Endometrial and Vaginal Atrophy
Treatment for endometrial and vaginal atrophy often involves hormonal therapies, like estrogen patches, creams, rings, or tablets. Nonhormonal therapies for those who can’t tolerate estrogen can include vaginal lubricants or moisturizers.
Fibroids
“Fibroids typically regress after menopause due to decreased estrogen,” says Rosser. “When fibroids are present in postmenopausal women, they may manifest as abnormal uterine bleeding.” She says this is particularly true of submucosal fibroids, which are the type that grows under the inner lining of your uterus.
According to Tangela Anderson Tull, MD, a menopause specialist with Hoffman and Associates, an all-female obstetrics and gynecology practice affiliated with Mercy Medical Center in Baltimore, some women who have fibroids may have postmenopausal bleeding, “but the more likely scenario is that perimenopause is not yet completely over.”
Endometrial Hyperplasia
Menopausal Hormone Therapy
“Hormone therapy may cause breakthrough bleeding in some women,” says Rosser.
Bleeding while taking hormone therapy typically stops after the first six months, and it isn’t usually a cause for concern. But if it continues beyond that time frame or the bleeding becomes heavier, you should check in with your healthcare provider.
Uterine Polyps
Uterine polyps are benign growths on the inner lining of the uterus, also known as the endometrium. They extend into the uterine cavity and can cause irregular bleeding in both perimenopausal and postmenopausal women.
“Postmenopausal polyps with bleeding warrant removal to rule out malignancy, though the overall risk is low,” says Rosser.
Treatments for endometrial polyps often include hormone therapy to improve bleeding symptoms, surgery to remove the polyps, or, in rare cases, a hysterectomy.
Endometrial or Cervical Cancer
“Research shows that only around 10 percent of women who have postmenopausal bleeding have endometrial cancer, with most cases due to benign conditions such as polyps, genitourinary syndrome of menopause, or bleeding in women using hormone therapy,” says Rosser. But the probability of endometrial cancer as the cause of postmenopausal bleeding increases with age, she adds. Cervical cancer, on the other hand, is more common in women in their thirties.
Beyond the irregular bleeding, another sign of endometrial cancer includes pain in the pelvic area.
Endometrial cancer is usually first treated with surgery to remove the uterus, fallopian tubes, and ovaries.
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