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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
Yours,
Jane
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.
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
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
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
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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