Patients in postmenopause have unique gynecological needs and concerns that differ from those of younger patients. With age, matters such as menstrual problems, fertility and pregnancy are replaced by concerns related to pelvic health. For instance, about 70 percent of visits to gynecologists are due to abnormal uterine bleeding. For these gynecological issues in postmenopausal women, careful evaluation and diagnosis are key to appropriate care.
Unique Risks for Postmenopausal Women
Postmenopausal patients present a growing patient base for gynecologists. According to a recent report by Population Bulletin, some 40 million people in the U.S. are age 65 or older — a number that is expected to more than double to 89 million by 2050. Physicians can expect to see many women living into their 70s and beyond, making knowledge and skill in assessing their specific health risks especially important.
In particular, risks in postmenopausal women include the following, according to the Ian Donald School Journal of Ultrasound in Obstetrics and Gynecology:
- Postmenopausal bleeding: Postmenopausal bleeding and ovarian cancer do not always go hand in hand, but more than 90 percent of women with uterine (endometrial) cancer do experience bleeding. Most cases of postmenopausal bleeding will have other causes. Two of the most common reasons are the use of hormone therapy and age-related thinning and atrophy of the endometrium and vagina. Other causes of bleeding in this population include endometrial polyps, uterine fibroids, hyperplasia and infections of the uterus or cervix.
- Enlarged uterus: Because the uterus typically atrophies over time once estrogen levels have dropped, pelvic masses that could indicate uterine enlargement need to be evaluated. Common benign causes of uterine enlargement include adenomyosis and fibroids. Rarely, an enlarged uterus can be a sign of leiomyosarcoma or another malignant condition that has triggered an increase in estrogen levels.
- Enlarged ovaries: Likewise, the ovaries naturally atrophy over time. Gynecologists should try to palpate the ovaries during a physical exam and consider further evaluation if they suspect enlargement, which can indicate ovarian cancer.
- Endometrial polyps: Although most polyps are benign, they are a common cause of postmenopausal bleeding.
Endometrial Polyps
Ultrasound Evaluation: A Valuable Tool
Ultrasound is a valuable tool for gynecologists, especially for those evaluating postmenopausal patients. Indeed, 3D ultrasound is considered the first-line technique for identifying causes of postmenopausal bleeding. This is because 3D ultrasound can reconstruct the coronal plane, creating images that more realistically represent the internal organs, including the uterus. This makes it a valuable tool for identifying causes of postmenopausal bleeding, such as fibroid tumors and endometrial polyps.
Compared with other approaches such as endometrial biopsy and CT scans, transvaginal ultrasound is convenient and cost effective. Gynecologists with postmenopausal patients should consider investing in this technology to offer in their office, which allows for easy, on-site evaluation. Having the right tools at your fingertips can help improve patient care, particularly for gynecologists with a focus on postmenopausal women.
