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What causes vaginal bleeding after menopause?

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Answered by

General & Family Physician
Practicing since : 2004
Answered : 612 Questions
Question
Hello
I am 61yo eleven years post menopause
I have had two children, I am 5’6” and weigh 140 pounds. No family or personal hx of cancer. I have hypertrophic vaginitis
A year ago I noticed absolutely clear very thick jelly like discharge, small amount. Being the retired nurse that I am I found a large swab, swabbed the vaginal os-no bleeding-there was blood near the vaginal opening on the vaginal wall, scant amount bright red.
I disregarded it as vaginal wall bleeding-wasn’t sure about the mucus but I surmised some type of inflammatory response.
Nothing after that-until exactly one year later same thing?
I should note that I had a kidney stone this year with an abd/pelvic CT scan which was negative except for the stone. They compared it to a CT scan 7 years previous which may or may not be relevant. I know endometrial CA will not show up on a CT but a tumor or spread probably would
Your opinion?
Thanks!
Wed, 23 May 2018 in Women's Health
 
 
Answered by Dr. Zotaj Antoneta 1 hour later
Brief Answer:
Very likely it is self limiting and nothing to worry- some tests recommended to be on safe side

Detailed Answer:
Hello,
Thank you for asking at healthcaremagic.

I carefully read your question and understand your concern.

The most common cause of vaginal bleeding in women in menopause is due to vaginal atrophy and very likely this is the case and there is nothing to worry. It is also that a CT scan would show an advanced tumor that has spread.
On the other hand endometrial cancer happen with age and is a present risk in women with vaginal bleeding after menopause. Even though the chances are small to have endometrial cancer still it is recommended to have specific tests to rule it out whenever a woman has vaginal bleeding in menopause.

When was your last pap smear? it is recommended to have one if you did not have one in the last 3 years or earlier checks if changes are found in the previous ones. After 65 years of age it is not recommended anymore so very likely you have this one to be sure and do not need to repeat it again but i would recommend you to have it done.

When having a pap smear the doctor can also check the vulva and vaginal walls for lesions or possible reasons for bleeding.

The vaginal ultrasound is a test to check for the endometrial thickness, it is not very invasive, is very much available and gives a lot of information so I would recommend you to have one done.

If all these are normal, the vaginal exam, pap smear and vaginal ultrasound, than chances are that it is just vaginal atrophy and nothing to worry, using local estrogen can help.

If these tests identify lesions than you will need to be followed up accordingly.
If no lesions but still there is bleeding than you will need to have endometrial biopsy.

So to conclude:
- very likely it is vaginal atrophy and there is nothing to worry, having tests keeps you on the safe side
- have a vaginal exam, pap smear and vaginal ultrasound
- be followed up accordingly after the results

I hope this is helpful and answers to your questions but please feel free to contact me in case of any more clarification is needed on this.

Kind regards,

Antoneta Zotaj, MD
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