Why does my mother have bleeding after menopause?

Question

Hello doctor,

My mother who is 54 years old has experienced irregular vaginal bleeding since three months ago although she was already in menopause two years back. Her gynecologist had told her that there is an abnormal thickness of the uterine lining as observed in her ultrasound.

Does this mean that she has got endometrial cancer? Or does it mean something else?
What all investigations are needed urgently?

We are very worried.

Please do guide us.

Thanking You.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Postmenopausal bleeding always needs evaluation, but please remember: many causes are benign, not necessarily cancer. Still, it is good that you are taking it seriously and asking about tests early.

Bleeding after menopause can have several possible causes. A thick endometrium on ultrasound may be seen in conditions such as -

Endometrial hyperplasia, which is an overgrowth of the uterine lining and may be simple or associated with atypia.
It can also be due to an endometrial polyp, which is a localized growth inside the uterus.
Endometrial cancer is another important cause that needs to be ruled out.
Hormonal imbalance or excess estrogen exposure may also lead to thickening.
In some cases, even an atrophic endometrium (a thin, fragile lining) can cause bleeding.
Other possibilities include a submucous fibroid or cervical pathology

At age 54 with menopause for two years, the most important step is to rule out hyperplasia or malignancy, but many women with thick lining end up having polyps or benign hyperplasia.

In postmenopausal women, an endometrial thickness of four millimeters or less is generally considered low risk for cancer. If the thickness is greater than four to five millimeters, further evaluation is needed.

When there is significant thickening of the lining, as seen in cases with a thickness of about eight to ten millimeters or more, then it is better to take a biopsy to determine the underlying cause.

The further actions include:

Endometrial biopsy, which is considered the most essential diagnostic action. It is an easy process that can be done in an outpatient setting using a Pipelle and helps to obtain the diagnosis of tissues that may show hyperplasia or cancer.
Hysteroscopy with biopsy might also be recommended when the ultrasound suggests a polyp or focal thickening.
Sometimes a repeat ultrasound through the vagina is also done if the first result was inconclusive.
Also, a Pap smear or Papanicolaou test is recommended in order to exclude any possible causes from the cervix for abnormal bleeding.
Taking into account this particular situation, it is reasonable to perform a biopsy.

I hope I have answered your question.

Let me know if I can assist you further.

Regards.