Menopause is a natural process in which ovulation and menstrual bleeding end in women between the ages of 45-55. Postmenopausal bleeding (bleeding after menopause) is bleeding that can occur in varying amounts at least 1 year after the last menstrual period and is seen in 10% of women in this period. Postmenopausal bleeding; It requires a detailed evaluation regardless of amount, duration and frequency. Because bleeding during menopause can never be considered normal, it is often a sign of a problem and must be investigated.
Sometimes bleeding may occur from the urinary tract or intestines/anus. These bleedings may be confused with vaginal bleeding. However, these bleedings are not considered postmenopausal bleeding. First of all, these bleedings other than gynecological diseases must be distinguished.
The causes of post-menopausal bleeding include: external estrogen supplementation, excessive thinning of the inner layer of the uterus, excessive thickening of the inner layer of the uterus and polyp development, fibroids (originating from the uterus). benign tumors) wounds and polyps in the cervix, drugs used for breast cancer, uterine/cervical and ovarian cancers, thinning of vaginal tissue, inflammation and trauma.
Applicants with complaints of postmenopausal bleeding. In patients, a detailed gynecological examination is first performed to determine the source of bleeding. With vaginal examination, pathologies related to the vagina and cervix are evaluated, and with USG examination, the uterus and ovaries are evaluated. In some patients, additional examinations such as SIS and Hysteroscopy (visualization of the uterine internal structure) may be required. If deemed necessary as a result of all examinations, an endometrial biopsy (removing a piece from the uterus by curettage) is performed for definitive diagnosis. Biopsy is important in early diagnosis and treatment of some malignancies. In the postmenopausal period, the thickness of the inner layer of the uterus is at most 5 mm. Even if there is no complaint of vaginal bleeding after menopause, an endometrial biopsy is taken for control purposes in patients with a thickness of the inner wall of the uterus over 5 mm.
The treatment of post-menopausal bleeding depends entirely on the cause of the bleeding. For example, if the cause of bleeding is a polyp in the cervix This needs to be removed and pathological examination performed. If the cause of bleeding is the medications used (hormone therapy, blood thinners), the treatment must be rearranged. If the cause of bleeding is excessive thickening of the inner wall of the uterus, treatment varies from simple hormone treatments to advanced surgical treatments, depending on the biopsy result.
80% of bleeding in the postmenopausal period occurs for benign reasons. However, for the diagnosis and treatment of possible malignancies in the 20% group - at an early stage - patients must be conscious and consult a Gynecology and Obstetrician at the time of first bleeding.
Op. Dr. Fatma Türkan Ayan
Gynecology and Obstetrics Specialist
Private Optimed Hospital
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