Post-Menopausal Vaginal Bleeding: Causes and Next Steps for Evaluation

Postmenopausal vaginal bleeding

Hello Doctor, I have been menopausal for eight years.
Last November, I went to the hospital due to brown discharge and lower abdominal pain.
Since I have no sexual experience, the doctor performed an abdominal ultrasound and a urine test, and later informed me that I had a urinary tract infection with no other tumors present, and the endometrial thickness was 0.41 cm.
However, after completing the antibiotics, I still experienced intermittent bleeding.
Recently, I visited the hospital again, and the doctor only performed another abdominal ultrasound, stating that both the ovaries and uterus appeared normal.
When I asked the doctor why I still have brown discharge and experience abdominal pain and lower back discomfort, he said that since I have no sexual experience, pelvic inflammatory disease is unlikely and attributed it to aging, advising me to monitor the situation.

I would like to ask Dr.
Chen, as I still occasionally have brown discharge (at least once or twice a week), is this truly a sign of aging, and will the bleeding eventually stop? Or should I seek another physician for further evaluation? What kind of tests should I undergo to accurately determine the cause of the bleeding? I hope you can provide some guidance.
Thank you!

CY, 50~59 year old female. Ask Date: 2023/01/14

Dr. Chen Zhiyu reply Obstetrics and Gynecology

Hello! For abnormal bleeding after menopause, it is recommended to first perform an ultrasound examination.
If necessary, a CT scan, MRI, or hysteroscopy may be added to assist the physician in making a diagnosis.
Thank you!

Reply Date: 2023/01/14

More Info

Post-menopausal vaginal bleeding can be a concerning symptom, especially after a significant period of time without menstruation. Given your history of eight years of amenorrhea and the recent episodes of brown discharge and abdominal pain, it is important to approach this situation with caution and thorough evaluation.

Firstly, it is essential to understand that post-menopausal bleeding can have various causes, ranging from benign to more serious conditions. Some common causes include:
1. Atrophic Vaginitis: This is a condition resulting from decreased estrogen levels, leading to thinning and inflammation of the vaginal walls. This can cause dryness, irritation, and bleeding.

2. Endometrial Hyperplasia: This condition involves the thickening of the uterine lining, which can occur due to hormonal imbalances. It may lead to abnormal bleeding and, in some cases, can progress to endometrial cancer.

3. Polyps: These are benign growths on the cervix or inside the uterus that can cause irregular bleeding.

4. Endometrial Cancer: While less common, any post-menopausal bleeding should be evaluated to rule out the possibility of cancer.

5. Other Causes: Conditions such as fibroids, infections, or even trauma can also lead to abnormal bleeding.

In your case, the fact that you have experienced ongoing brown discharge and abdominal pain, despite being treated for a urinary tract infection, warrants further investigation. While your doctor has indicated that your ultrasound results were normal, it may be beneficial to consider additional diagnostic tests. Here are some recommendations for next steps:
1. Transvaginal Ultrasound: This is a more sensitive method for evaluating the uterine lining and can provide better visualization of any abnormalities.

2. Endometrial Biopsy: If the ultrasound shows any thickening of the endometrium or if there are persistent symptoms, an endometrial biopsy may be necessary to rule out hyperplasia or cancer.

3. Hysteroscopy: This procedure allows direct visualization of the inside of the uterus and can be used to remove polyps or take biopsies if needed.

4. Hormonal Evaluation: Since you have been experiencing symptoms that could be related to hormonal changes, checking hormone levels may provide insight into your condition.

5. Consultation with a Specialist: If your current physician is unable to provide satisfactory answers or if you feel your concerns are not being addressed, seeking a second opinion from a gynecologist who specializes in menopausal health may be beneficial.

In summary, while some degree of vaginal bleeding can be attributed to aging and hormonal changes, persistent symptoms should not be ignored. It is crucial to pursue further evaluation to determine the underlying cause of your symptoms. Early detection and treatment of any potential issues can significantly impact your health and well-being. Please consider discussing these options with your healthcare provider to ensure you receive the appropriate care and peace of mind.

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