By: DR YUGISHA GURUNG
Menopause is the time when women stop having monthly menstrual bleeding, signifying the end of their reproductive years. They often occur between the ages of 45 and 55, but can also occur prematurely in women who have had their uterus or ovaries removed or are undergoing treatment for cancer.
Menstrual bleeding needs to have ceased for 12 months before it can be diagnosed. The stage prior to menopause is called Perimenopause, whereby women continue to menstruate but they become irregular until they finally cease. Women are perimenopausal and or have entered menopause experience a wide array of symptoms such as vaginal dryness, painful intercourse, urinary symptoms, sweating, lack of energy, dry skin, and lack of sleep. They may also experience anxiety, irritability, and memory problems. These symptoms can impact women’s lives, relationships, and work, so medical advice and support should be sought from medical personnel.
What is post menopausal bleeding?
As the name suggests, post menopausal bleeding is any bleeding from the vagina after menopause has been established. It is not normal for women to bleed after menopause, and thus, any bleeding after menopause needs to be investigated.
Common causes of post menopausal bleeding can include thinning of the vaginal lining, which may bleed on penetration, cervical or endometrial polyps, and uterine fibroids. However, post menopausal bleeding may be due to endometrial cancer and/or ovarian cancer. Endometrial cancer is cancer of the lining of the uterus, and ovarian cancer is cancer affecting the ovaries.
Therefore, any post menopausal bleeding must be discussed, and investigated by a doctor.
What will the investigation involve?
The initial test for post menopausal bleeding is a transvaginal ultrasound.
It is a device that is placed in the vagina to look for any source of the bleeding and to measure the thickness of the endometrial lining. Then, the doctor may do an examination of the pelvis and vagina, using a speculum. A speculum is a plastic device that allows a doctor to look at the inside of the vagina and to identify the cervix. A more invasive investigation may need to be done called a hysteroscopy, which involves passing a thin camera via the vagina and into the cervix to visualise the inside of the uterus. Biopsies may be taken during this investigation. This is normally done under local or general anaesthesia.
Whilst these investigations may sound intrusive and uncomfortable, it is important to remember that they are performed to rule out sinister causes of post menopausal bleeding such as cancer.
Therefore, we encourage our readers who may be experiencing these symptoms or know a loved one who is having post menopausal bleeding to seek medical attention, advice and support.