anuary 30, 2017: Ephraim Resnik, MD, Gynecologic Oncologist with Highland Medical, P.C., encourages women to pay attention to postmenopausal signs such as bleeding.

While bleeding on and off for about six months while a woman is going through menopause is normal, bleeding after a woman has finished with menopause is not, says Ephraim Resnik, MD, Gynecologic Oncologist with Highland Medical, P.C., “If you see even a tiny amount of blood starting a year after you have had your last menstrual period and any time thereafter, see your doctor,” he advises. In many cases, bleeding after menopause is an easily treatable condition. It may be due to a lack of estrogen that leads to thinning, drying and inflammation of the vaginal walls (vaginal atrophy), or the thinning of the lining of the uterus (endometrial atrophy). However in up to 20 percent of cases, postmenopausal bleeding can be a sign of uterine cancer, also known as endometrial cancer, Dr. Resnik says. An estimated 60,050 women were diagnosed with endometrial cancer in the U.S. in 2016, according to the National Cancer Institute.

Other causes of postmenopausal bleeding include:

• Polyps: These growths, usually noncancerous, can develop in the uterus, on the cervix or inside the cervical canal.
• Endometrial Hyperplasia: This condition causes a thickening in the lining of the uterus (endometrium).
• Uterine Fibroids: These are noncancerous growths of the uterus that often appear during childbearing years.

Diagnosing the Cause of Postmenopausal Bleeding
The doctor will first ask about your medical history, and consider factors such as your age. “The majority of endometrial cancers occur about a decade after menopause, or around age 60,” Dr. Resnik says. “Women with hypertension and diabetes, as well as those who are overweight, are also much more prone to developing endometrial cancer.”

The doctor will then conduct a thorough physical exam, to see if the blood may be coming from somewhere other than the uterus. For example, blood can come from hemorrhoids or from polyps in the urethra (the tube that conducts urine from the bladder to the outside of the body).

Tests the doctor may conduct to diagnose the problem include:

• Transvaginal Ultrasound: The doctor inserts an imaging device inside the vagina to view the pelvic organs.
• Endometrial Biopsy: The doctor inserts a thin tube into the uterus and takes a tiny sample of the uterine lining for examination in the lab.
• D&C (dilation and curettage): In this surgical procedure requiring anesthesia, the doctor passes a small instrument through the vagina into the uterus, and removes tissue from the lining so it can be sent to a lab for analysis.
• Hysteroscopy: This procedure allows the doctor to look inside the uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope, a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus.

Treatment
Treatment for postmenopausal bleeding depends on the cause.

• If polyps are causing the bleeding, they are removed with minimally invasive surgery.
• Fibroids also may be treated with radiographic embolization (placing medications through a catheter into a blood vessel to block blood flow to an area of the body), minimally invasive surgery, or with a hysterectomy (surgical removal of the uterus).
• Endometrial hyperplasia may be treated with medication or surgery to remove thickened areas of the endometrium.
• Vaginal atrophy can be treated with estrogen cream.

In most cases, treatment for endometrial cancer is a total hysterectomy, which involves removing the uterus, cervix and ovaries. Women with more advanced endometrial cancer may also need to undergo lymph node biopsy, and chemotherapy or radiation. If the cause of postmenopausal bleeding is cancer, the sooner it is treated, the better the chances for a full recovery.

Dr. Resnik notes that today the overwhelming majority of hysterectomies performed because of endometrial cancer are done with minimally invasive laparoscopic surgery that involves small incisions. Some doctors perform robotic-assisted laparoscopic hysterectomy, using a computer to control the surgical instruments. “Laparoscopic and robotic surgery provides for a quicker discharge from the hospital, and a faster recovery and return to normal functioning, with better cosmetic results,” he says.