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

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.