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Post menopausal, not had hysterectomy. Having bleeding. Underlying cause?

Mar 2016
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Practicing since : 2011
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I am a 69 year old post menopausal female whose never had a hysterectomy.
I am having bleeding and need to know if I have atrophy and a calcified fibroid tumor should I be concerned.
Posted Fri, 4 Oct 2013 in Vaginal and Uterus Health
Answered by Dr. S Patra 33 minutes later
Brief Answer:
Need additional investigation.

Detailed Answer:

Thanks for writing to us on Healthcare Magic.

Postmenopausal bleeding at your age is not always normal thing. Here, we need to rule out additional pathology like endometrial hyperplasia and malignancy by relevant investigation. These include Trans Vaginal Ultrasound scan (TVS), FSH level, CA-125, pap smear & HPV test etc.

If all test results are normal, then risk of malignancy is eliminated and follow up visit is required on yearly basis. In such case, atrophy and calcified fibroid tumor will be not your concerned thing. However, some treatment is required to arrest bleeding on temporary basis.

Low dose progesterone supplements are quite helpful in controlling bleeding with reduction of postmenopausal symptoms. Tranexamic acid can be given for short duration. Kindly, consult with your gynecologist for overall health check up and proper guidance on management of the case.

Hope, I have answered your query. If you need any clarification, you can freely ask me.

Wish your good health and take care yourself.

Dr Soumen

For future query, you can directly approach me through
Above answer was peer-reviewed by
Follow-up: Post menopausal, not had hysterectomy. Having bleeding. Underlying cause? 11 minutes later
I have been in touch with my OBGYN and said he saw lots of atrophy and believes that is what is causing this problem and wants to put me on some type of estrogen. He has not seen me since my hysterscopy which was done 5-12. Should I insist that me see me and do the tests above or myabe see someone else
for a second. I am scared and don't which route to take.
Also, if the bleeding stops this time, what am I to expect in the future? I have not had a pap smear since 05/12. At that time my gyn told me not to come back to him for 2 years.
Answered by Dr. S Patra 27 minutes later
Brief Answer:
Yes, you have to undergo above tests.

Detailed Answer:

Thanks for your follow up query. Don't be scared. Just follow this:

1) First thing, you would need to undergo above mentioned tests to exclude potential risk of malignancy or other etiology. Your OBGYN will help you regarding this.

2) If atrophy and calcified fibroid are the main reason of bleeding, then hormonal supplement and tranexamic acid can be given as treatment of choice.

3) Estrogen is quite effective to treat atrophy but should not be used for long term as the risk of increasing endometrial carcinoma and deep vein thrombosis.

4) You have history of stroke 2 years ago. Then estrogen alone is not a good choice as it is associated with risk of thrombus formation and it may precipitate the same. Therefore, it should be combined with progesterone supplement to combat the adverse effect of estrogen.

5) I would treat you with low dose progesterone and tranexamic acid to control bleeding and reduce menopausal symptoms.

6) Natural estrogen therapy can be given for some duration and you need check up on yearly basis. It is alternative to steroidal estrogen and has less adverse effect. Here, you can take phytoestrogens like isoflavone etc which is plant based estrogen).

7) In addition, dietary supplements with soy, beans, peas, lentils, whole grains, rye, millet etc are quite useful. Drink more water/ fluid and take balanced diet with fresh vegetables and iron supplements.

Hope, I have guided you with my experience. If you don't have any other query, you can close the discussion.

All the best. Good luck.

Dr Soumen
Above answer was peer-reviewed by
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