When a woman is close to menopause, and the ovaries begin retiring, underlying hormonal imbalances bring undesirable symptoms, and heavy or irregular bleeding is one of them. In the past, many doctors would simply recommend a hysterectomy. Assuming there are no other issues like fibroids, cervical polyps, STDs, endometrial hyperplasia or cancer, uterine ablation is a better option. NOVASURE ablation is a simple, in-office procedure that removes the uterine lining (endometrium) so that it cannot grow. Bleeding is greatly reduced or stopped altogether.
Women who are post-menopausal and taking estrogen must also take progesterone to balance their hormones. Progesterone ensures the uterine lining doesn’t grow too thick, which can cause hyperplasia, or possibly cancer (this takes years to happen, so don’t panic). When otherwise healthy women first begin HRT, the estrogen heals and revitalizes their vaginal and uterine tissues, so some bleeding can occur. The most common reasons for vaginal bleeding in postmenopausal women on HRT is that the progesterone dose is not strong enough or there are fibroids present. Finding the right balance of estrogen and progesterone is the key, but it can take some time to find the right progesterone dosing and regimen. The Mirena™ IUD can be helpful, as it delivers a low dose of progesterone directly to the uterine lining.
If bleeding continues despite all attempts to achieve a good hormone balance, a trans-vaginal ultrasound and/or biopsy may be indicated to ensure everything is fine. Occasionally, a D&C can help by cleaning out the old uterine lining. Another option is the NOVASURE uterine ablation procedure mentioned earlier. Rarely, some women will opt for a total hysterectomy, but it’s best to avoid major surgery if there’s a simpler option like ablation. Finally, post-menopausal women who aren’t on any form of HRT who experience any vaginal bleeding should be evaluated quickly and thoroughly to rule out endometrial hyperplasia or uterine cancer.
If you’re suffering similar symptoms, we can help. Call 480.619.4097 and ask for an appointment with Dr. Jennifer Iacovelli, our OB/GYN, or another member of Team DeRosa.