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Getting a period at 67 years old.
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Phoenixwoman posted:
My last period was 18 years ago when I was 51. I was on the patch for 5 years and used a .50 dosage. Today out of now where I started bleeding. I have a few tumor fibroids but they have not bothered me. My last pap screening was 2 years ago and I have an appointment this Thursday to do a pap smear. Is it normal to get a period at my age or could there be a problem.
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Jane Harrison Hohner, RN, RNP responded:
Dear Phoenixwoman: This would be considered postmenopausal bleeding and there can be a number of reasons for this to happen:

1. Use of postmenopausal estrogen without accompanied progesterone--In this instance the lining of the uterus can become overly thickened and start to slough off, creating bleeding. Yet, if your last use of the estrogen patch was 13 years ago I really doubt this is your culprit.

2. Too thin a lining---Some women will also bleed when the lining gets too thin (eg after 13 years without estrogen).

3. Fibroids--While fibroids shrink after menopause (they are "fed" by estrogen), they can still impact surrounding blood vessels.

4. Isolated focus of atypical/precancerous cells

5. Cervical cancer---This would be unlikely given your normal PAP within the past two years. Additionally, this type of bleeding tends to worsen with intercourse/vaginal penetration when the fragile area of a cervical cancer is "bumped".

You did the right thing in contacting your own GYN. They can give you the most "for sure" answer after doing an ultrasound, and endometrial biopsy. If you would, could you kindly let us all know what your diagnosis is? Through the magic of the Internet your descriptive subject line will lead other women to your experience allowing them to benefit from your answers.

Yours,
Jane
 
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Phoenixwoman replied to Jane Harrison Hohner, RN, RNP's response:
I will let you know. One think is I went to a day spa a week before and went into a hot tub then went for a swim and after that went into the sauna for about 2 or 3 minutes. I have gone into a hot tub in the past and nothing happened but wondered if doing all three in one day stimulated my body. That was a lot of heat.
 
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Jane Harrison Hohner, RN, RNP replied to Phoenixwoman's response:
Dear Phoenixwoman: Yes, I conur with you. It is less likely for hot tub exposure to prompt postmenopausal bleeding. You can always mention it to the GYN, but they will want to work you up for all the usual causes.

Yours,
Jane
 
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Phoenixwoman replied to Jane Harrison Hohner, RN, RNP's response:
My blood test came back and my thyroid is the same and I am still postmenopausal. The pap smear will take a little longer. The RN is sending me to a GYN and recommends biopsy of the uterus.
 
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farmgirl64 responded:
dear Phoenixwoman,
i just went through the same thing thats going on with you. I had not had a peroid for 12 years. I started spotting, then it was a little bigger spots,then there was a liitle more of a flow.
Anyways, I watched it and then I had a pap smear. It came
back normal. I was still spotting . They told me my cervix was seaping blood. I had a biospy and it came back abnormal.There was pre cancer cells. I let it go and I fianally had my surgery and no more peroids. You definitely dont need to let it go to long. You ask if it is normal to get a pap smear, I think so, because after you get older you should keep a close watch on your body.By the way, I am 63 and this was my first surgery.So please take care of yourself.
 
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cat831 replied to Jane Harrison Hohner, RN, RNP's response:
I have spotting,Iam 56yrs old had a hysterectomy 16 yrs ago what can be causing this?
 
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An_247752 replied to farmgirl64's response:
I am 63 yo and my situation is slightly different. I started having bleeding exactly like my former menstrual cycle--including cramps & clots. I went to my gyn, ultimately had a digital scan plus pap & everything was normal. She ultimately put me back on hrt, as this started about 6 wks after my internist took me off hrt. I stayed on hrt for several months, with no bleeding. Due to finances I had to stop again. Bleeding is back. One other curios factor--my bleeding is often associated w/ straining when constipated. Anyone else relate or have info for me? BTW, I don't remember when my last real period was. I was diagnosed as post menopausal in my early 40's.
 
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Jane Harrison Hohner, RN, RNP replied to farmgirl64's response:
Dear farmgirl: Thanks for your input. Surprisingly, abnormal cells from the cervix is a less common reason for postmenopausal bleeding than problems from the lining of the cervix. Yet, as your experience shows, cervical sources have to be checked out with a PAP smear or a curettage (scraping) from the inside of the cervical canal.

It sounds like Phoenixwoman is slated to have a biopsy of the lining of the uterus ("endometrial biopsy). This, along with a PAP and ultrasound, are standard for evaluation of postmenopausal bleeding.

Yours,
Jane
 
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Jane Harrison Hohner, RN, RNP replied to cat831's response:
Dear cat: There are a number of POSSIBLE explanations:

1. If you had a supracervical hysterectomy (cervix left in place), there is still enough glandular tissue (same as uterine lining) lining the cervix to respond to estrogen from HRT, or ovaries left in place.

2. If you have known endometriosis, there are case reports in the literature of endo growing into the scar at the back of the vagina where the cervix was removed.

3. If your ovaries are gone and you are using no estrogen, the vaginal tissues can become so thin and fragile that they can bleed. In this same scenario, a prolapsed urethra can cause spotting when the delicate tissues are rubbed by under wear. If your ovaries were left in place,cat831, you may now be postmenopausal--also with low estrogen levels.

4. If your surgery was for cancer there is a VERY remote chance that the bleeding is from a return of the cancer

5. Sixteen years post-surgery is probably too long a time for there to be granulation tissue at the site of the scar in the back of the vagina. This is a more common problem sooner after surgery.

I would recommend that you see your GYN to see if there is an obvious source of the spotting. Having examined patients with concerns similar to yours I would have to say that sometimes we are never able to find out what prompted that isolated bleeding incident.

Yours,
Jane
 
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Jane Harrison Hohner, RN, RNP replied to An_247752's response:
Dear An: Thanks for continuing this discussion about postmenopausal bleeding with your different kind of experience. As you may have read above, when estrogen levels drop, there can be bleeding and dryness from the vaginal tissues. Additionally, if the tissues that make up the uterine lining become very thinned out due to low estrogen, it can make the lining tissue less stable and easier to bleed.

The most important thing in working up the bleeding pattern that you have described is to make sure that the lining is both very thin, and that there is not some small focus of abnormal cells amid a generally thinned out lining. This can be assessed with a hysteroscopy (fiber optic light scope looks inside the uterus), ultrasound, and/or an endometrial biopsy/D&C. It sounds like your GYN decided the bleeding was from a very thin lining, and not from abnormal cells.

In terms of the spotting being present after bearing down, even young women with breakthrough bleeding will report the spotting is present after bearing down. Heavy exercise and sex can be linked to this as well. ...Hopefully you can get in to get this followed up, Just tell your internist you are having renewed postmenopausal bleeding--usually they will refer you out to a GYN.

Yours,
Jane
 
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Phoenixwoman replied to farmgirl64's response:
What kind of surgery did you have and how was it done? I have an appointment with a GYN at the Mayo Clinic next week. I did not hear from the lab on my pap smear so I think it is normal. I will find out the end of this week when I see the RN. Thank you for you in put. I started spotting Monday and when I move my bowel more blood appears from the viginia. I felt like an egg was dropping from my left ovary Saturday. That is just like it was when ever I got my period when I was younger. I would feel it either on my right or left just before my period would start.
 
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Phoenixwoman replied to Phoenixwoman's response:
I had all my tests and they all came back negetive. My estrogene level was very high 179 so I was getting hormones from somewhere and the test for ovarian tumor was negetive so next week I am having a D&C. The doctor will take another sample to test and will look into the womb with a camera to see the walls. I do have a tumor fibroid leaning against the back of the inside of the womb. So, so far things don't look too bad.
 
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Jane Harrison Hohner, RN, RNP replied to Phoenixwoman's response:
Dear Phoenixwoman: I'm responding to your original post because other women were following your progress. Hope that's OK.

Yes, if you have an estradiol level of 179 picograms that would be very high for a postmenopausal woman. That is a level we would see in a twenty-something woman. It's good that testing for an estrogen producing tumor of the ovary was done and was negative. The level also explains why there was enough estrogen available to build up a uterine lining to shed as postmenopausal bleeding. The hysteroscopy (fiber optic camera) is an excellent choice to actually examine the inside of your uterus.

So where would that extra estrogen be coming from? Some other POSSIBLE sources might include: tumor of the adrenal gland which makes estrogen precursors that body fat then turns into estrone, use of over the counter DHEA pills, or poorly controlled oriental medications (some have been shown to contain actual pharmaceuticals). Your GYN sounds like they are actively looking for the cause of your bleeding, so do keep us posted.

Yours,
Jane
 
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Phoenixwoman replied to Jane Harrison Hohner, RN, RNP's response:
My hormone levels have returned to normal. I had a biopsy at the hospital and the doctor said I have a type 3 endometrial cancer. It is an aggressive type. It may have spread through the walls of the womb. I am scheduled to have a robotic removal of the uterus Nov 1. If the lymph glands look good the robot will finish the surgery but if they look like the cancer spread then the doctor will have to open me and remove any lumps and I will have to have chemo therapy. He is a top surgeon one of the best so I will have confidance in him. Thank you for all the input.


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