health} 2. A polyp is a small overgrowth of the uterine lining; you can think of it as a skin tag of the endometrium, which can have associated bleeding. Polyps are typically not dangerous, but rarely can have areas of precancer (hyperplasia) or cancer on them, and therefore in most situations, gynecologists recommend that they be removed and tested. 3. Hyperplasia is the term we use for overgrowth or thickening of the endometrium. Many types of hyperplasia are a pre-cancer of the uterine lining, and sometimes they progress into uterine cancer (also called endometrial cancer). Rarely, they have already developed into endometrial cancer by the time someone has postmenopausal bleeding. Cancers and precancers typically require at least a hysterectomy for full treatment. The biggest risk factor for hyperplasia is obesity. This biggest reason we recommend always having an evaluation for postmenopausal bleeding is to make sure you do not have something dangerous, like the pre-cancer hyperplasia or cancer. I want to emphasize that most postmenopausal bleeding is not caused by cancer or precancer, but often we
can catch endometrial cancer at an early stage because patients have postmenopausal bleeding and come in to be evaluated. Postmenopausal bleeding always deserves an evaluation to make sure that a precancer or cancer is not the cause. [If you are taking a blood thinner, any of the causes of uterine postmenopausal bleeding (atrophy, polyp, hyperplasia) may be more likely to bleed and continue bleeding. There are some other causes of postmenopausal bleeding to look out for where the bleeding is not actually coming from the uterus. This could be bleeding from the rectum, the bladder, or the urethra, that is confused for vaginal bleeding. Sometimes people can have bleeding from the skin (also called the mucosal surfaces) of the vagina, because it is more likely to be irritated and tear when the body is in a low estrogen state like menopause. Infections of the vagina and cervix, like yeast, bacterial vaginosis, gonorrhea, herpes, and chlamydia, can cause ulcerations of the vagina and cervix (opening of the uterus), which can bleed. Additionally, precancers or cancers of the cervix can cause bleeding, but if you are up to date on your pap smear, this is very unlikely.]
No — it is never normal to have postmenopausal bleeding, but it is not always serious or dangerous. It does, however, always deserve to be evaluated by your gynecologic care provider in order to make sure nothing dangerous is happening, and also to find ways to stop the bleeding if it is bothersome to you.
w
406
oman.com 47