Women and men just aren’t the same, particularly when it comes to their health risks. The first step to staying healthy is knowing what you’re up against, and then taking the necessary precautions to reduce your risk. The good news is that many of the leading threats to women’s health, which can vary based on a woman’s age and background, are preventable. In this section we demystify the problems, and discuss options for treatment.
Postmenopausal bleeding is any vaginal bleeding 1 year after the last period. Often postmenopausal and other abnormal bleeding will have no sinister cause. However it can be the first sign of cancer so it is important to be investigated.
Causes of Postmenopausal Bleeding
Polyps: These are growths, usually noncancerous, that can develop in the uterus, on the cervix, or inside the cervical canal. They might cause bleeding.
Endometrial atrophy (thinning of the endometrium): The endometrium, the tissue that lines the uterus, can become very thin after menopause because of lower estrogen levels. This may cause unexpected bleeding.
Endometrial hyperplasia: In this condition, the lining of the uterus becomes thick, and bleeding may occur as a result. Obesity may be the cause of the problem. Some people with endometrial hyperplasia may have abnormal cells that can lead to endometrial cancer (cancer of the uterine lining).
Endometrial cancer (uterine cancer): Bleeding after menopause can be a sign of endometrial cancer.
Other causes: Hormone therapy, infection of the uterus or cervix, use of certain medications such as blood thinners, and other types of cancer can cause postmenopausal bleeding.
During your visit the doctor will conduct a physical examination and scan. Ideally this scan will be vaginal however this is not always appropriate. We will then discuss with you if you require further investigations. Management may sometimes be in the form of a minor surgical procedure – hysteroscopy, dilatation and curettage to evaluate the lining of the womb
Amenorrhoea – The complete absence of periods or Oligomenorrhea – Irregular/infrequent periods
Primary amenorrhoea is a term given to a girl of 16 or younger who has not yet started her monthly periods. This may occur with or without other signs of puberty.
Causes of this include:
Secondary amenorrhoea is a term given when a women’s regular menstruation cycle has stopped for over 6 months.
Dysmenorrhoea – Period Pain
Endometriosis is a condition where the lining of the womb migrates to other areas such as the ovaries/ the external surface of the womb. This can lead to inflammation and pain. Women may have problems getting pregnant if the condition affect the ovaries and fallopian tubes.
Enlargement of the female pelvic organs is usually detected during pelvic internal examination or an imaging such as CT scans or pelvic ultrasounds.
Pelvic masses may originate from gynecologic organs (cervix, Uterus, Uterine adnexa) or from other pelvic organs (intestine, bladder, ureters, skeletal muscle, bone).
Common reasons for a pelvic mass include fibroids and ovarian cysts. However, it can be something more serious in the form of malignancy. It can also affect your reproductive ability.
Type of mass tends to vary by age group.
In infants, in utero maternal hormones may stimulate development of adnexal cysts during the first few months of life. This effect is rare.
At puberty, menstrual fluid may accumulate and form a vaginal mass (hematocolpos) because outflow is obstructed. The cause usually an imperforate hymen; other causes include congenital malformations of the uterus, cervix, or vagina.
In women of reproductive age, the most common cause of symmetric uterine enlargement is pregnancy, which may be unsuspected. Another common cause is fibroids, which may extend outwards. Common adnexal masses included graafian follicles (usually 5 to 8 cm) that develop normally but do not release an egg (called functional ovarian cysts). These cysts often resolve spontaneously within a few months. Adnexal masses may also result from ectopic pregnancy, ovarian or fallopian tube cancers, benign tumors (eg, benign cystic teratomas), or hydrosalpinges. Endometriosis can cause single or multiple masses anywhere in the pelvis, usually on the ovaries.
In postmenopausal women, masses are more likely to be cancerous. Many benign ovarian masses (eg, endometriomas, myomas) depend on ovarian hormone secretion and thus become less common after menopause.
The evaluation of the mass can include a physical examination and investigative tests such as a transvaginal ultrasound and blood tests. Your doctor will discuss all diagnosis and treatment options with you in detail to create a specific plan suited to your individual case.
When to See Your Doctor
Common methods of medical treatment for cysts include:
How are fibroids diagnosed?
What are the treatments for fibroids?
Surgery to treat fibroids. When medications have not worked, the patient may have to undergo surgery. The following surgical procedures may be considered:
Below are some symptoms that women may have around the time of menopause
Most women do not need treatment of menopausal symptoms. Some women find that their symptoms go away by themselves, and some women just don’t find the symptoms very uncomfortable. But if you are bothered by symptoms, there are many ways to deal with them, including medications and lifestyle changes.