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Bleeding in the menopause should never be ignored

Dear doctor, I am 60y old, and I recently experienced vaginal bleeding unexpectedly. I went through the menopause 10y ago. Should I be worried?

Menopause is defined as the end of natural reproductive ovarian cycles. It basically means that the ovaries are no longer having a cyclical production of eggs that can be available for conception. Consequently, ovarian production of hormones also wanes off. As the uterus is no longer being stimulated by any hormones, the monthly periods also stop. The average age of menopause is about 51years, and you are considered menopausal if you clock at least 12 months without ever having any periods.

Any bleeding whilst in the menopause years is considered abnormal. Attempts must be made to work out why the bleeding has occurred. For the majority, the cause of the bleeding will be innocent. For others, the bleeding might be caused by some disease conditions in the reproductive system that would warrant treatment.

The first point of call is your gynecologist. They will do a thorough medical assessment to try and find out the cause of the bleeding. The assessment will include reviewing your past reproductive health, and any other medical issues. You will also need a gynecological exam, which may be combined with updating your pap smear if this is due. You will also likely require a scan to view the pelvic organs in more details. If deemed necessary, you may be subjected to a biopsy to further assess the cells from inside the uterus.

Most bleeding in the menopause is due to the fragility of genital tissues as a consequence of low levels of reproductive hormones. This is medically referred to as genital atrophy. Some women may have disease conditions within the vagina or the cervix that may cause the bleeding. Others may have abnormal cells within the uterus, whose spectrum can range from reversible cell changes to cancer of the uterine lining (called endometrial cancer). Ovarian disease may also be associated with menopausal bleeding. A small category of women may also have some general medical conditions that can present with vaginal bleeding.

Recommendations for any treatment will depend on what the diagnosis turns out to be. Women with genital atrophy may be advised to use some form of hormone replacement. This can either be some vaginal gels or pessaries, or some tablets to take by mouth. If any disease conditions are found within the vagina or the cervix, then these will be treated accordingly. Early changes within the cells inside the uterus can usually be reversed with some hormonal medications. If endometrial cancer is unfortunately diagnosed, this will have specific treatment modalities.

You should never to ignore any bleeding during the menopause, however slight. For most women, all that will be required is reassurance that there is no underlying serious disease going on. For a minority, a specific diagnosis will be made, necessitating appropriate interventions.

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