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Dr. C.
Dr. C., Board Certified
Category: OB GYN
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Experience:  30 years of experience and an award-winning educator.
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What is going on during bleeding with menopase?

Customer Question

what is going on during bleeding with menopase?
Submitted: 1 year ago.
Category: OB GYN
Expert:  Dr. C. replied 1 year ago.

Hi, It's Dr. C. Board certified Ob-gyne. I can help you today.

I'm sorry that you have this scary bleeding right now. There are a few possible causes. Most of such light bleeding episodes in women in menopause are due to tissue thinning from lack of estrogen. This causes the blood vessels to come to the surface where they can pop and cause such bleeding.

But anytime a woman in your age group has such bleeding, we also need to consider less common causes. These include non-cancrous polyps, cancers and precancers. Some medications and other medical conditions can cause post-menopausal bleeding too. Blood thinners, Tamoxifen and liver disease would be the most common.

The way the doctor will figure out the cause is to take more history, examine your tissues for thinning and most likely have an ultrasound done. Nearly all uterine cancers start along the lining o fthe uterus. So we take a measurement there. If the measurement is greater than 4mm, the risk of a cancer or precancer is about 10%. In that case the doctor will want to do a biopsy. If the lining is 4 mm or less, they most likely would treat with a very low dose of estrogen placed vaginally to thicken and improve the health of the tissue. This prevents future tissue tears and future bleeding.

Risk factors for uterine cancer include obesity, family history of uterine or colon cancer, no childbearing, a history of skipping many periods at younger ages and diabetes. But even with risk factors present, chances are MUCH higher that it's from low estrogen causing blood vessels to pop and tissue tears.

So the next step is to call your gynecologist or primary care doctor. An exam and ultrasound are typical next steps.

I know it's hard not to worry about it being from cancer or precancer but it's much too soon to say that and statistics are WAY in favor of it not being that. Also if it is, it would likely be caught very early. Most advanced cancers of the uterus occur because women do not seek care for months or even years of abnormal bleeding.

I know this is scary but I hope my explanation has been somewhat reassuring and helpful. Please reply if I can clarify anything or provide more details.

Expert:  Dr. C. replied 1 year ago.

Any questions?

Expert:  Dr. C. replied 1 year ago.

I want to make sure you have the best service for your situation. So please do reply if I can add details. We can also talk by phone if that would help.

Expert:  Dr. C. replied 1 year ago.

The length of time doesn't matter in the answer. So if it's just been a few days or 3 months, the evaluation is the same. It's most likely from low estrogen levels but we also need to think and make sure it's not a cancer or precancer. I listed the risk factors for cancers above. So if you have none of them, your risk will be rather low. But even if you have some of the listed risk factors, it's still more likely to be tissue thinning from low estrogen levels.

Can I clarify anything else. Be sure to answer in this same box here and don't open a new question.

Expert:  Dr. C. replied 1 year ago.

I know this is scary but it's just a matter of getting a proper evaluation. Almost always it's either thinning from low estrogen or a non-cancerous polyp. That really does account for about 98% of what I see as a cause of post-menopausal bleeding.

Anything else I can help with about this?

Expert:  Dr. C. replied 1 year ago.

It's normal for a woman to be worried when she has post-menopausal bleeding. But as I've explained, the chances are HUGE that it's NOT cancer. As I worte above, about 98% of the time, the cause of the bleeding, even if it's been going on for 3 months, is NOT cancer. It's due to either tissue thinning with low estrogen or non-cancerous polyps. There are a few other non-cancer causes that I mentioned above.

I understand that you're scared and worried. But it's much too soon to say that you have anything serious going on. The chances are about 98% that you DO NOT.

Anything else?

Expert:  Dr. C. replied 1 year ago.

I hope you feel like you're getting excellent service from me. Please reply in this box right here on this page if you need more information still.

Expert:  Dr. C. replied 1 year ago.

If no more questions, please leave a rating for my service. I aim to provide excellent information and appreciate your feedback. Thanks and good luck with your evaluation.

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