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Have been having issues related to menopause (burning,

swelling, irritation), now experiencing bleeding...
Have been having issues related to menopause (burning, swelling, irritation), now experiencing bleeding in the vestibule, in a crevice between the urethra and vaginal opening...actually where my episiotomies were. Have had negative tests for bacterial, and yeast infections...had the wet prep and overnight cultures. Was told skin looked menopausal (49) two periods last year. Was treated with triamcinolone acetonide cream.1% Decreased swelling, and redness, burning remained. Ph was still very high, used RePhresh and burning decreased instantly but noticed spotting...looked and the blood is not coming from vagina but the vestibule? area as stated earlier...what is going on?? Very nervous!
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Customer reply replied 3 months ago
well duh, that's obviously not where I had my episiotomy but part of what?
Answered in 4 hours by:
9/28/2017
Dr. Mo
Dr. Mo, Board Certified MD
Category: OB GYN
Satisfied Customers: 1,782
Experience: Board Certified MD
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Hi, Dr. Mo here with JA. Please let me review the information and I'll reply shortly.

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Has your doctor ruled out postmenopausal bleeding by doing an endometrial biopsy? I agree that the bleeding is more likely coming from the the rugae (skin folds) of the anterior vaginal wall. It doesn't appear to be due to anything malignant or serious which is the good news. It could still be due to menopause and thinning of the tissue.

Have you considered several week trial of estrogen cream?

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Customer reply replied 3 months ago
Is your specialty gynecology? If not then, no offense intended but I'd rather wait...

Absolutely, let me opt out and I'm sure someone who specializes in Gyn will hop on.

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Customer reply replied 3 months ago
Thank you
Dr David
Dr David, Doctor
Category: OB GYN
Satisfied Customers: 48,023
Experience: Experienced physican trained in ob-gyn and oncology
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This is Dr. David

after menopause, women can develop vaginal dryness and thinning of the skin of the vaginal lining.

this can cause the skin to bleed much easier.

usually vaginal estrogen cream prescription can help decrease vaginal dryness and vaginal atrophy from menopause and help decrease the thin vaginal skin and bleeding from menopause

let me know if you have other questions.

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Customer reply replied 3 months ago
I'd really like to talk specifics, could you please leave this open for a gynecologist to answer...thank you
Dr Ted Manos
Dr Ted Manos, Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 806
Experience: 40 years experience; Board certified Ob-Gyn
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Hello,and thank you for choosing Justanswer about your concern. I’m Dr Ted Manos M.D., board certified obgyn. From the photo you provided the vestibule area looks pale and thinned out. Two periods in a year can indicate menopause and if you were a patient in my office I would examine vaginal secretions under the microscope and do a transvaginal ultrasound to determine the nature of the inner uterine lining (endometrium) and treat you according to my findings. Of course, you’re asking about your situation and you need to be seen by a gynecologist to do the basic things I said. I hope you understand my information and I had countless patients with your concerns and many had atrophic vaginal changes under the microscope or some imbalance of the normal vaginal bacteria that maintain a healthy vagina.
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Customer reply replied 3 months ago
Oh thank goodness a real gynecologist! Did visit the doctor, did have both a wet prep and the longer overnight version...nothing found in the way of infection. Ph was 5, had the ultrasound last year and everything was okay.
Here's my question/concern...the steroid cream I was prescribed was a bit irritating after a couple of days, switched to just hydrocortisone (lower strength) and that didn't help much either.
What did help was I waited a few days and then tried RePhresh, and that stopped the burning completely. Not sure if it was because it lowered the Ph, and lubricated or both. My Dr recommended Hyalo Gyn, as a moisturizer, it has to be ordered online. That finally came in the mail...so I gave that a try...it supposed to be more moisturizing then RePhresh, along the lines of RePlens but better. When I inserted the applicator that's when I started to bleed from the rugae. That's what freaked me out...is my skin so tender, and thin that something that simple can cause it to bleed?
Customer reply replied 3 months ago
Doctor believed it to be more of a dermatitis then anything, but did say my skin looked menopausal and gave me the beloved "Handbook on Menopause"! I feel like the high Ph was causing the irritation even if there was no infection present...I've had that before and used RePhresh, but now think my hormones are all over the place. What do you recommend for moisturizer? My Mother had breast cancer so would like to stay away from estrogen creams if at all possible.
If you have atrophy which is highly likely there are two things that can work. First is estrace vaginal cream using 1gm each day which has 0.5 mg of estradiol. You can use it every other day until the symptoms are improved and then once every 4 or 5 days. You can also take a probiotic pill orally each day which helps. Of course, the breast cancer is a concern but if you are sexually active the vagina would need the estrogen. If no sexual activity, then just taking the probiotic can help alone.
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Customer reply replied 3 months ago
Okay I paid top dollar so I'm going to keep asking you questions...hope you don't mind.
1. So is it possible for the skin to bleed with such little pressure as a q-tip or an applicator?
2. What probiotics do you recommend? I do eat greek yogurt everyday, and I have MS, new things are in the works for probiotics and MS but they just don't know which ones are helpful, and which are possibly harmful? I did try Culturelle and it really upset my stomach..
3. What do you recommend for your patients for a vaginal moisturizer or do you recommend any? How about can you do a moisturizer and a barrier cream? i.e. A & D, coconut oil, Peri-Garde
Customer reply replied 3 months ago
All hypothetical of course...I realize I'm not your patient, but want to compare your advice. Also how much does stress play a part in hormone fluctuation, I can guess the answer! I lost my father and my 14 1/2 year old dog this past month :(
Stress can interfere with the function of the pituitary gland that has direct contact with the lower part of the brain. Th ovaries are controlled by the pituitary and the ovaries effect the uterus and back to the brain and pituitary. I personally use Spring Valley probiotic products and read the packaging to determine what I’m looking for. Vaginal atrophy means the normal layering of the cells lining the vagina and vestibule are sloughed off and one basal layer is left that will bleed some by light touch. Not much else that I can add. Good luck.
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Customer reply replied 3 months ago
Do you recommend a vaginal moisturizer? i.e. RePlens, RePhresh,Hyalo Gyn
Do you recommend a barrier cream? i.e. Coconut oil, A & D, Peri-Garde, because my urine stream burns the vestibule skin when it's this irritated
Can I use both together, as one is inserted into the vagina, and one is on the outside skin?
I don’t recommend a moisturizer when there is such thinning. A barrier whe you are urinating to block the burning can work and ky gel would be neutral.
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Customer reply replied 3 months ago
Okay...thanks I think I may be all out of questions...I'll wait awhile before I close out
Ok.
Dr Ted Manos
Dr Ted Manos, Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 806
Experience: 40 years experience; Board certified Ob-Gyn
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