Why Postmenopausal Bleeding Is Never Okay

Most women reach the menopause milestone naturally, but a small percentage experience sudden menopause due to chemotherapy, radiation, removal of the ovaries, or other factors. No matter the path you took to get to postmenopause, it’s not normal to have vaginal bleeding after going 12 consecutive months without a period.

What is Postmenopausal Bleeding?

Postmenopausal bleeding (PMB) is any bleeding, spotting, or small amount of pink or brown vaginal discharge that occurs after you’ve transitioned to postmenopause. PMB is most likely to happen in the year after reaching menopause, but postmenopausal women at any age can experience PMB.

Why You Should be Concerned About PMB

PMB is not usually serious. For most women, PMB is due to changes in the vagina, vulva, or the uterus lining. As women age, vaginal tissue becomes very thin and can tear, which may cause bleeding. Other causes can include endometrial atrophy (thinning of the lining of the uterus), fibroids, or endometrial polyps. These causes are not life-threatening and can be treated.

However, PMB may be an early sign of endometrial (uterine) cancer. Ninety percent of women with a diagnosis of endometrial cancer report vaginal bleeding. Depending on age and risk factors, 1%-14% of women with PMB will have endometrial cancer.

The incidence of endometrial cancer in the U.S. is higher among African-American and Caucasian women than in other racial groups. This form of cancer is most prevalent among women in their 60s

It doesn’t matter whether PMB lasts for a week, a day, or even minutes—it’s PMB and needs further investigation by a clinician. Don’t wait for your annual appointment, make one right away. The earlier endometrial cancer is detected, the better the outcome.

What to Expect at Your Clinical Visit

The first step is to update your medical history. Your provider will ask about your family history, current health status, and what medications and supplements you’re taking.

The next step is to complete a physical exam and a pelvic exam. You may be referred to a clinician experienced in conducting pelvic exams if your primary care provider isn’t trained in this area. Lab tests may be ordered as well.

Depending on the results of the pelvic exam and a review of your medical history, your clinician may recommend a transvaginal ultrasound or endometrial biopsy. The transvaginal ultrasound (using a probe inserted into the vagina) looks at the uterus for the presence of fibroids and polyps and measures the thickness of the endometrium (lining). It can also see the ovaries and fallopian tubes.

Cysts, polyps, and fibroids are usually benign, meaning they don’t necessarily indicate endometrial or ovarian cancer. The ultrasound will also allow your doctor to examine the ovaries for cysts or masses. An endometrial biopsy is a simple procedure done in the office. The procedure takes tissue from the lining of the uterus and doesn’t require anesthesia.

If your clinician suspects that you may have cancer, they should refer you to a gynecological oncologist, a physician who specializes in female cancers. Getting specialized treatment can lead to better outcomes. Insist on being seen within two weeks of your referral. Be a strong advocate for yourself to ensure you get the prompt, specialized attention you deserve.

Lower Your Risk of Endometrial Cancer

Endometrial cancer is one of the few cancers on the rise in the U.S. This is partially because obesity and diabetes have become increasingly common over the last few decades. Women who are overweight or obese are two to four times as likely to develop endometrial cancer than women of healthy weight.

We might sound like a broken record, but a healthy diet—plant-based or the Mediterranean diet is best—and exercise are the two primary ways to lower your risk of endometrial cancer. That goes for many other diseases and managing many menopause symptoms as well.

Limiting consumption of fast food, sweets and sugar-filled foods, meat (particularly red and processed meats) and alcohol are key dietary changes. Physical activity has been shown to lower the risk of endometrial cancer by 20-40%. Even small amounts of exercise can help lower your risk of serious conditions.

Compounded bioidentical hormone therapy (cBHT) that is not regulated by the FDA has also been implicated in the rise of endometrial cancer. However, the data is insufficient to confirm this. We know from rigorous studies that it’s critical to have the correct balance of estrogen and progesterone in hormone therapy.

Research and investigative reporting have shown that non-FDA-regulated cBHT frequently does not match what has been prescribed. This means that someone receives too much or too little estrogen, progesterone, or both. Taking cBHT without FDA approval is a practice that women should avoid. For women who want to use plant-based bioidentical hormone therapy, the FDA has approved a product called Bijuva that is available by prescription from your clinician.

The Bottom Line on PMB

Always get PMB checked out promptly. Most of the time, the cause of PMB is benign and not life-threatening. However, if someone is diagnosed with endometrial cancer, their odds of survival are much higher when cancer is detected early. As a physician in practice for over 30 years, I strongly encourage my patients to see me or at least call or message me if they have PMB.

Don’t worry about bothering your provider, and don’t delay because you think your PMB is not important and can wait. Pick up the phone or go online and make your appointment. Ensure that you get an appointment either in person or virtually within a couple of weeks, or find another provider who can see you sooner.

Please do women a favor and share this article with a friend or family member! Join us in helping to spread the word about PMB.