For many women across the Coast, menopause brings a longawaited sense of freedom. But when bleeding returns, even lightly, it can create worry, embarrassment or the hope that it will simply fade away. Dr. Dona Kioseff, a boardcertified OB/GYN, wants women to know one thing: Postmenopausal bleeding is never normal.
Menopause is typically diagnosed after 12 months without a menstrual cycle. Any vaginal bleeding afterward, whether light or heavy, is considered abnormal and should be evaluated by a gynecologist.
“Postmenopausal bleeding is a common concern we see in the office,” Dr. Kioseff says. “Some women in early menopause may believe their menstrual cycle is simply ‘restarting.’ Some experience an episode of bleeding that stops after a day or so and feel that they do not need to be evaluated. I ask all my postmenopausal patients if they’ve experienced bleeding at their annual gynecological visit, and patients often will nonchalantly mention that they have seen bleeding ‘here and there.’”
Here on the Coast, where women often put family and community first, many delay seeking care, but Dr. Kioseff stresses that early evaluation is essential.
COMMON CAUSES AND WHEN TO WORRY
Most of the time, the cause is benign.
“The most common cause of postmenopausal bleeding is due to endometrial or vaginal atrophy, or when the uterine lining or vaginal tissue becomes thin and fragile,” Dr. Kioseff says. Other causes include polyps, infection, medications or hormone therapy.
Still, bleeding may signal something more serious.
“Bleeding after menopause sometimes can be a sign of endometrial cancer,” Dr. Kioseff explains. “In fact, 90% of patients with endometrial cancer will have vaginal bleeding as their first symptom.” Thankfully, only about one in 10 women with postmenopausal bleeding is diagnosed with cancer.
She explains, “If you are experiencing bleeding to the point where you are soaking pads quickly or feel dizzy, light-headed or short of breath, you should seek medical evaluation right away.”
WHY WOMEN WAIT
Dr. Kioseff sees a common pattern.
“Some women are embarrassed to talk to their providers about this issue or have a pelvic exam performed at this stage of life,” she says. “It is important to know that postmenopausal bleeding is common and something that gynecologists evaluate frequently.”
In addition, she shares, “Some patients will wait months to years, especially if their bleeding is very light or is only spotting.” However, early detection dramatically improves outcomes, with “fiveyear survival rates around 95%.” When endometrial cancer goes undetected and advances, outcomes are much poorer.
WHAT TO EXPECT AT THE APPOINTMENT
“Your doctor may recommend a pelvic ultrasound and/or an endometrial biopsy,” Dr. Kioseff says. “These tests usually are done in the office and are not typically invasive.”
If you feel dismissed, Dr. Kioseff encourages directness.
“Explicitly state that you are having postmenopausal bleeding,” she advises. “You can also request a second opinion or referral.”
If you’re experiencing symptoms, it’s important to consult a qualified healthcare professional. Early evaluation can make all the difference.
Dr. Dona Kioseff is a boardcertified OB/GYN who practices at Memorial Gulfport OBGYN Clinic. Contact her at (228) 822-6898 or visit wearememorial.com to learn more.