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I Am A 44 Year Old Woman How Has Not

Posted on Mon, 9 Nov 2020

Question: I am a 44 year old woman how has not had a period in 19 months and am considered by my doctor to be menopausal. I am about 50-60 lbs overweight. I often will have slight bleeding after sex (which is also painful) but after getting checked out my doctor was not concerned. I have now had very slight bright red/pink spotting on two different occasions in the past two weeks. The first was close enough to the last time I had intercourse so I thought it was related to that. This time was a little more blood (still very minimal, just on the toilet paper) and I have not had sex in two weeks. I do experience dryness, painful urination, some itching that I thought were related to vaginal dryness. Do I need to be worried about cancer (or even pregnancy?) and should I see my doctor again?

Answered by Dr. Ramadevi Wani (2 hours later)

Brief Answer:
Details below.

Detailed Answer:
Hi,
Welcome to Ask a Doctor.
I am Dr Ramadevi. I will be answering your concerns. I have read your notes carefully. It is not usual to have bleeding after sex. when did you last have your pap smear test? Please repeat it again.
The slight bleeding you noticed, could probably be due to atrophy of the vaginal mucous membrane. Yet it is important that you get an internal examination done by gynecologist and an ultrasound of uterus and ovaries, to make sure that there is no other cause for this bleeding.
If you have further concerns, I will be happy to answer.
Kindly work on reducing weight to maintain good health.
Best wishes.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Ramadevi Wani (27 minutes later)

I had a negative Pap smear in 2017 along with a negative HPV test. The doctor recommends a Pap smear every five years after this combination of results, so I haven’t had one in three years. I had several ultrasounds over the past year, the last one being in March of 2020, both of them with normal results. The doctor thought the bleeding after sex was due to menopausal changes/dryness because of the increased pain with sex since I’ve gone through menopause and the other tests were negative/normal. I will get an appointment scheduled, but just wanted to get some peace of mine in the meantime.

Answered by Dr. Ramadevi Wani (10 minutes later)

Brief Answer:
Details below.

Detailed Answer:
Hi,
Welcome back.

It is very reassuring to know that Pap and HPV testing in 2017 were negative.
Yet, because you are having postcoital bleeding, it is better to repeat it. If your doctor has confirmed the bleeding to be due to vaginal dryness, then you need not repeat it.
Since your recent ultrasound in 2020 is normal, it is unlikely that there is any problem. Yet because it is more than 6 months, since the last ultrasound, please repeat again.
I am expecting the results to be normal.
Best wishes.

Above answer was peer-reviewed by : Dr. Kampana