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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 almost three years into menopause and have recently

Customer Question

I am almost three years into menopause and have recently noticed an increase in discharge and tiny amount of spotting following exercise. I called the nurse in the doctor's office and she recommended I treat as a yeast infection. I am doing so and the discharge does seem to have diminished but, after working out this morning, I noticed another tiny spot of very pale, brownish blood on my underwear. It always seems to be on the left side of the underwear. I do not have any risk factors for endometrial cancer and had a normal pap smear only three months ago. Still, I am very anxious. Thank you for any feedback you might be able to offer.
Submitted: 2 years ago.
Category: OB GYN
Expert:  Dr. C. replied 2 years ago.
Hi, It's Dr. C. Board-certified Ob-gyne. I'm sorry that you're having this concern. Usually we wouldn't choose to treat this as a yeast infection over the phone. By far the most common reason for such bleeding is thinning of the tissue due to low estrogen levels. During exercise, the blood pressure goes up and that can be enough to cause some oozing of blood from blood vessels in the genital area. The lack of estrogen in menopause causes the overlying tissue to get thin. I normally would have a woman get a pelvic ultrasound to measure the endometrial lining. If less than 4 mm, the risk of cancer or precancer is low enough to treat as if it is the low estrogen. If greater than 4mm, the risk of a precancer or cancer is about 10% and normally we'd do a biopsy to make sure. If the lining is 4mm or less, we'd next treat with low dose topical estrogen. The symptoms are very common in women who are in menopause or nearing menopause. It is usually quite easy to solve. 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 7nights, than use 1 gram twice weeklyVagifem pellets - use one pellet nightly for 14 nights, than use twice weeklyMost women will notice an improvement within 2 weeks. I hope this information has been reassuring and helpful. Please reply if I can clarify anything. I want to make sure you have the most helpful information for your situation.
Expert:  Dr. C. replied 2 years ago.
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Customer: replied 2 years ago.
Thank you for your response. By the way, I am 52 years old. I have made an appointment with the Dr. In the meantime, do you think the fact that the spitting us do minimal and occurs only sporadically is at all reassuring that it is not cancer/precancerous? The nurse I spoke with indicated that cancer would usually involve more bleeding. I am planning on following up in any case, but I am curious about this. Thank you again.
Expert:  Dr. C. replied 2 years ago.
Yes usually bleeding due to the low estrogen causing thinning tissue is very slight and sporatic. But even so we tend to be very careful because early detection of uterine cancer makes a big difference in long term outcome. Sometimes, I'll treat with the estrogen first without getting an ultrasound and only order the ultrasound if the bleeding doesn't go away completely with 3 months of estrogen treatment. That's reasonable as long as there aren't any increased risk factors for endometrial cancer. The most common risk factors are obesity, family history of uterine or colon cancer and diabetes. Anything else?
Expert:  Dr. C. replied 2 years ago.
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