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Post Menopausal Bleeding

Post menopausal bleeding is vaginal bleeding that occurs after menopause. We consider you to be in menopause when you have gone a full year without having a period.

If you have post menopausal bleeding you should see your doctor right away. Sometimes post menopausal bleeding is related to atrophy or breakdown of the lining of the uterus that is normal with aging, but sometimes it can be related to abnormalities that can be benign (like polyps) or malignant (like uterine cancer). If you have post menopausal bleeding, we need to make sure that cancer is not causing it.

Your doctor may order an ultrasound for you, and will offer to either do an endometrial biopsy in their clinic, or refer you to a doctor who can do this if your doctor doesn’t provide that service.

An ultrasound is used to measure the thickness of the lining of the uterus. Normally the lining will measure 5mm or less when you are in menopause. If the lining is thicker than that, this is abnormal but will still require a biopsy in order to determine what is causing it. The ultrasound itself cannot diagnose or rule out cancer.

An endometrial biopsy (biopsy of the lining of the uterus) can usually be done in the office using a device that looks like a thin straw. This is used to pass through the opening of the cervix and into the uterus, and then pieces of the lining of the uterus are sucked out. This procedure can be very crampy and painful while it is being done, but it is a fairly quick procedure (usually less than a minute) and the cramping subsides afterwards. Results from the biopsy are usually back within 2 to 3 weeks.

Sometimes the cervix becomes very tightly closed after menopause (called “stenotic”) and it is sometimes not possible to pass the straw-like device through the opening of the cervix in the clinic. In these cases, depending on the level of suspicion of an abnormality, you may be offered a small procedure with an anesthetic in order to get through the cervix and get a good sample of the lining. Sometimes you may be asked to take a medication vaginally prior to the procedure to help soften the cervix so it can be opened.

Once a sample of the lining has been obtained (either in clinic or with a procedure with anesthetic) your doctor will review the results from the pathologist with you in 2 to 3 weeks and either reassure you that the tissue was normal, or discuss the results and treatment options with you.