"What Steps Should I Take to Address Bleeding After Menopause?"

Postmenopausal Vaginal Bleeding: Causes, Diagnosis, and Treatment

After menopause, women gradually enter the stage of menopause, but the occurrence of vaginal bleeding thereafter is abnormal and should be considered a warning sign of underlying pathology. Such conditions may include abnormal uterine bleeding due to anovulation, uterine fibroids, and gynecological malignancies. Timely examination, diagnosis, and treatment are paramount, adhering to the doctor's recommendations for medications like norethisterone and gonadotropin-releasing hormone analogues or undergoing surgical intervention.

1. Anovulatory Abnormal Uterine Bleeding During Menopause

Persistent bleeding during menopause is frequently caused by anovulatory abnormal uterine bleeding. The treatment principles encompass hemostasis, menstrual cycle regulation, menstrual flow reduction, and prevention of endometrial pathology. Hormonal medications are typically employed for hemostasis and menstrual cycle adjustment. In cases of acute bleeding, norethisterone can be prescribed.

2. Causes of Postmenopausal Bleeding: Benign vs. Malignant

Western medicine recognizes multiple causes of postmenopausal bleeding, which can be broadly categorized into benign and malignant diseases. Benign diseases are predominantly atrophic endometritis, with other causes including senile vaginitis and cervical polyps. If gynecological malignancies, such as endometrial cancer, cervical cancer, and ovarian cancer, are confirmed as the cause, surgical treatment is often recommended. The prevalence of these two disease categories is roughly equal.

3. Management of Benign Diseases like Uterine Fibroids

For benign conditions like uterine fibroids, targeted drug therapy is administered. For mild symptoms, patients nearing menopause, or those who are medically unfit for surgery, gonadotropin-releasing hormone analogues (GnRH-a) may be prescribed. Surgical intervention is indicated when excessive menstrual bleeding leads to secondary anemia despite ineffective drug treatment, severe abdominal pain, dyspareunia or chronic abdominal pain, and acute abdominal pain resulting from pedunculated fibroid torsion. Hence, elderly women should be vigilant about any vaginal bleeding, regardless of its volume or frequency, and promptly seek gynecological evaluation for early diagnosis and timely treatment.