If you’ve been on hormone replacement therapy (HRT) for a while to relieve menopause symptoms, you may be wondering, what now? Should you stop taking it? If so, when? And how do you go about it?
If you are healthy, most experts agree that HRT is safe to use at the lowest dose that helps for the shortest time needed. If you're 59 or older, or have been on hormones for 5 years, you should talk to your doctor about quitting.
Here are the most common causes of postmenopausal bleeding.
Causes of Postmenopausal Bleeding
Polyps: These are growths, usually noncancerous, that can develop in the uterus, on the cervix, or inside the cervical canal. They might cause bleeding.
Endometrial atrophy (thinning of the endometrium): The endometrium, the tissue that lines the uterus, can become very thin after menopause because of lower estrogen levels. This may cause unexpected bleeding.
Endometrial hyperplasia: In this condition, the lining of the uterus becomes thick, and bleeding may occur as a result. Obesity may be the cause of the problem. Some people with endometrial hyperplasia may have abnormal cells that can lead to endometrial cancer (cancer of the uterine lining).
Endometrial cancer (uterine cancer): Bleeding after menopause can be a sign of endometrial cancer.
Other causes: Hormone therapy, infection of the uterus or cervix, use of certain medications such as blood thinners, and other types of cancer can cause postmenopausal bleeding.
Figuring Out the Cause of Postmenopausal Bleeding
Your doctor can determine the cause of your bleeding by taking your medical history and doing a physical exam and a few tests. Tests may include:
Transvaginal ultrasound: During this test, an imaging device is inserted inside the vagina, so your doctor can view the pelvic organs and look for anything unusual.
Endometrial biopsy: A thin tube is inserted into your uterus, and a tiny sample of the uterine lining is removed. It's sent to a lab to look for anything unusual.
Saline-infused sonogram: Saline is placed in the uterus through the cervix with a small, thin tube. The doctor looks by ultrasound to see if there are any masses within the uterine lining. It's often done along with an endometrial biopsy.
Hysteroscopy: During this test, your doctor uses an instrument with a light and small camera to examine the inside of the uterus and look for problems.
D&C (dilation and curettage): This test allows your doctor to remove tissue from the uterus lining, so it can be sent to a lab for analysis.
Ultrasound and biopsy can be performed in your doctor's office. Hysteroscopy and D&C are usually done in a hospital or outpatient surgical center.