UTERINE BLEEDING, POSTMENOPAUSAL

General Information

DEFINITION--Unexpected, menstrual-like bleeding that begins 1 or more years after menopause.

BODY PARTS INVOLVED--Vulva (vaginal lips); vagina; cervix (lower third of the uterus); endometrium (inner uterine lining).

SEX OR AGE MOST AFFECTED--Women after menopause.

SIGNS & SYMPTOMS

• Vaginal bleeding, which may be a light-brown discharge or heavy, red bleeding (with or without clots). Mucus may accompany the bleeding. Bleeding episodes vary in length.
• Pelvic pain (sometimes).

CAUSES

• Cancer of the reproductive system.
• Irritation, infection or thinning of the membranes lining the vulva.
• Injury or trauma to the vagina, associated with reduced estrogen levels.
• Polyps or benign tumors of the cervix.
• Polyps on the inner uterine lining, myomas.
• Hormone therapy that stimulates the endometrium (uterine lining), causing sloughing similar to normal menstruation. Estrogens (female hormones) taken irregularly are a common cause of this.
• Disorders of the blood cells, lymphatic system or bone marrow.
• High blood pressure.
• Congestive heart failure.
• Liver disorders.
• Anticoagulant or aspirin-containing drugs.

RISK INCREASES WITH

• Recent vaginal infection.
• Adults over 60, due to fragile blood vessels and thin vaginal lining.

HOW TO PREVENT--No specific preventive measures.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory blood studies, Pap smear (See Glossary) and endometrial aspiration (insertion of a thin tube into the uterus to obtain a sample of the lining).
• Dilatation and curettage, (D & C) (See Glossary).

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Specific therapy, usually medications or surgery, is dependent on the cause.

POSSIBLE COMPLICATIONS

• Anemia.
• If cancer is the cause, it may spread to other body parts and cause death.

PROBABLE OUTCOME--Depends on the underlying cause and treatment chosen.

How To Treat

GENERAL MEASURES--

• Use heat to relieve pain. Place a heating pad or hot-water bottle on the abdomen or back.
• Take frequent hot baths to relax muscles and relieve discomfort. Sit in a tub of hot water for 10 to 15 minutes as often as necessary.
• Use sanitary pads instead of tampons.

MEDICATION--Your doctor may prescribe:

• Hormones.
• Medication to treat the underlying disorder, such as antihypertensives for high blood pressure.
• Anticancer drugs if a malignancy is diagnosed.

ACTIVITY--

• Resume your normal activities as soon as symptoms improve.
• Resume sexual relations as soon as possible after diagnosis and treatment.

DIET--No special diet.

Call Your Doctor If

• You have postmenopausal vaginal bleeding. Don't delay. This is a warning signal for cancer.
• Bleeding persists for 1 week, despite treatment.
• Your bleeding becomes excessive (saturates a pad more frequently than once each hour).
• You develop signs of infection: fever, a general feeling of ill health, headache, dizziness and muscle aches.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.