Question 1

What is hematuria?

Accepted Answer

Hematuria refers to the presence of red blood cells in the urine. Gross hematuria is visible to the naked eye, while microscopic hematuria is detected only on urine testing. Both forms warrant evaluation, even if symptoms are mild or intermittent.

Question 2

What causes blood in the urine in women?

Accepted Answer

Hematuria can have many causes, including:

• Urinary tract infections
 • Kidney or bladder stones
 • Inflammation of the bladder or urethra
 • Vigorous exercise
 • Kidney disease
 • Tumors of the bladder or kidneys
 • Contamination from vaginal bleeding 
 • Menopausal changes of the bladder, related to decreasing estrogen levels

Question 3

Is hematuria always serious?

Accepted Answer

Not always, but hematuria should always be evaluated. Many causes are benign and treatable, but hematuria can be an early sign of more serious conditions, particularly in women over 40 or those with certain risk factors.

Question 4

How is hematuria evaluated?

Accepted Answer

Evaluation begins with a detailed medical history and physical examination, including a pelvic exam when appropriate. Urine testing is used to confirm hematuria and assess for infection. Further evaluation may include cystoscopy and imaging of the kidneys and urinary tract.

Question 5

What is a cystoscopy?

Accepted Answer

A cystoscopy is a diagnostic procedure that allows your provider to directly examine the inside of the bladder and urethra using a thin, flexible camera called a cystoscope. It is one of the most effective tools for evaluating blood in the urine because it allows visualization of the bladder lining in real time.

During the procedure, the cystoscope is gently inserted into the urethra and advanced into the bladder. The bladder is then filled with sterile fluid to allow clear viewing of the bladder walls. This enables the provider to look for inflammation, stones, bleeding, abnormal tissue, or other structural changes that may not be visible on imaging studies alone.  If a biopsy is needed, it can be collected during the procedure.

Cystoscopy is typically performed in the office, does not require anesthesia, and is well tolerated by most patients. The procedure is brief, and while some pressure or discomfort may be felt, it is generally minimal. Cystoscopy plays a critical role in ensuring that serious causes of hematuria are identified or confidently ruled out.

Question 6

Can hematuria be related to menopause?

Accepted Answer

Yes, menopausal changes can contribute to urinary symptoms and, in some cases, microscopic hematuria. Declining estrogen levels can lead to thinning and increased fragility of the vaginal and urethral tissues, which may result in irritation or minor bleeding.

However, menopausal changes should never be assumed to be the cause of blood in the urine. A thorough evaluation is essential to rule out more serious conditions such as infection, stones, inflammation, or malignancy.

Once worrisome causes have been appropriately ruled out, vaginal estrogen therapy may be recommended to improve urethral and vaginal tissue health. Restoring tissue integrity can help reduce irritation and may decrease the likelihood of recurrent microscopic hematuria and other urinary symptoms related to estrogen deficiency.

This stepwise approach ensures both safety and long-term symptom prevention.

Question 7

Can pelvic organ prolapse cause blood in the urine?

Accepted Answer

Pelvic organ prolapse does not typically cause hematuria directly. In some cases, it may contribute indirectly by causing incomplete bladder emptying or recurrent infections, which can lead to irritation.

Question 8

What happens after the evaluation?

Accepted Answer

Once the cause of hematuria is identified or serious conditions are ruled out, treatment is tailored accordingly. Some patients may require treatment, while others may be monitored over time.

Question 9

When should I see a urogynecologist for hematuria?

Accepted Answer

You should seek evaluation if you notice visible blood in your urine, have persistent microscopic hematuria, or experience urinary symptoms alongside hematuria. Early evaluation leads to timely diagnosis and peace of mind.