I entered menopause 2 years ago and yesterday I found
Patient :I entered menopause 2 years ago and yesterday I found I was bleeding. I had vaginal ultrasound and endometrium line is 3 mm.
I had gastric bypassa 8 months ago and lost 51 quilograms.
I'm terrified with the possibility of have endometrial cancer but I read that a dramatic weight loss can be the cause for post menopause bleeding.
I'm 51 years old.
Thanks for the query to ATD for an opinion,
I understand your concerns regarding endometrial cancer following an episode of post menopausal bleeding after 2 years of menopause. But the fact is there can be multiple causes of post menopausal bleeding and endometrial carcinoma can be just one of them.
1. The most common cause for post-menopausal bleeding is atrophic vaginitis, which is an inflammation of the lining of the vagina, caused by lower levels of oestrogen.
2. The second most common causes of bleeding post menopause are polyps and fibroids. Polyps and fibroids can occur in the uterus, and may cause irregular post menopausal bleeding, and are usually harmless
3. Endometrial atrophy is when the lack of oestrogen causes thinning of the lining of the uterus. It also causes the small blood vessels in the uterine lining to break down, and is similar to when a severe cold causes the lining of the nasal passages to break down, resulting in spontaneous bleeding.
4. Endometrial Hyperplasia is a condition where overgrowths of the uterine lining develop. This can cause post menopausal bleeding, and can sometimes turn cancerous. If caught early, it is treatable with progesterone, but if left, severe cases can result in a hysterectomy being required.
Not all cases of post menopausal bleeding are caused by a medical problem. Sometimes lifestyle and stress levels can have an effect on the body, causing bleeding to occur.
1. Dramatic weight loss can lead to oestrogen, normally stored in fatty tissues, being released into the bloodstream, leading to bleeding in the same way that hormone replacement treatment does. To avoid this, post menopausal women are recommended to lose weight gradually.
2. Emotional stress seems to have ties to post menopausal bleeding. Many women have reported spontaneous bleeding at times of extreme anxiety or excitement.
The only way to determine the cause of most cases of post menopausal bleeding is by a thorough gynaecological examination. This usually involves a range of tests :-
1. An ultrasound pelvis especially transvaginal, which you have rightly done, for estimating the endometrial thickness which should be less than 4mm in post menopausal status ( as is yours) to rule out any hyperplasia or endometrial cancer. An Endometrial thickness of 3mm in your case rules out endometrial cancer, so you may feel relieved.
2. Hysteroscopy may be done to look for any endometrial pop or fibroid and also for taking a biopsy of the endometrium.
In your case, it is indeed the dramatic weight loss which has probably caused this single episode of vaginal bleeding. It is suggested that you should maintain observation for a repeat episode which if occurs shall demand a thorough gynaecological examination. At present the cause is not hyperplasia but dramatic fat loss.
I hope I have answered your query in detail ,
Wishing you good health,
These Q&A’s are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.