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Dr. C.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience:  30 yrs experience, awarding winning educator
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I had a total vaginal hysterectomy Nov 2013 and over the

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Hi I had a total vaginal hysterectomy Nov 2013 and over the last month have had some bleeding I visited my gp he done swabs for infection which were clear on the second bleed I got refered back to hospital where I saw a consultant last Monday there was no bleeding at the time he examined me and said everything was fine everything was healed and no granulation tissue was seen then again there has been more bleeding and I don't now feel like I want to return to the gp could this be hormones related
Hi, It's Dr. C. Thanks for asking for me. I'm sorry that you've had some bleeding. But glad that the consultant checked and saw the vaginal cuff free of granulation tissue and healing well. It's possible to have some bleeding that is due to lowering estrogen hormone levels after a hysterectomy. Usually bleeding would be light and spotty or just pink tinged discharge. If the ovaries were also removed, this increases the chance of that as a cause. But it's also possible even if the ovaries were not removed. The way we'd usually treat hormonal bleeding is to prescribe a very low dose of vaginal estrogen. Estrogen cream is usually cheaper but messier to use. Vagifem tablets are easier to use but more expensive. Women need to check with their insurance to see if they have coverage for both equally. If so, the Vagifem tablets are preferred. Although it's an estrogen product, there is virtually no absorption into the bloodstream of estrogen. So even though the package insert (which is required for all estrogen products by the FDA) will say things about breast cancer, blood clots, etc., these warning do not apply to the Vagifem product. There is somewhat more absorption into the blood system with the cream. The only reason why women will definitely want the tablets is if a woman has a history of breast cancer, blood clots or heart attack. The proper usage is to use for the 2 products is as follows:Estrace (estradiol) cream - use 1 gram nightly for 7nights, than use 1 gram twice weeklyVagifem pellets - use one pellet nightly for 14 nights, than use twice weeklyMost women will notice an improvement within 2 weeks. I hope this information was helpful. Let me know if you have any questions.
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