Bleeding/ Spotting After Menopause

Q: Hi, I am 60 years old woman. My doctor said I have a heterogenous cystic lesion measuring 4×4 cm with internal separation in right adnexal region. My uterus has been removed a long time ago. What am I supposed to do?

Reply:

Why was your uterus removed?

You may go for further investigation. The lesions is big enough and needs further evaluation.

Ruling Out Malignancy

A biopsy needs to be taken to know the nature of cells in the cystic lesions. At your age, any chances of malignancy should be ruled out.

Menopause

Defined as the cessation of menstrual cycles. It is said to have occurred when there are no menses since a year.

Menopause is a natural phase that comes in every women’s life after the end of her active reproductive life.

Bleeding PV (from the  vagina) after menopause is abnormal and needs to be evaluated with urgency, preferably within two weeks.

Causes of Post Menopausal Bleeding

• After menopause, the reproductive organs of a female shrink and thin out. Thining of the uterine lining and the vaginal mucosa may sometimes lead to blood stained secretions.
• Growth inside the uterus, like, fibroid or a polyp.
• Infection in the uterus, endometriosis.
• Any injury down there.
• Malignancy cervix, uterus or the vagina.

Because postmenopausal bleeding may be as serious a symptom as that of malignancy, it has to taken seriously.

Risk Factors for Malignancy

• History of taking unopposed estrogen for a long duration, may be HRT for peri menopausal phase.
• Infertility or low parity
• History of cysts in ovaries
• Obesity with type 2 diabetes
• Mediactions like tamoxifen

All cases need evaluation. D&C may be done. Biopsy is taken during the procedure and send for histoloical examination.

Alternatively, a transvaginal ultrasound scan (TVUS) may be doen where biopsy is taken during the procedure.

Take Care,

Buddy M.D.