Postmenopausal Uterine Bleeding

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Dr. Maupin and Brett Newcomb discuss the diagnoses and treatment for Postmenopausal Uterine Bleeding.

In this week’s podcast, we are talking about Postmenopausal Uterine Bleeding. This is a serious issue for doctors because postmenopausal bleeding is the first sign of uterine cancer. It is an indicator that compels doctors to investigate whether or not their patient has cancer. Once they can determine that it is not cancerous, then they can begin to think about why is it happening and what can be done treat it.

Women who suffer from postmenopausal uterine bleeding need to go through a hierarchy of steps in order to deal with it.  One of the first steps is to get a non-invasive ultrasound. An ultrasound is going to tell them if their uterine lining is too thin. If it is, and they have had some bleeding, there is really nothing to worry about except for the hassle and the mess.

I used to deal with this all the time as an OBGYN. I do not deal with it as much today, but I still encounter it through my estrogen replacement therapy practice.  It is never an issue when we replace testosterone; it is only when the estrogen is replaced that this bleeding can sometimes happen. Any time we give estrogen and then get bleeding, after investigating whether the bleeding is cancerous or not, we work to figure out how to balance the amount of estrogen to avoid uterine bleeding.

There are several steps we discuss in this podcast. They range from taking progesterone with the estrogen (usually at night) to getting a Mirena IUD, to monitoring whether or not the woman is taking too much Vitamin K or is on blood-thinning medication such as Warfarin. These can also cause uterine bleeding.

It is important to remind women (and sometimes their doctors) that replacing testosterone will never cause uterine bleeding. When we replace estrogen we sometimes get bleeding and there are straightforward strategies for dealing with it. We never discount it because it can be a first sign of cancer. Once we have determined that it is not Cancer, we begin to look at strategies in order of invasiveness and cost to try and regulate the estrogen amount so that the woman does not have issues with postmenopausal uterine bleeding. These issues, when they develop are irritating and messy, but not deadly and not incremental in terms of causing other problems.

Listen to today’s podcast to obtain reassurance and information to help you make good decisions.