound. An ultrasonographer uses a wand-like transducer (yes, inserted into your vagina) to measure the thickness of the endometrial lining to look for any abnormal tissue growth. Combined with some tests to measure hormone levels, your provider can decide whether a closer look is needed.
If your endometrial lining measures thicker than 4 millimeters on the ultrasound, they will do an endometrial biopsy. An endometrial biopsy is an in-office procedure similar to a Pap smear that samples your endometrial lining. A laboratory then examines your endometrial cells for pre-cancerous changes.
Ignore the Temptation to Ignore Your Postmenopausal Bleeding
Simply put, women who experience postmenopausal bleeding should always have it evaluated as soon as possible. Too few midlife women know about postmenopausal bleeding and the link to endometrial cancer, so pay it forward by taking what you have learned from reading my blog and telling all your friends. That way, as women helping women, we can live healthier, happier, and longer.
My motto: Suffering in silence is OUT! Reaching out is IN.
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