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Post menopausal bleeding – what can it possibly be?

What is postmenopausal bleeding?

Postmenopausal bleeding is any bleeding that occurs in a woman’s vagina after she has undergone menopause. Once a woman has gone 12 months without a period, she’s considered to be menopausal.

In order to rule out serious medical problems, women with postmenopausal bleeding should always see a gynecologist.

What is vaginal bleeding?

Vaginal bleeding can have a variety of causes. These include normal menstrual cycles and postmenopausal bleeding. Other causes of vaginal bleeding include:

  • trauma or assault
  • cervical cancer
  • infections, including urinary tract infections
  • Polyps
  • Endometrial hyperplasia
  • Fibroids

If you’re experiencing vaginal bleeding and are postmenopausal, your Gynecologist will ask about the duration of the bleed, the amount of blood, any additional pain, or other symptoms that may be relevant.

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Because abnormal vaginal bleeding can be a symptom of cervical, uterine, or endometrial cancer, you should get any abnormal bleeding evaluated by a gynecologist immediately .

What causes postmenopausal bleeding?

Bleeding can occur in postmenopausal women for several pathological reasons. For example, women who take hormone replacement therapy for menopause may have vaginal bleeding for a few months after starting the hormones. It’s also possible for a woman who thought she was in menopause to begin ovulating. If this occurs, bleeding may also occur.

There are a variety of other conditions that can cause postmenopausal bleeding such as polyps, endometrial hyperplasia, and endometrial atrophy.

Uterine polyps

Uterine polyps are noncancerous growths. Though benign, some polyps may eventually become cancerous. The only symptom most patients with polyps will experience is irregular bleeding.

Uterine polyps are particularly common in women who have gone through menopause. However, younger women can also get them.

Endometrial hyperplasia

Endometrial hyperplasia is the thickening of the endometrium. It is a potential cause for postmenopausal bleeding. It is often caused when there is an excess of estrogen without enough progesterone. It occurs frequently in women after menopause.

Long-term use of estrogen can lead to increased risk of endometrial hyperplasia. It can ultimately lead to cancer of the uterus if not treated.

Endometrial cancer

Endometrial cancer begins in the uterus. The endometrium is a layer of the uterus. In addition to abnormal bleeding, patients may experience pelvic pain.

This condition is often detected early. It causes abnormal bleeding, which is easily noticed. The uterus can be removed to treat cancer in many cases. Less than 10% of women who have postmenopausal bleeding have endometrial cancer.

Endometrial atrophy

This condition results in the endometrial lining becoming too thin. It can occur in postmenopausal women. As the lining thins, bleeding may occur.

Cervical cancer

Bleeding after menopause is often harmless. However, it can also be a rare sign of cervical cancer. Cervical cancer tends to progress slowly. Gynecologists can sometimes identify these cells during a regular exam.

Annual visits to the gynecologist can help with early detection and even prevention of cervical cancer. This can be done by monitoring for abnormal Pap smears.

Other symptoms of cervical cancer can include pain during sex or abnormal vaginal discharge, including in women who are postmenopausal.

Symptoms of postmenopausal bleeding

Many women who experience postmenopausal bleeding may not have other symptoms. But symptoms may be present. This can depend on the cause of bleeding.

Many symptoms that occur during menopause, like hot flashes, often begin to decrease during the postmenopausal time period. There are, however, other symptoms that postmenopausal women may experience.

Symptoms postmenopausal women may experience include:

  • vaginal dryness
  • decreased libido
  • insomnia
  • stress incontinence
  • increased urinary tract infections
  • weight gain

Why Dr. Ruchi Tandon is the best choice?

Dr. Ruchi Tandon is a gynecologist with over 13 years of experience in clinical menopause and is a trained Hysteroscopy surgeon, practicing in leading hospitals of South Delhi such as Max smart super specialty hospital, Saket, Apollo Cradle Royale, Nehru Place. She specializes in hormone replacement therapy and recommended the management of menopausal symptoms.

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Ovarian cyst – laparoscopy is treatment of choice

Ovarian cysts are fluid-filled sacs or pockets in the ovary or on its surface. Women have two ovaries — each about the size and shape of an almond, 2-3cm in size— on each side of the uterus. Eggs, which develop and mature in the ovaries, are released in monthly cycles during the childbearing years.

Many women have ovarian cysts at some time. Most ovarian cysts present little or no discomfort and are harmless. The majority disappears without treatment within a few months.

However, ovarian cysts — especially those that have ruptured — can cause serious symptoms. To protect your health, get regular pelvic exams and know the symptoms that can signal a potentially serious problem.

Symptoms of ovarian cyst

Most cysts don’t cause symptoms and go away on their own spontaneously. However, a large ovarian cyst can cause:

  • Pelvic pain — a dull or sharp ache in the lower abdomen on the side of the cyst
  • Fullness or heaviness in your abdomen
  • Bloating

Complications of ovarian cyst

An ovarian cyst often causes no problems, but sometimes it can lead to complications.

  • Torsion: The stem of an ovary can become twisted if the cyst is growing on it. It can block the blood supply to the cyst and cause severe pain in the lower abdomen.
  • Burst cyst: If a cyst bursts, the patient will experience severe pain in the lower abdomen. If the cyst is infected, pain will be worse. There may also be bleeding. Symptoms may resemble those of appendicitis.
  • Cancer:less than 10 % of ovarian cysts can become malignant or cancerous.

Laparoscopy in ovarian cyst

A small incision will be made just below the navel. Next, a laparoscope will be inserted. This is a thin tube with a camera on the end. To allow the doctor to better view the organs, carbon dioxide gas will be pumped into the abdomen. The laparoscope will be used to locate the cyst. When it is found, 1 or 2 more incisions will be made. Surgical instruments will be inserted to remove the cyst. Tissue may be removed for testing. If cancer is found, both ovaries may need to be removed. After the cyst is removed, the instruments will be removed. The incision area will be closed with stitches or staples.

Immediately After Procedure

After the procedure, you will be given IV fluids and medications while recovering.

How Long Will It Take?

1-2 hours

Will It Hurt?

There will be pain after the surgery. You will be given pain medication.

Average Hospital Stay

You may stay overnight, or you may be able to leave the hospital the same day as your surgery.

Why Dr. Ruchi Tandon?

Dr. Ruchi Tandon is a trained laparoscopic Gynecological surgeon, practicing in best hospitals in South Delhi such as Max smart super speciality hospital, saket, Apollo Cradle Royale, Apollo Spectra Hospitals, Delhi. She has over 14 years of experience in the field of operative Gynecology and endoscopic procedures.

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What is abortion in pregnancy?

Abortion is the removal of pregnancy tissue, products of conception or the fetus and placenta (afterbirth) from the uterine cavity. In general, the terms fetus and placenta are used after eight weeks of intrauterine pregnancy. Pregnancy tissue and products of conception refer to tissue produced by the union of sperm with the ovum.

Other terms for an abortion include elective abortion, induced abortion, MTP, termination of pregnancy and therapeutic abortion.

Preparing for abortion

Your doctor will ask about your medical history and examine you internally as well. Even if you used a home pregnancy test, another pregnancy test often is needed to confirm that you are pregnant or not. In some cases, you will need an Ultrasound, may be transvaginal, to determine how many weeks into the pregnancy you are and the size of the fetus, and to make sure the pregnancy is not ectopic /tubal.

An ectopic pregnancy is one that is growing outside of the uterus, mostly in the tubes.

A blood test will determine your blood type and whether you are ABO Rh positive or negative. The Rh protein is made by the red blood cells of most women. These blood cells are considered Rh-positive. Some women have red blood cells that do not produce Rh protein; these blood cells are considered Rh-negative.

Pregnant women who have Rh-negative blood are at risk of reacting against fetal blood that is Rh-positive. Because a reaction can harm future pregnancies, Rh-negative women usually receive an injection of Rh immunoglobulin (RhIG) to prevent Rh-related problems after miscarriage or abortion.

How it is done

Doctors can use medicines, surgery or a combination of both to end a pregnancy. The method depends on how far along in the pregnancy you are, your medical history and your individual preference.

Abortions during early pregnancy, before 49 days, can be done safely with medications. Abortions between 6 and 14 weeks usually are done surgically, although medications may be used to help soften and open the cervix.

After 14 weeks, abortions can be done using labor-inducing medications that cause uterine contractions or by using these medicines in combination with surgery.

Medical abortion
Abortions completed with medication, called medical abortions, can be performed within 49  days of gestation. Days of gestation are the number of days beginning on the first day of your last menstrual period.

Most often doctors use a combination of mifepristone and misoprostol.

Surgical abortion

Suction or aspiration abortion

Sometimes called a suction D & E (for dilation and evacuation), this procedure can be done up to 14 weeks after the first day of the last menstrual period. Suction D & E is the procedure most commonly used to end a pregnancy. One dose of antibiotics is recommended prior to the procedure to prevent infection. The cervix is dilated (widened) and a rigid hollow tube is inserted into the uterus. An electric pump sucks out the contents of the uterus. The process takes about 15 minutes. Local anesthesia is usually applied to the cervix to minimize the pain of dilating the cervix. Medication given intravenously (into a vein) may help to decrease anxiety and relieve pain.

Why Dr. Ruchi Tandon is the best choice for your abortion?

Dr. Ruchi Tandon, is a gynecologist, based in South Delhi, practicing Obstetrics and Gynecology for over 14 years. She is proficient in all kinds of medical, surgical and high-risk abortions. She is available at her clinic in greater Kailash part 2, max smart super specialty hospital, Saket and Apollo Cradle Royale, Nehru Place, Delhi.

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Menopause in Indian women – An enigma

Menopause is the process through which a woman ceases to be fertile or menstruate completely. It is a normal part of life and is not considered a disease or a medical condition.

Symptoms may occur years before a woman’s final period also called as Perimenopause. Some women may experience symptoms for months or years afterward or before actual menopause.

In India, the average age for menopause is 47 years.

Despite being a natural process in the body of any woman, menopause can cause drastic changes that trigger a variety of symptoms.

While menopause is not a disease or disorder, it does trigger some profound changes in a woman’s body.

A diagnosis of menopause is confirmed when a woman has not had a menstrual period for one continuous year. However, the symptoms of menopause generally appear before the end of that one-year period.

Signs and symptoms

Irregular periods

Changes to the menstrual pattern are the first noticeable symptoms of menopause. Some women may experience a period every 2 to 3 weeks. Others will not menstruate for months at a time.

Lower fertility

Perimenopause is the 3-to-5-year period before menopause.

During the perimenopausal stage, a woman’s estrogen levels will drop significantly. This reduces her chances of becoming pregnant.

Vaginal dryness

Dryness, itching, and discomfort of the vagina tend to occur during perimenopause.

As a result, some women may experience Dysparenuia , or pain during sex. Women experience this pain due to lowering estrogen levels. These lower levels cause vaginal atrophy.

Vaginal atrophy is an inflammation of the vagina that happens as a result of the thinning and shrinking of the tissues, as well as decreased lubrication.

Hot flashes

A hot flash is a sudden sensation of heat in the upper body. It may start in the face, neck, or chest, and progress upward or downward.

The skin may become red and patchy, and a woman will typically start to sweat. Her heart rate may suddenly increase, strengthen, or become irregular. Hot flashes generally occur during the first year after a woman’s final period.

Night sweats

Hot flashes that occur during the sleep cycle are called night sweats. Most women say their hot flashes do not last more than a few minutes.

However, studies have confirmed that moderate-to-severe night sweats and hot flashes may pose a problem for 6-8 years before actual menopause.

Disturbed sleep

It can be difficult for women to fall asleep and stay asleep as they progress through menopause.

In some cases, night sweats can lead to discomfort during the night and difficulty sleeping. Sleep disturbance may also be caused by insomnia or anxiety.

Urinary problems

Menopause can disrupt a woman’s urinary cycle.

Women tend to be more susceptible to Urinary tract infections (UTIs) during menopause, such as cystitis. They may also find that they also need to visit the toilet more often.

Emotional changes

Women can experience depression and low mood during menopause.

Hormonal changes can often trigger depressed feelings and mood swings. In many cases, these emotional symptoms also go hand-in-hand with sleep disturbance.

Women may also experience low libido, or sex drive, as a result of these emotional changes.

Problems focusing and learning

Menopause can affect cognitive functions, such as concentration.

Some women may also experience short-term memory problems and difficulty focusing for long periods.

Other effects

Other symptoms of menopause include:

  • a buildup of fat in the abdomen, sometimes leading to overweight and Obesity.
  • Hair loss and thinning hair
  • breast shrinkage

Without treatment, symptoms usually taper off over a period of 2 to 5 years. However, symptoms can persist for longer. In some cases, vaginal dryness, itching, and discomfort can become chronic and eventually get worse without treatment.

Complications

Menopause can lead to the development of complications, including:

  • Cardiovascular disease: A drop in estrogen levels has been associated with an increased risk of cardiovascular disease.
  • Osteoporosis: A woman may lose bone density rapidly during the first few years after menopause. Low bone density leads to a higher risk of developing Osteoporosis.
  • Urinary incontinence: Menopause causes the tissues of the vagina and urethra to lose their elasticity. This can result in frequent, sudden, and overwhelming urges to urinate. These urges can be followed by an involuntary loss of urine. Women may involuntarily urinate after coughing, sneezing, laughing, or lifting during menopause.
  • Breast cancer: Women face a higher risk of breast cancer following menopause. Regular exercise can significantly reduce the risk.

Menopausal remedies at South Delhi

Dr. Ruchi Tandon is an exceptional  Gynecologist specializing in disorders such as menopause. She has over 14 years of experience in pregnancy, fibroids, fibroids, excessive bleeding, and hot flashes. She is a new generation doctor with a holistic approach towards her Perimenopausal and menopausal patients. She specializes in providing the best treatments for all patients.