Beware of Postmenopausal Bleeding!

It is essential for women to consider any bleeding which is outside the menstruation cycle as abnormal and take it seriously. This issue becomes even more critical in cases of bleeding that occurs in women who have physiologically entered menopause since such a symptom can be indicative of cancer. Professor İlkkan Dünder, a gynecologist/obstetrician and gynecologic oncologist at Acıbadem Taksim Hospital, notes that any vaginal bleeding during menopause, whether it is mild or heavy, short term or long term, or in the form of red or brown blood, is sufficient cause for women to consult a doctor as soon as possible.

Menopause is a special process for all women. Having detailed information about this period, in which women are affected both psychologically and physiologically, enables women to be prepared for potential risks. While the average age of menopause is 49 to 50 in developed countries, the women in Turkey enter menopause between the ages of 47 and 49 on average. According to specialists, if a woman does not have any vaginal bleeding for 6 months after her last period, she is considered to have entered menopause. Any bleeding that occurs after menopause is subject to pathological evaluation and definitely checked for the underlying causes. The time, duration and amount of bleeding are also important factors. Professor İlkkan Dünder, a gynecologist/obstetrician and gynecologic oncologist at Acıbadem Taksim Hospital, states that there is a possibility for women to underestimate postmenopausal bleeding with the belief that they have not entered menopause yet. However, cases similar to one in which a 49-year old woman experiences bleeding after 2 months of not having her period are considered to be perimenopause cases instead of menopause cases.

The underlying cause may be a benign or malign tumor!

Pathological bleeding which occurs after a 6-month period of no bleeding can arise from benign or malign elements. Bleeding which occurs due to benign causes can be due to two factors: Externally administrated hormones and drugs, and benign disorders. Professor İlkkan Dünder lists the disorders which cause postmenopausal bleeding as follows: “Benign polyps that develop in the organ referred to as vagina, as well as vaginal cancer, lesions or cancer in the cervix, benign tumors or tumors which can turn malign in time within the cervical canal, benign tumors of the ovaries which produce estrogen, and ovarian tumors of a wide range which can lead to ovarian cancer are all factors which can cause vaginal bleeding. Apart from these and on a rare basis, it is also possible for bleeding to occur due to general systemic disorders. Benign bleeding can also occur due to atrophy of tissues in the later stages of menopause.”

A doctor should be consulted as soon as possible in case of bleeding

If a woman experiences bleeding despite not using any estrogen (hormonal therapy) to eliminate menopausal problems, the underlying reasons need to be looked into. Therefore, it is essential to consult a doctor as soon as any bleeding occurs. Women who consult a doctor undergo a general examination as well as a transvaginal ultrasound exam in order for the cause to be identified. Thickness of the uterine lining is of great importance during transvaginal ultrasound exams. Abnormal thickness is acceptable to a certain degree in women who use estrogen. While a thickness up to 5 millimeters is considered to be normal in women who do not use any drugs, an endometrial biopsy is critically important for thicknesses that are determined to be 8 millimeters and over.

The risk of endometrial cancer is higher for diabetics, obese women and women who have not given birth or breastfed. Therefore, bleeding is more common among such women.

When should a biopsy be performed?

Professor İlkkan Dünder, a gynecologist/obstetrician and gynecologic oncologist at Acıbadem Taksim Hospital, states that regardless of amount, duration and endometrial thickness, a biopsy is essential in women who experience bleeding despite not using any drugs, and says, “95% of cases of non-drug-related postmenopausal bleeding between the first day of menopause and the end of life occur due to benign elements while 5% of these arise from cancer. The optimum identifier for this is biopsy. Biopsies are simple procedures which take little time and should not be feared. However, since the uterus shrinks and uterine canals become narrower in women who experience menopause, the biopsy can be painful; therefore, it is common for the procedure to be performed with anesthetics”. In gynecologic cancer cases, vaginal bleeding usually occurs in the earliest stages. Therefore, any vaginal bleeding during menopause, whether it is mild or heavy, short term or long term, or in the form of red or brown blood, is sufficient cause for women to consult a doctor as soon as possible.


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