Doctor's post shows why bleeding after menopause is so vital to get checked

After going through the trials and tribulations of menopause, the light and the end of the tunnel is being able to avoid periods.

For some people, though, this isn’t the case.

A Facebook post from Sheila Toll has highlighted how limited our gynaecological knowledge is, and what to look out for.

The original post was made back in September – apparently at the request of a family doctor friend of Sheila’s – and reposts have continued to do the rounds online.

In it, Sheila tells the story of a patient called Julie (shared with permission). During a routine check-up, the doctor friend asked Julie if she’d experienced bleeding since menopause.

Sheila writes: ‘She said “no” but then laughed and added, “Other than when my period came back for a few months last year”.’

This was a red flag to the GP, who sent Julie for further tests, including a pelvic ultrasound.

‘Julie was surprised to see me so concerned,’ the post continued, ‘especially since the symptoms had not recurred over many months.

‘Sure enough, a pelvic ultrasound and tissue sampling confirmed cancer of the uterus.’

While Julie has now undergone chemotherapy and a hysterectomy – and is cancer-free – it was a wake-up call for both patient and doctor. Julie admitted she had no idea a ‘short return’ of her period was a danger sign, and nor did many others she spoke to.

The rest of the post says: ‘[Julie] addressed the topic with friends over coffee and discovered that, out of 20 women, NONE of them knew this symptom was abnormal.

‘She admonished me to “Tell women this! Don’t assume we know it!” From that day on, I have kept Julie’s advice in mind when talking with post-menopausal patients.’

We contacted Sheila for confirmation about the story, but haven’t been able to reach her. However, health professionals worldwide echo the advice within it.

For example, in this anecdote includes the doctor writes: ‘All health care professionals are taught early on that “vaginal bleeding in a post-menopausal woman is cancer of the uterus until proven otherwise”.’

That sounds scary, but try to remember this isn’t a diagnosis, but a diagnostic tool for physicians.

According to The American Congress of Obstetrics and Gynecology, bleeding is the presenting sign in more than 90% of women with uterine cancer. However, only between 1% to 14% of women with postmenopausal bleeding will have this disease.

So rather than catastrophising, try to see a returning period as something to get looked at presently. That way you can rule out anything serious or hopefully catch it early and improve treatment options.

Ashfaq Khan, consultant obstetrician, consultant gynaecologist, and founder of Harley Street Gynaecology, says there are a number of reasons for bleeding after menopause.

He tells Metro.co.uk: ‘The most common causes of bleeding after menopause are atrophic changes related to dry vagina or dry cervix, infection of the vagina or cervix, and lichen sclerosis or other skin condition causing tears or bruises to the vulva. Bleeding could be from the bladder or back passage.’

Ovarian, cervical, endometrial, and vaginal cancer signs

If you’re experiencing any of these symptoms, it might be nothing to worry about. However, they can point to cancer, so it’s important to seek the advice of a healthcare practitioner as soon as possible:

  • bleeding between periods (if premenopausal) or after having sex
  • pain during sex
  • longer or heavier periods than usual
  • unusual discharge from the vagina
  • vaginal bleeding after menopause
  • bloody or watery discharge, which might have a bad smell
  • blood in urine
  • abdominal pain and bloating that won’t go away
  • pelvic pain
  • difficulty urinating or pain when using the toilet
  • changes in bowel habits, including constipation
  • unexplained weight loss or weight gain
  • unexplained fatigue

However Dr Khan adds that ‘the main reason doctors get worried is because this could point to endometrial cancer. Ovarian cancer, cervical, or vaginal cancer can also present as vaginal bleeding.’

As we mentioned, it’s not something to panic about. But do ensure you get a check-up sooner rather than later.

‘An immediate check-up is necessary, which is likely to include an ultrasound scan, speculum examination, and sometimes colposcopy assessment,’ says Dr Khan.

‘It is important to do regular self-checks including breast examinations. Women should also keep check on symptoms such as aches, hot flushes, and insomnia.’

As if menopause wasn’t already difficult enough, this might feel like yet another thing to worry about. But the danger of ignoring symptoms is compounded the longer you leave it – and any anxiety you have around your health will only grow too.

If anything changes for you and seems a little off – be it a period you didn’t expect or differently-textured discharge than usual – book an appointment with your GP or gynaecologist.

Like Julie – who caught her symptoms early enough to successfully treat – you’ll be glad you did.

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