I am 50 years old, I have a hormonal IUD and I am following hormone therapy for menopause. For the past week I have started having light bleeding and I am very worried. Could it be cancer?

Question

Dr Florian André Vallecillo Cabrera · Accepted Answer

Hello Julia,

I fully understand your concern. It is very common for unexpected bleeding to cause fear, and for the first thing that comes to mind to be the possibility of cancer. However, I want to reassure you: the vast majority of bleeding in this situation is not caused by cancer.

At 50, during perimenopause or the early years of menopause, the body goes through significant hormonal changes. In addition, using a hormonal IUD together with hormone replacement therapy can promote small bleeds or spotting, especially during the first months of treatment, after a dose change, or even after a long period without any bleeding.

There are many benign causes that can explain this type of bleeding, such as the endometrium adapting to hormone therapy, small uterine polyps, slight thinning or thickening of the endometrium, or simply changes typical of this stage of life.

This does not mean it should be ignored. Any bleeding after menopause or during hormone therapy deserves to be assessed, but assessing it does not mean there is a serious problem. In most cases, a gynaecological examination and a transvaginal ultrasound make it possible to identify the source of the bleeding and confirm that everything is within normal limits. Only in certain circumstances may the gynaecologist consider it necessary to perform an additional test, such as an endometrial biopsy.

My advice is to book an appointment with your gynaecologist so they can assess you calmly. In the meantime, try not to anticipate the worst-case scenario. In my practice I often see this type of situation and, fortunately, most have a completely benign explanation.

You should seek care sooner if the bleeding is heavy, lasts several days, is accompanied by intense pain, or if you feel dizzy or weak.

I hope I have reassured and guided you.

Kind regards,
Dr Florian André Vallecillo Cabrera