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Dr. C.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience:  30 years of experience and an award-winning educator.
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I am 71 years old and have had a problem with vaginal bleeding

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I am 71 years old and have had a problem with vaginal bleeding for over a year. I have had 2 D&C's since last September. The latest one in May. I have been told that all my test have been negative and there is no sign of cancer but my bleeding has continued. My gynocoligist has suggested another D&C and that she will try to go deeper into my uterus but cannot guarntee that my bleeding will stop. She also said that a hysterectomy is not recommended at my age. Can you suggest anything that could help me with my problem??

Dr. C. :

I am glad to help you. Answers are intended to provide general medical information only.

Dr. C. :

Let me read your question carefully.

Dr. C. :

The reason for the bleeding is most likely "atrophic". Having another D&C is likely to cause more trouble than to help.

Dr. C. :

There are 2 main reasons for bleeding in the postmenopause. The first is when the lining of the uterus gets too thick. When this is extreme it is cancer.

Dr. C. :

The second reason is when the lining gets too thin. In this case the bare blood vessels are exposed to the surface and ooze blood. The way to correct that is to thicken the lining slightly to stabilize the bleeding.

Dr. C. :

Some women can bleed massively from too thin uterine lining.

Dr. C. :

The treatment of choice is a low dose of estrogen.

Dr. C. :

It can be given vaginally and very little is absorbed into the system that way. So the risk of breast cancer, blood clots and other things found with systemic use of estrogen are not present.

Dr. C. :

Bleeding not related to cancer can also be related to other things such as the use of blood thinners or liver disease.

Dr. C. :

If there has been an ultrasound done, the lining usually will be quite thin in cases of atrophic bleeding.

Dr. C. :

With 2 D&Cs already, cancer is not likely the reason for bleeding and the use of a low dose of estrogen vaginally would be the most likely thing to help provided there are no medications or other medical issues that explain the bleeding.

Dr. C. :

I taught for 8 years at a medical university on the topic of menopause so am quite familiar with this situation.

Dr. C. :

If you have any questions I would like to explain more or provide more details for you.

Dr. C. :

Do you have questions?

Dr. C. :

I will cut and paste something I wrote about the use of vaginal estrogen. It will just take a minute or so.

Dr. C. :

Most likely, some vaginal estrogen cream or tablets will be helpful. Estrogen cream is cheaper but messier to use. Vagifem tablets are easier to use but more expensive. Women need to check with their insurance to see if they have coverage for both equally. If so, the Vagifem tablets are preferred. Although it's an estrogen product, there is virtually no absorption into the blood stream of estrogen. So even though the package insert (which is required for all estrogen products by the FDA) will say things about breast cancer, blood clots, etc., these warning do not apply to the Vagifem product. There is somewhat more absorption into the blood system with the cream. The only reason why women will DEFINITELY want the tablets is if a woman has a history of breast cancer, blood clots or heart attack. The proper usage is to use for the 2 products is as follows:

Estrace (estradiol) cream - use 1 gram nightly for 7 nights, than use 1 gram twice weekly

Vagifem pellets - use one pellet nightly for 14 nights, than use twice weekly


Dr. C. :

You can print this chat out to show to your doctor.

Dr. C. :

In some cases women can bleed very heavily from atrophy and need to receive estrogen by IV to stop the bleeding. This is very rare.

Dr. C. :

We are taught early in our training that post-menopausal bleeding = cancer and sometimes don't think outside the box for other causes. But atrophic bleeding is something that I see often enough.

Dr. C. :

Please ask questions if you have any.

Dr. C. and other OB GYN Specialists are ready to help you
Customer: replied 4 years ago.
Do you think I should change doctors? I asked about hormones and she told me no. She said I would just have to live with my problem unless I wanted her to try another D&C.
It seems like maybe she is just un-experienced. You can print out this chat to refer to and ask her specifically:

"Do you think my bleeding might be from atrophy?"
"Do you think some low dose vaginal estrogen might help?"

If she gets defensive or still reluctant then yes, changing doctors would be a good idea. Most likely she just hasn't seen enough post-menopausal women with bleeding to have learned this yet. The more important thing is whether she can recognize the possibility and learn from it. If she can, she is a perfectly fine doctor.

Please ask more questions if you have any.