[51F] With unexpected menstrual bleeding after 2+ years of amenorrhea

Patient Description

A 51-year-old female experienced unexpected menstrual bleeding after over two years of amenorrhea, assuming she was through menopause. The bleeding was normal in duration and heaviness. The patient reports pelvic pain that is exacerbated by walking and sitting. There is no unusual vaginal discharge other than the bleeding, and no urinary symptoms such as pain during urination or increased frequency. Bowel habits remain unchanged, with no constipation or diarrhea. The patient has a medical history significant for beginning stage congestive heart failure diagnosed in September. She is currently taking Lisinopril 10mg twice a day for blood pressure management. The patient has allergies to morphine and hydrocodone but no other known drug allergies. No other medications, supplements, or herbal remedies are being taken.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Postmenopausal Bleeding: This is any vaginal bleeding that occurs after you have gone through menopause. It can be caused by a variety of factors, including hormonal changes, endometrial atrophy (thinning of the lining of the uterus), polyps, or more serious conditions like endometrial hyperplasia or cancer.

    • Typical Treatments and Testing: Your doctor may perform a pelvic exam, ultrasound, or endometrial biopsy to determine the cause of the bleeding. Treatment will depend on the underlying cause but may include hormone therapy, medication, or surgical procedures.
  • Endometrial Polyps: These are growths attached to the inner wall of the uterus that extend into the uterine cavity. They can cause irregular menstrual bleeding, including bleeding after menopause.

    • Typical Treatments and Testing: Diagnosis is usually made via ultrasound or hysteroscopy. Treatment may involve the removal of the polyps through a minor surgical procedure.
  • Endometrial Hyperplasia: This is a condition where the lining of the uterus becomes too thick, often due to excess estrogen without enough progesterone. It can cause abnormal bleeding and may increase the risk of developing endometrial cancer.

    • Typical Treatments and Testing: An endometrial biopsy is often performed to diagnose this condition. Treatment may include hormone therapy or a procedure to remove the thickened lining.
  • Hormonal Imbalance: Even after menopause, some women can experience hormonal fluctuations that may cause unexpected bleeding.

    • Typical Treatments and Testing: Blood tests to check hormone levels and possibly hormone replacement therapy if deemed appropriate by your doctor.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Keep a Symptom Journal: Use MDandMe to journal your symptoms, track your progress, and share longitudinal medical notes with your provider. Note the duration, heaviness, and any associated symptoms like pelvic pain.
  2. Stay Hydrated and Maintain a Healthy Diet: Proper hydration and nutrition can help your body manage symptoms better.
  3. Avoid Strenuous Activities: Since walking and sitting irritate your pelvic pain, try to avoid activities that exacerbate your discomfort.
  4. Monitor Your Symptoms: Keep an eye on any changes in your bleeding pattern, pain, or other symptoms. This information will be valuable for your healthcare provider.

What you should look out for

Seek medical attention more urgently if you experience any of the following:

  • Heavy Bleeding: If you experience heavy bleeding that soaks through a pad or tampon every hour for several hours.
  • Severe Pain: If you have severe pelvic pain that doesn't improve with over-the-counter pain medication.
  • Fever or Chills: These could indicate an infection.
  • Unexplained Weight Loss: This could be a sign of a more serious underlying condition.

Remember, while this information can help you understand what might be happening, it is not a substitute for professional medical advice. Please consult your healthcare provider for a formal diagnosis and appropriate treatment.

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5 mo ago


People Also Ask


What causes postmenopausal bleeding?

Postmenopausal bleeding can be caused by hormonal changes, endometrial atrophy, polyps, or more serious conditions like endometrial hyperplasia or cancer. It's important to consult a healthcare provider for proper diagnosis and treatment.


How are endometrial polyps diagnosed and treated?

Endometrial polyps are diagnosed using ultrasound or hysteroscopy. Treatment typically involves the removal of the polyps through a minor surgical procedure.


What is endometrial hyperplasia and how is it treated?

Endometrial hyperplasia is a condition where the uterine lining becomes too thick, often due to excess estrogen. It can be diagnosed with an endometrial biopsy and treated with hormone therapy or a procedure to remove the thickened lining.


What should I do if I experience unexpected bleeding after menopause?

If you experience unexpected bleeding after menopause, it's important to consult a healthcare provider. They may perform tests such as a pelvic exam, ultrasound, or biopsy to determine the cause and recommend appropriate treatment.


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