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What causes vaginal bleeding and lower abdomen cramps in a elderly woman?

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Posted on Thu, 5 May 2016
Question: I am a 74 year old post menopausal woman who have had yearly gyn exams and pap smears that were all normal. I do have vaginal prolapse which my gyn says is due to having multiple children and probably happened during childbirth. Since I am not sexually active, art is not painful. However, during the past week I have experienced vaginal bleeding ( not heavy) and some pain in my lower abdomen resembling cramps. It doesn't last for a long time and it may not be experienced for several days. I am hypertensive and take losartan (50 mg /day) and amlodipine (25 mg per day). I have mad an appt to see my Gyn but he won't return to the office for several days. Is this an emergency or can I wait a couple of days before seeing my doctor?
doctor
Answered by Dr. Nishikant Shrotri (1 hour later)
Brief Answer:
You need thorough work up. Start with ultrasonography

Detailed Answer:
Dear XXXX,

At the age of 74, after menopause, any vaginal bleeding should be investigated thoroughly to rule out any alarming conditions, particularly cancer.

In hypertension, the blood vessels have undergone atherosclerotic changes. Such changes in the uterine lining may lead to uterine bleeding; however, it has to be proved and not hoped for.

You are undergoing regular yearly check ups for your health, which include ultrasonography and Pap smear also. Would you please let me know when was this check up performed last?

You will have to consult your Gynaecologist at the earliest no doubt; however, if he is not available immediately, you can start few investigations of your own. Please get ultrasonography of your pelvic organs done. I would advise you go for abdominal as well as travs-vaginal ultrasonography. Thickness of the uterine lining (Endometrium) is a very important finding. If the endometrium is more than 4 mm thick, it demands further histopathological study of the endometrium. The endometrium biopsy should be collected by hysteroscopy. Pain in the lower abdomen could be due to some tumour in the uterine wall. Ultrasonography can locate such lesions also.

Ultrasonography will inform about the site of the bleeding and the conditions of the other pelvic organs also.

If after ultrasonography also your Gynaecologist is not available for indefinite several days, I would advise you to take opinion of another Gynaecologist. I can be of some immediate help to you.

I would appreciate if you upload the images and reports of this ultrasonography and all previous latest reports.

For any more information, I am always available for you, XXXX.

Dr. Nishikant Shrotri
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Nishikant Shrotri (56 minutes later)
The pa smear and GYN examination was last performed in May, 2015. My annual GYN check-ups are usually in May or XXXXXXX of each year. My visit to GYN's office is on Thursday by I will be examined by Board Certified Nurse practitioner in his absence. He will return on Monday. Should I follow her recommendations? Have never been seen by her but she is in his office practice.

Can the interactive effects of the medications I am taking cause vaginal bleeding, particularly, the Losartan. What about prolapse of the vaginal walls, could this also be a cause.

I will definitely follow-up with your recommendations to get a full and thorough work-up.
doctor
Answered by Dr. Nishikant Shrotri (12 hours later)
Brief Answer:
Nurse cannot substitute Gynaecologist's examination and advice

Detailed Answer:
Dear XXXX,

I would advise you to get examined vaginally to find out whether you have any ulceration on the vaginal walls due to prolapse. These ulcers can be caused by impaired blood supply to the vagina leading to sloughing of the tissue. These ulcers can bleed. However, they would not bleed freely like menstrual bleeding. They usually ooze if they are bleeding. Congestion of the uterus due to extreme prolapse may cause uterine bleeding.

Losartan you are consuming for your high blood pressure is angiotensin II receptor antagonist. It keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow. This medicine is not reported to cause any abnormal bleeding from any site.

Are you on any low dose aspirin treatment? Aspirin affects the clotting properties of the blood and hence is known to cause bleeding from any site.

Monday is not too far. Meanwhile you may get examined from nurse; however, an examination and review by Gynaecologist is very important. If possible, please get reference from the nurse to the ultrasonologist for scan and as I have suggested you in my previous communication, please utilize this time in getting your ultrasonography done. In addition, complete haemogramme with platelet count, bleeding time, clotting time and Prothrombin time will also be handy. It will reflect on two things:
1. Whether blood clotting or bleeding factors are responsible for this bleeding
2. Severity of the bleeding and how much it has affected your haemoglobin percentage.

I would appreciate if you upload all these and previous reports on this forum for my review.

For any more information or advice, you are most welcome to ask me. You may please post a favourable review with 5 star rating for me if you feel so.

Dr. Nishikant Shrotri
Above answer was peer-reviewed by : Dr. Prasad
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Dr. Nishikant Shrotri

OBGYN

Practicing since :1968

Answered : 2916 Questions

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What causes vaginal bleeding and lower abdomen cramps in a elderly woman?

Brief Answer: You need thorough work up. Start with ultrasonography Detailed Answer: Dear XXXX, At the age of 74, after menopause, any vaginal bleeding should be investigated thoroughly to rule out any alarming conditions, particularly cancer. In hypertension, the blood vessels have undergone atherosclerotic changes. Such changes in the uterine lining may lead to uterine bleeding; however, it has to be proved and not hoped for. You are undergoing regular yearly check ups for your health, which include ultrasonography and Pap smear also. Would you please let me know when was this check up performed last? You will have to consult your Gynaecologist at the earliest no doubt; however, if he is not available immediately, you can start few investigations of your own. Please get ultrasonography of your pelvic organs done. I would advise you go for abdominal as well as travs-vaginal ultrasonography. Thickness of the uterine lining (Endometrium) is a very important finding. If the endometrium is more than 4 mm thick, it demands further histopathological study of the endometrium. The endometrium biopsy should be collected by hysteroscopy. Pain in the lower abdomen could be due to some tumour in the uterine wall. Ultrasonography can locate such lesions also. Ultrasonography will inform about the site of the bleeding and the conditions of the other pelvic organs also. If after ultrasonography also your Gynaecologist is not available for indefinite several days, I would advise you to take opinion of another Gynaecologist. I can be of some immediate help to you. I would appreciate if you upload the images and reports of this ultrasonography and all previous latest reports. For any more information, I am always available for you, XXXX. Dr. Nishikant Shrotri