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Menopause
Empowering Women's Health
Bleeding After Menopause
Menopause is said to have occurred if you do not have period for 1 year. The average age of menopause is 51 years, but it can happen anytime from 45 to 55 years.
Bleeding after menopause is not normal and you should see a gynecologist for a checkup. The bleeding can be due to various causes as follow:
-
Polyps –
These are small finger like growths from the lining of the uterus. They grow from the lining into the cavity of the uterus and sometimes into the cervical canal. They may also protrude out of the external opening of the cervix and may be seen with a naked eye on a speculum examination of the vagina. They are usually noncancerous. They can cause heavy irregular bleeding and sometimes bleeding after sex. -
Endometrial hyperplasia –
In this situation the lining of the uterus becomes thick. This happens when there is estrogen production but no progesterone available after menopause. Sometimes the cells of the lining can become abnormal and eventually turn into cancer. Women usually complain of heavy frequent and abnormal vaginal bleeding. -
Withdrawal bleeding –
This is bleeding that occurs sometimes when a menopausal women is on hormonal therapy and then discontinues with it. -
Endometrial cancer –
This occurs in the menopausal women, is usually slow growing, and does not spread fast. Women complain of blood stained discharge or frank bleeding after menopause.
If you have bleeding after menopause then you will need a complete examination and certain tests:
- A pelvic sonography is the commonest test
- You may also need diagnostic hysteroscopy (i.e. look into the cavity of the uterus with a camera)
- Dilatation and curettage i.e. the lining of the uterus is scraped and sent for examination under a microscope. The report of the lining will decide the further course of action.
Polyps can be removed at the same time. Hyperplasia can be treated with medication but in some cases with complex hyperplasia, it may be prudent to remove the uterus.
Endometrial Hyperplasia
The lining of the uterus changes throughout the menstrual cycle in response to the hormones (oestrogen and progesterone) that is produced by the ovaries. Oestrogen is made before the egg ovulates and progesterone is made after the egg ruptures. Oestrogen enables the lining to grow and progesterone enables the lining to store glycogen. As and when the fertilized egg comes along, the lining can nourish it and enable it to attach itself to the uterus and thus grow.
If fertilization has not happened, then the hormone levels decrease and the lining is eventually shed as a period.
There are times when a woman may not ovulate, oestrogen is produced, progesterone is not produced (as in patients with PCOS, perimenopause women, long term use of drugs like tamoxifen and commonly after menopause). In this case the lining continues to grow in response to oestrogen but it is not shed as there is no progesterone. It is not shed appropriately and the woman may have irregular bleeding and spotting.
The lining can then become very thick. It is then called hyperplasia. This is not cancer but the same lining can become cancerous in the long run.
The commonest presenting symptom for endometrial hyperplasia is abnormal bleeding. This may be in form of heavier cycles, longer duration of flow, short cycles, erratic bleeding and bleeding after menopause.
One must report to the gynaecologist in case one as any abnormal bleeding. The doctor will do a complete gynaecological examination and then suggest tests. These may be blood tests and pelvic sonography.
A definitive diagnosis is obtained only after the doctor takes a small fragment of the lining and it is examined under the microscope to see changes of hyperplasia.
There are various ways of getting a fragment of the lining i.e. endometrial biopsy.
- We can do it in the clinic with a small instrument called endometrial sampler that is easy to insert easily without anaesthesia. It collects a fragment that can then be sent to the histologist for examination.
- The traditional method of Dilatation and curettage is done under anaesthesia and will collect most of the lining.
- The ideal technique is curettage after hysteroscopic visualization of the uterine cavity. This helps the doctor identify and deal with polyps, and helps identify the area in the cavity that looks thickened and abnormal.
Once the diagnosis is confirmed on histology then the treatment can be decided.
- Final histology report
- Age of patient.
- Desire for childbearing
The treatment is usually progesterone which can be given as a tablet, singly or in combination with oestrogen, suppository or as an intra-uterine device. The doctor will tailor the choice of treatment to suit the needs of the patient.
When there is no remission, recurrence or presence of atypia suggesting a risk of cancer then removal of the uterus is required.
Menopause and weight Gain
Its quite common to gain weight after menopause.
Why do women gain weight after menopause?
There are multiple factors. Due to lack of estrogen there are metabolic changes in the way one uses their glucose and fat. There is also fat mobilization and shift in the areas that get deposited with fat. There is increased fat deposition at the waist and hips.
As one ages there is decrease in mobility and that can contribute. The BMR also declines with age and therefore after menopause one will need to increase the physical activity as compared to before to burn the same number of calories.
What is the impact ?
Increase weight will only complicate other coexisting medical conditions like Blood Pressure, Diabetes and Osteoarthritis to name a few.
What Can you do ?
Exercise is the best answer. A regular disciplined schedule is advisable. Exercise benefits in multiple ways.
- Improves overall health
- Lower risk of Heart attack and osteoporosis
- Improves the Diabetes
- Keeps joints and muscles strong
- Relieves depression and anxiety
It is important to be active therefore do anything that you enjoy. It is ideal to exercise daily but try to do for atleast 5 times a week for 45 mins at least.
There are 2 main goals
-
Cardiac Fitness –
Aerobic exercise i.e. walking, jogging, cycling, swimming and dance. -
Muscle building and joint mobility. –
this is strength training i.e. yoga, weight machines dumbbells, bands and any form of resistance training.
- Be well hydrated
- Wear comfortable clothes and shoes.
- Always do 10 minutes of warm up and 10 minutes of cool down.
- Do stretches before the exercise.
- Keep changing the routine so that you don’t get bored and remain motivated.
Sex and Menopause
Menopause can lead to sexual problems. The hormonal deprivation (especially of estrogen) after menopause can lead to changes in the women’s desire for sex. The lack of oestrogen can affect the texture of the vagina making it very dry. This can make sex very painful.
Multiple other factors can influence sex after menopause. For Eg.
- Hot flashes leading to lack of sleep and therefore tiredness
- Depression and mood swings
- Bladder control issues
- Coexisting medical conditions like Diabetes.
The best way to tackle the problem is communication between the partners and counselling ideally by professional therapist.
Foreplay is very important component during sex to arouse both partners and to lead to satisfaction. It is frequently ignored.
The vaginal dryness can be easily treated with water-based lubricants such as K Y jelly. It is not advisable to use non-water-soluble lubricants such as Vaseline, as they can weaken the latex of the condoms and can cause an accidental unwanted pregnancy. They also provide a medium for growth of bacterial infection.
Vaginal Oestrogen creams are very effective and safe to use. They do not have the side effects of oral hormonal treatment. Hormone Replacement therapy is also effective but has to be used after proper assessment of the patient with due consideration to the risks and the benefits.
Eventually even if Sex is not happening it is important to understand that love affection and companionship are equally important. It is worthwhile spending quality time together and to keep the romance going. Intimacy can be improved with foreplay, change of sexual routine, masturbation, and any activity that both partners enjoy together.
At the bottom of it all you need to protect yourself from sexually transmitted infections at all stages of life. Menopause may protect you from pregnancy but surely does not protect you from STD’s. Therefore, practice safe sex.
Learn More about Menopause
Low Libido
Low Libido is one of the problems which many women face but feel shy to discuss openly. Below are the causes of low libido/loss of sex drive. It is better that these issues are discussed ....
Effect of Menopause On Breast
It is very important that women know the effect of menopause on the breast. The lack of hormones after menopause has a significant impact on the breast.
There is an obvious change in shape and size...
Hot Flashes Treatment
Hot flashes are the most common symptom of menopause and perimenopause. The good news is Hot Flashes Treatment is available.
Many women have hot flashes, which may last from a few months to a few years after menopause...
Isoflavones In Menopause Management
The article discusses Isoflavones In Menopause Management. Menopause brings about many symptoms such as hot flashes, mood swings, urinary symptoms, and vaginal dryness, besides...
Menopause And Mental Health
Menopause and mental health have a connection. Menopause can lead to various mental health issues such as mood changes, anxiety, anger, irritability, and depression....
Menopause And Urinary Symptoms
It is common in women that menopause can lead to various problems related to the urinary tract. Menopause and urinary symptoms are some of those issues.
They can be mild to very distressing....
Managing Menopause without hormones
Managing menopause without hormones involves lifestyle changes, such as a balanced diet, regular exercise, stress reduction techniques, and the use of natural remedies to alleviate symptoms...
Osteoporosis
Osteoporosis is a condition characterized by weak and brittle bones, leading to an increased risk of fractures. It often affects older adults, particularly postmenopausal women. Prevention includes a healthy diet, exercise, and avoiding smoking and excessive alcohol...
Sex After Menopause
Menopause can lead to sexual problems. The hormonal deprivation (especially of estrogen) after menopause can lead to changes in the woman’s desire for sex. The lack of oestrogen can affect the texture of the vagina making it very dry...
Signs And Symptoms Of Menopause
Women experience multiple signs and symptoms of menopause after an age. Each woman will have different combinations of symptoms and also, they may vary in intensity and duration...
Weight Gain After Menopause
There are multiple factors. Due to lack of estrogen there are metabolic changes in the way one uses their glucose and fat. There is also fat mobilization and shift in the areas that get deposited with fat....
Reproductive Health Risks in the young are unwanted pregnancy, unsafe abortion, STDs, sexual violence and indulgence in sex not by choice
The young indulge in sexual activity impulsively and many a times it is not planned. They may not have a condom or the emergency contraceptive and may not be aware of the need for contraception. Even if they get pregnant they are more likely to not realize that they are pregnant. They may not seek help early as they are scared or shy or simply unaware and are more likely to indulge in unsafe practices for abortion with the help of friends or quacks and are more likely to have complications.
Relationships are not stable in this age group, thereby increasing the risk of sexually transmitted infections including HIV, and their complications such as chronic pelvic pain, ectopic pregnancy, long term health risks and infertility.
Pregnancy carries a lot more risks for the young. They have more risks of anaemia, pregnancy induced hypertension, addiction, malnutrition, obstructed labour and growth restricted babies.
Most young people do not access and accept contraception services due to lack of access, information, confidentiality, and to the myths associated with them.
