AMCC BLOG: BLEEDING AFTER THE CHANGE OF LIFE

Your periods may not be normal, if you are still having periods in your 50s.

For some people, the period is never over.

Imagine you have a problem that worries and concerns you, and at the end of one office visit, you drive home knowing that not only had your problem been diagnosed, but it has also been treated.

Advanced Menstrual Care Center (AMCC) is one of the few Centers in the country to provide comprehensive office-based assessment and treatment of abnormal vaginal bleeding. AMCC has invested in the unique combination of expertise, experience, staff and equipment to provide a unique diagnosis and treatment program called "Velocity of Care" targeted to women with postmenopausal bleeding.

Having suffered to some degree with your menstrual cycle from your early teens to your early fifties, over 40 years, you look forward to ending your monthly trials. Finally! No more monthly cycle, no more feminine hygiene products and an end to your daughters asking if you have any pads or tampons.

However, the end is not really the end for some patients. At menopause, the ovaries no longer grow eggs. During the menstrual cycle, it is the developing eggs that produce the primary female hormones, estrogen and progesterone. Once the eggs stop developing in menopause, for most patients, these hormones are no longer made.

However, for some patients, small amounts of estrogen are made from sources other than the ovaries. These estrogen hormones are less potent and in smaller amounts than during the premenopausal period. However, over an extended period of time they can have a major impact on the uterus and the lining of the womb. After the change of life, the impact of these weak estrogens can lead to vaginal bleeding, polyps, hyperplasia (pre-cancer) and cancer.

As a result, any bleeding after the change of life should be evaluated as soon as possible. Cancer of the lining of the womb is the most common kind of gynecologic cancer. It is responsible for up to 15% of women who have bleeding after the change of life (postmenopausal bleeding). If you have bleeding after the menopause, seek medical from a Gyn specialist right away.

During an evaluation for postmenopausal bleeding, your Gyn doctor will usually perform the following assessments:

The pelvic ultrasound is an important test in the evaluation of postmenopausal bleeding. This test is often performed with a full bladder and using an abdominal probe that transmits, then listens for reflected sounds waves. These sound waves are then interpreted into images that can provide fine details of your pelvic anatomy. Unlike X-rays, there is no radiation with ultrasounds. It uses sounds only to create images of the body.

After the abdominal portion of the pelvic ultrasound is completed, you will be allowed to empty your bladder. Then the transvaginal (vaginal) ultrasound is performed. The vaginal ultrasound is similar to the doctor performing a pelvic exam, except the doctor, or technician, will insert a slender ultrasound probe into the vagina. Since this ultrasound probe is much closer to the organs being examined (uterus and ovaries), more detailed examination can usually be accomplished.

One of the most valuable details obtained from a pelvic ultrasound examination is the assessment of the lining of the womb, the endometrium. Measuring the thickness of the endometrium may be the only test required for many women.

Estrogen is a growth hormone for the lining of the womb. The endometrium responds to estrogen by getting progressively thicker. During the menstrual cycle, this endometrial thickening is limited by the production of progesterone after the egg ovulates. If a woman gets pregnant, the progesterone matures the estrogen stimulated endometrium so that it can support and nourish the early pregnancy. If a pregnancy does not occur, a normal menstrual cycle occurs, and the whole menstrual cycle starts over again.

Remember those weak estrogens that can occur in the menopause, they are growth hormones too. However, since there are no eggs in the menopause, there is no progesterone made after ovulation. So in menopause, these weak estrogens constantly stimulate the endometrium, sometimes for decades. So, without the maturing effects of progesterone, this long-term stimulation of the endometrium can lead to hyperplasia (possible pre-cancer) and even cancer.

With this background, let's return to the vaginal ultrasound. This test can, in most cases, measure the thickness of the endometrium. This endometrial thickness is a measure of pre-existing estrogen stimulation. Many women after menopause will have an endometrial thickness of 1-2 mm. Remember, there are 25 mm to an inch. An endometrial thickness of 4 mm or less is considered normal, unless there is persistent or recurrent postmenopausal bleeding.

An endometrial thickness more than 4 mm requires further evaluation. Most of these cases will be benign (non-cancer), but an endometrial biopsy is needed to confirm the diagnosis. Some patients may have benign polyps or fibroids as the cause of their bleeding. While the biopsy may be benign, polyps and fibroids will often be overlooked, unless a hysteroscopy is performed. During hysteroscopy a slender telescope is used to look inside the uterus. The lining of the womb is seen, and any tumors such as polyps and fibroids can also be seen. This procedure can be performed in the office, often with no anesthesia or numbing medicine needed.

AMCC can often provide these diagnostic tests and evaluations at the initial office visit. The Medical Director, Dr. Steven W. Tucker, can perform a complete history and plan examination, including Pap smear and perform the pelvic ultrasound. If indicated, Dr. Tucker can also immediately perform a hysteroscopy with a telescope less than 3 mm in size. If tumors, such as polyps and fibroids are found, Dr. Tucker can usually remove these tumors in 1 or 2 office visits.

These skills, experience, staff and equipment are unique to AMCC. These unique services provide a valuable service because in many cases, in one visit Dr. Tucker is able to diagnose and treat, in an office setting, problems that otherwise usually requires multiple visits and hospitalization to complete.

AMCC and its unique services including the "Velocity of Care" provides this unique service to the vast majority of patients with postmenopausal bleeding. As Dr. Tucker often states "Reassurance its worth it's weight in gold."

Author
Dr. Steven W. Tucker, M.D., ACGE, FACOG is Medical Director of Advanced Menstrual Care Center (AMCC). Steven W. Tucker, M.D., ACGE, FACOG Dr. Steven W. Tucker, ACGE, FACOG is Medical Director of Advanced Menstrual Care Center. He is a board-certified GYN physican, who have provided high-quality care in the Baltimore Metropolitan area for over 30 years. He is a specialist in minimally invasive surgery. He provides comprehensive GYN women's care and specializes in the diagnosis and treatment of menstrual bleeding disorders, including heavy menstrual bleeding (HMB), abnormal uterine bleeding (AUB), postmenopausal bleeding (PMB), fibroids, polyps, endometriosis, pelvic pain and painful sex. He has helped focus the services of Advanced Menstrual Care Center by developing a skilled staff with extensive training to provide patients care for menstrual bleeding disorders that is safe, rapid, convenient, cost-effective and office based. This combination of personnel, experience, skills, training, and equipment is unique. Office procedures include diagnostic and operative hysteroscopy, ultrasonography, and endometrial ablation focused on safety.

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