DEAR DOCTOR K:
I thought I entered menopause five years ago, but now I seem to be having a period again. Is this normal?
A woman is considered to be in menopause once it has been one year since her last period. Once menopause begins, vaginal bleeding is not normal.
Post-menopausal bleeding (PMB) can happen for many reasons. It may result from infection or injury. Non-cancerous growths such as polyps and fibroids can cause PMB. So can bleeding disorders or use of blood thinners.
The most worrisome cause of PMB is cancer, especially of the uterus. Cancer can usually be ruled out with a biopsy and a pelvic ultrasound. But if you do have cancer or pre-cancer of the uterus, it’s very important to make the diagnosis — and begin treatment — as early as possible.
If the bleeding is from your vaginal walls, the likely cause is vaginal atrophy. This accounts for about half of the cases of PMB.
Vaginal atrophy develops during menopause, when age-related changes cause the ovaries to make less estrogen. Estrogen helps keep vaginal tissues lubricated and healthy. When levels of estrogen are low, vaginal tissue becomes thin, dry and shrunken. The vagina becomes prone to inflammation and tearing. Vaginal atrophy typically develops slowly. You may not notice any symptoms until five to 10 years after menopause begins.
You can try a water-soluble vaginal lubricant to relieve vaginal dryness and moisten vaginal tissues. If that doesn’t work, vaginal atrophy estrogen therapy can help. Your doctor may prescribe an estrogen pill, a topical estrogen cream, vaginal suppositories, an estrogen skin patch or a vaginal estrogen ring.
So schedule an appointment with your doctor. He or she needs to identify the source of your bleeding before you can take the next step. One or more of three diagnostic tests often is ordered:
- An endometrial biopsy. A sample of the inner lining of your uterus is taken to look for malignant cells.
- A pelvic ultrasound. This imaging test can look at the thickness of the lining of your uterus, and for non-cancerous growths in the uterus, as well as possible cancers in the ovaries.
- A Pap smear. This test can spot cancer of the cervix, another cause of PMB.
Post-menopausal bleeding is one of those symptoms that cause you to worry even though it usually turns out you had nothing to worry about. Because it can indicate cancer, it has to be taken seriously. Fortunately, at the end of the diagnostic evaluation, the news usually is good.