Dr. Vinita Agarwal

Postmenopausal bleeding
Post menopausal bleeding is vaginal bleeding that happens at least 12 months after your periods have stopped.
About 4 % of women suffer with the above problem.It is not normal to bleed after menopause and it has to be investigated.

Causes of post menopausal bleeding
Most common cause of post menopausal bleeding is atrophic vaginitis and atrophic endometritis.After menopause due to decrease in the level of harmones in the body there can be thinning and inflammation of the inner lining of the uterus.
Other causes of post menopausal bleeding are 
polyps they refer to the extra growths of the inner lining of the uterus as well as the neck of the uterus(cervix).
PMB can also be because of thickening of the inner lining of the uterus, also called as hyperplasia.it can be because of extraneous harmones or obesity.
Less than 10% of the woman who suffer from PMB may have cancer of endometrium ,cervix and vagina.

Diagnosis
1)Pelvic examination
your doctor will do an internal examination to examine the cervix and do a papsmear if it is due.
2)USG scan is done to note down the size of uterus and the thickness of the endometrium.based on these reports the doctor might decide about the further tests.
3)Endometrial biopsy a small tube will be inserted into the uterus and cells are collected and sent to lab to note if there is any thing abnormal .This is an office procedure.and ususlly does not require admission
4)Hysteroscopy it is a procedure where a small camera is put inside the uterus and a targetted biopsy taken from the suspicious area.

Treatment
The treatment of PMB depends upon the cause.
If endometrial atrophy was the reason it can usually be traeated with estrogen creams and pessaries
Cervical and endometrial polyps require surgery to remove them.Hysteroscopic polypectomy refers to the surgery where in the polyp is removed under the guidance of the camera which is inserted into the uterus.
Endometrial hyperplasia can be treated with progesterone tablets or progesterone impregnated intrauterine devices.
Endometrial cancer will have to be treated with surgery for the removal of uterus and ovaries.Some patients may require chemo or radiotherapy as the stage of cancer may demand.
All in all postmenopusal bleeding doesnt mean the patient has cancer 90 percent of the time it is because of the benign causes but it should not be ignored but investigated.Its betTer to be safe than sorry.

6 Changes in your body you can expect during the second trimester of pregnancy

The second trimester (starting from the 4th and lasting through the 6th month) of pregnancy is considered to be the easiest for a woman. During this time, your energy is at its peak and instances of fatigue and morning sickness are less severe. Your baby, on the other hand, continues to develop inside your womb.

In addition to these, you can expect big changes within your body during the second trimester, which include:

1. Backaches: The additional weight that you gain during these past few months begins to bear down on your back, making it achy and tired. For relief from pressure, there are certain things that you can do such as using a chair that offers strong support to your back; sleeping on the side with a pillow placed in between your legs and wearing shoes that come with solid arch support.

2. Bleeding gums: Hormonal changes occurring during this period bring about a greater flow of blood to the gums, making them extremely sensitive and prone to bleeding. The gums don’t remain tender for long and return to their normal form after delivery. But during these three months, make sure to use toothbrushes with softer bristles and being gentle when flossing.

3. Congestion and bleeding of the nose: In addition to making your gums tenderer, hormonal changes also bring about the swelling of mucous membranes that line your nose. These changes can lead you to have a stuffy nose as well as may even cause your nose to bleed very easily. To clear any nasal congestion that may occur during this period, you should use natural methods or saline drops obtained from a chemist.

4. Hair growth: Pregnancy also sees your hair growing rapidly due to the action of the hormones on the hair follicles. Additionally, you also experience hair growth in places where hair is sparse. To remove unwanted hair, you should stick to tweezing or shaving, waxing and the use of depilatories aren’t recommended by medical experts as they aren’t considered safe for the baby.

5. White vaginal discharge: White vaginal discharge during this time is very common. The discharge ensures that harmful yeast or bacteria don’t breed in your private areas. But if the discharge takes on a foul smell and a green or yellow colour, you should immediately consult a gynaecologist as you may be down with a vaginal infection.

6. Leg cramps: A very common occurrence during the second trimester, leg cramps usually last through the last leg of pregnancy, which is the third trimester as well. The reasons behind their occurrence may be hormonal, weight-related or deficiency of magnesium and calcium. In case you have a concern or query you can always consult an expert & get answers to your questions!