Post Menopausal bleeding-Benign Hysteroscopy

Hi gravity, I am about to be 56 as of next week. And yes, the doctor mentioned hysterectomy if there was any cancer found, but I had told her I was good with that even if cancer wasn’t the case, but random bleeding issues kept happening. Why would I want to wait for something to be cancer when I can have it handled ahead of time? She agreed with that logic, but after the 2nd hysteroscopy being negative, she said she didn’t think any intervention was needed. Also, this bleeding isn’t heavy, it’s like a very light period day and then tapers off. It’s just the unpredictability of it that is getting me anxious. As well as always wondering… is it suddenly going to get worse. I’m a super anxious person and all of this has made that worse.

I understand the need to lose weight, it is actually the root cause of the majority of my health issues, which are all being amped up in this last year. I have to get serious about it, but it’s so hard. I live alone, and hate cooking, so my downfall is always ordering. But lately I’ve been trying to keep that to a minimum and even ordering better options, cutting out some things and so on. I’m on Metformin since Late March, and I have Ozempic which I’m supposed to start but I have so much going on with this health issue (and others with my breast but that’s another discussion). For what it’s worth, I was at my heaviest last October at 260, and actually these last few months (probably due to Metformin), I am now 251.

On top of all this, I’ve been out of work since October (literally when all this started happening as well). So I have job hunting to the mix. I’m sure stress is also involved in some of this, but I don’t know how it could cause actual physical symptom like on and off spotting. Also, I have read that Metformin can cause heavier periods in some women. This isn’t a period as I’m post meno, but it just seems odd to me. The doctor doesn’t think it could be the cause.

Did your D&C show hyperplasia or estrogen stimulated tissue?
It is not unusual for estradiol of any kind when used, especially vaginally, to cause hyperplasia or bleeding from estrogen stimulated tissue or to stimulate polyps with resulting bleeds.
Of course you have had a uterine polyp and uterine polyps are a common cause of abnormal uterine bleeding, An elevated estrogen (estradiol) levels may cause or stimulate their growth. These, often benign, growths on the inner uterine lining frequently cause spotting, heavy periods, or postmenopausal bleeding.

You might be better served with an estriol vaginal cream. Estriol is 10 times less strong than estradiol and not tied to polyps or hyperplasia.
Scientific literature generally suggests that estriol is "endometritically silent." This means that at standard doses for vaginal atrophy, it typically does not cause the uterine lining to thicken.
In contrast, while Yuvafem is also considered very safe, its more potent nature means that in a small percentage of women—particularly those who are highly sensitive or using the product more frequently than prescribed—the estradiol can trigger spotting or localized growth like polyps.
Estriol works in the vaginal area but generally does not significantly thicken the uterine lining (endometrium) because of its short duration of action on receptors. It is a weak estrogen that binds to vaginal receptors long enough to treat dryness and atrophy, but dissociates too quickly from endometrial receptors to cause proliferation.

Also, with a system like yours which is sensitve to estrogen it is safest to use progesterone systemically and maybe vaginally to counteract any estrogen over reaction. Please ask your doctor; there is a ratio of progesterone to estrogen which is considered safe which you doctor should be able to maintain for you.

Your story is one that I hear over and over again. It seems that doctors have grown used to prescribing estradiol for women, women that were for years predominately without a uterus or ovaries.
That is less and less the case nowdays, and doctors are seeing that women with a uterus/ovaries are more senstitive to estrogens and do better on estriol, whereas women without a uterus/ovaries seem to need the stronger estradiol. At this point this is all self reporting and doctors speaking out on line, but hopefully a research or population study will clarify this better in the future.

Now though we are left with our own bodies' speaking to us and us having to listen very carefully.
personal example: I have bled twice in my around 28 years in menopause and both times I was taking estradiol systemically. Seems, I was making my own estradiol and was basically overdosing on estradiol when I used the topical estradiol cream. I found a doctor that uses hormone testing and the tests showed that I made plenty of estradiol naturally. I have not used estradiol again until just recently when at the age of 73 my estradiol levels have begun to fall; we will see how I do on this tiny amount of estradiol skin cream balanced by progesterone which I am now taking, plus upping my estriol vaginally.

I know it’s not normal, that’s why I’m always so worried and why I went to the gynecologist as soon as I could. But actually, there are a number of reasons it could be happening. The obesity factors in because fat cells turn the androgens to estrogen, which can thicken the endometrium, and may cause bleeding. I was not able to include a link, but if you google post meno bleeding obesity, you can find the same info my doc told me in some detail.
So for me, in the last year I’ve had two hysteroscopy that were both benign. Since the spotting/light bleeding seems to have started again, 2 months after the last hysteroscopy/D&C, I will definitely speak to my doctor again. I agree that the weight thing sounds odd, but it does show up as a common risk factor for causing cancer eventually, which is why she’s saying to lose weight overall.
Regarding hormone bloodwork, yes I had that done back in March from an endocrinologist, which was my first visit. Everything was fine hormone wise, the estradiol was high, but my doctor said they don’t treat based on numbers, they treat when there are symptoms. So, I’m guessing now in my case, this is a symptom!! I’ll be sure to bring that up to her in the next visit.
Only other thing was A1C being in the diabetic range now (6.7, the cut off is 6.4) which is why I started the Metformin. I am due to go back to him in early September, so I suppose I will see what info that brings.
Thank you for responses! This is all just frustrating and I was hoping to see if others had similar experiences, but that haven’t happened yet. I guess we all are different, yet the same!

@rainee2025

Hi,

Reading your story was so comforting in a way, for i do not feel alone, im 48 tears old soon to be 49. Ive been skipping periods for the last almost 3 years, i though it was due to the stress of my mother battle with cancer. After she passed. Things just took a turn, I went fro occasionally spotting to non stop bleeding (longest I have experience was almost 14 days. )

I decided to ditch my regular ob and made an appointment to see an oncologist obgyn. Because I was getting no where with my regular gyn. Giving my dr. All the detail of my family, she decided to do an mri. And another endometrial biopsy, had one last year (negative 🙌🏿🙌🏿🙌🏿) i am obese as well weight in 232lb for my 5'6 hight. I was given metformin, but I refused to take it due to study of what it does to other things.

Needless to, Thank you for your story. It has helped me tremendously

Trainee..did you ever get this resolved? I am 68 and 25 years post menopausal. I started bleeding..my docs were wonderful.. Ultra sound and MRI, Hysteroscopy and D& C. All tests came back negative for cancer. No polyps found . Endometrial strip was thickened. I had little or no bleeding post procedure.

6 weeks later, I am experiencing menstruation cramps and spotting....

I am 5ft 2 and 150lbs.. I go to the gym for strength and Balance classes. I don't feel obese..but I could certainly lose a few pounds.

I would love to know if you resolved your situation.

Stephanie

@kathleen1314 thanks very much for the reply. Your opening question was, “ Did your D&C show hyperplasia or estrogen stimulated tissue?”. I had some thickening prior to the D & C. My lining was 5mm, which is considered too thick according to my Gyn. She said they like to see 4mm or less. I don’t know how to find out if I have estrogen stimulated tissue. My Gyn didn’t mention that, though she wants me to go lower on my estradiol patches, which I have started doing 2 weeks ago (from .2mg to .1mg). My N.P. for hormones said yesterday that estrogen does not cause polyps. That was surprising to hear and contrary to what you said. I told her the Gyn did not say that.
What you said about switching to localized estriol over estradiol is interesting. My gut is telling me that the Yuvafem is the culprit for the new bleeding. It’s just so hard to convince my providers, since from what I read online, this is not wildly reported. All they say is bleeding after menopause is not normal.
I was on .2mg patches twice a week, for the systemic portion of my estrogen. The reason I was on a higher dose than usual was based on a blood test I had 2 years ago where my estrogen was 30. At that time I was on .1mg patches. My last blood test, in Dec. 2025, estrogen was 134. I have gone down to .1mg patches again, as of 2 weeks ago, though started on the Yuvafem because of vaginal discomfort (thinning, pain, etc). I take 200mg of oral micronized progesterone and my test result was in a normal range last Dec. You mentioned taking it vaginally. I asked my Gyn about it. She said, “I guess you could place the pills up inside of you”. She never heard of it before though. I hesitate to do so because they smell awful. I looked up why that is and, supposedly, the capsules are beef gelatin rather than vegan. Not really something I would like to place up in me. She also offered an IUD. I am terrified of that type of pain though. I have chronic pain and have a low tolerance for acute pain, esp. in that area. My Gyno said it’s no big deal. My friend who works as a PA in women’s health said to stay away from IUD’s. Many women online have reported awful pain, whether during insertion or removal. I also never had kids, so that may play a part in having low pain tolerance for that, according to what I have heard.
As you discussed, I’m thinking I just might be extra sensitive to estradiol. Though, unlike you I don’t think my body produces it on its own. Based on how things were 2 years ago when I got tested and had a low number. I could feel that it was low then. Figuring all this stuff out has been so challenging. I would just like to be at a place where I have enough hormones and no bleeding.
I hope your new system works out well for you.