For anyone who’s lived with a uterus and monthly menstrual cycles, menopause is time of major physical change. Usually occurring sometime in your late 40s or early 50s, menopause is a naturally occurring biological change which marks the end of a person’s period of fertility and reproduction. In most cases, you’ll know you’ve made it through menopause when you’ve gone 12 consecutive months without menstruating.
Changing levels of the hormones progesterone and estrogen can lead to some unpleasant symptoms during this transition, including hot flashes, vaginal dryness, and shifts in your sex drive. However, once you’re fully through menopause, one particular symptom is a red flag that you should always bring to your doctor’s attention. Read on to find out what it is, and why oncologists say it’s never a good sign.
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It’s common and natural to experience changes to your monthly cycle during and leading up to menopause, according to the North American Menopause Society (NAMS). Most women during this time report irregular periods, they say, which tends to be caused by fluctuating hormones and less frequent ovulation.
However, things change once you’re postmenopausal. “It’s important to know that bleeding after menopause is never normal,” Emily G. Blosser, MD, PhD, and OB-GYN at Newport Women’s Health Services, shared via YouTube. “If you have spotting or heavy bleeding after going 12 months without having a period at all, it’s important to come see your doctor right away,” she explained.
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Best Life spoke with Clare Bertucio, MD, radiation oncologist and CEO of Medicine Mama’s Vmagic, to chat about postmenopausal bleeding. She explained that with so many organs and tissues involved in the reproductive system, the source of vaginal bleeding is not always apparent at first glance.
“When you have bleeding, it’s hard to tell where it’s originating. You’re having blood come through the vagina, but did it start in the uterus, or did it start in the cervix, or did it start in the vagina? That’s something your physician would need to examine you, to help you with.”
“A couple of sexually transmitted diseases can give you some clotting,” Bertucio says. “Medications [such as blood thinners] can cause bleeding,” she adds, and mentions that bleeding can also occur if you’re taking hormone therapy.
Gregory Bolton, MD at Lakenau Medical Center, says via YouTube that postmenopausal women who are on cyclic hormone replacement therapy (HRT) “can be expected to have a bleed at the end of the cycle.” Bolton goes on to say that, “the women who are on continuous hormonal replacement therapy really should not have any bleeding… if they bleed, that’s a concern.”
Polyps (noncancerous growths which develop in the uterine lining) or “endometrial atrophy,” which happens when tissue lining the uterus thins after menopause, can also cause postmenopausal bleeding, Matthew Carlson, MD, wrote in the UT Southwestern Medical Center’s blog.
“There are a number of things that aren’t cancer that can cause bleeding,” says Bertucio, “but we always have to rule out cancer first.” And professionals across the field share her sentiment.
“Too often I see women with advanced endometrial cancer [uterine cancer] who tell me they experienced postmenopausal bleeding for years but didn’t think anything of it,” Carlson wrote. “Women need to know postmenopausal bleeding… may be an early symptom of endometrial cancer. Any bleeding, even spotting, should trigger a visit to your doctor as soon as possible. Don’t wait to make an appointment until after the holidays or even next week. Do it today.”
In 10 percent of people who experience postmenopausal bleeding, the diagnosis might be endometrial cancer, according to the National Library of Medicine.
“Cancer is very frightening,” admits Bertucio. “But it’s not the way we used to think about it. We’ve gotten so much better at treating cancer, and getting people through cancer, that I always say to people… let’s see what we’re dealing with. And then let’s see what the treatment course for you specifically will be. When caught early, most of these cancers are very treatable.”
“My advice to all women—and actually everyone, men too, but especially women—is: Any of the cancers that we can screen for, you should be screening for on a yearly basis, once you’re at the age we screen for cancers,” she says. That means getting mammograms to screen for breast cancer, pap smears to screen for cervical cancer, and colonoscopies to screen for colon cancer.
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Bertucio encourages anyone who is dealing with changes in their body to remember that they aren’t alone. “We should all be talking amongst ourselves, so that you have a sense of what’s normal and what’s abnormal,” she says. “What can I expect, and what can I do about it? I think that that dialogue will really empower women to keep moving forward, and feel good about themselves. You don’t have to stay at home and be ashamed that these things are happening. They’re happening to everyone, and there are things we can do to mitigate.”