Postmenopausal Bleeding: What You Need to Know
If you have gone through menopause, you may be surprised to see some vaginal bleeding. Menopause is the stage in a woman's life when her monthly periods stop, usually around age 51. It means that you have not had a period in at least one year.
Vaginal bleeding that occurs after menopause is not normal. It can be light (spotting) or heavy. It can be a symptom of various conditions, some benign and some serious. In about 10% of women, bleeding after menopause is a sign of uterine cancer.
Possible Causes of Postmenopausal Bleeding
There are many factors that can lead to bleeding or spotting after menopause, such as:
- Endometrial or vaginal atrophy: This is the thinning and drying of the tissue that lines your uterus or vagina due to low oestrogen levels after menopause. It can cause irritation, inflammation, and bleeding.
- Hormone replacement therapy (HRT): This is the use of oestrogen and progesterone supplements to decrease some menopausal symptoms, such as hot flashes and vaginal dryness. HRT can also cause changes in your endometrium and trigger bleeding.
- Uterine cancer or endometrial cancer: This is the cancer that affects the lining of your uterus. It is the most common type of reproductive cancer in women. Bleeding is the most common symptom of uterine cancer after menopause.
- Endometrial hyperplasia: This is the thickening of the lining of your uterus due to an imbalance of oestrogen and progesterone after menopause. It can cause abnormal cells to grow in your endometrium, which can lead to cancer if left untreated.
- Uterine polyps: These are noncancerous growths that develop in your uterus. They can cause irregular or heavy bleeding, especially after sex.
- Cervical cancer: This is the cancer that affects your cervix, the lower part of your uterus that connects to your vagina. It can cause bleeding after sex or between periods.
- Cervicitis or endometritis: These are infections or inflammations of your cervix or uterus, usually caused by sexually transmitted diseases (STDs) or other bacteria. They can cause pain, discharge, and bleeding.
- Bleeding from other areas: Sometimes, bleeding may come from your bladder, rectum, or vulva (the skin around your vagina). This can be due to infections, injuries, or other diseases.
- Medications: Some drugs, such as blood thinners, tamoxifen (a breast cancer drug), or certain herbal remedies, can cause bleeding as a side effect.
How Postmenopausal Bleeding Is Diagnosed
If you experience any bleeding after menopause, you should see a doctor as soon as possible. They will do a physical exam and review your medical history. You may need one or more of the following tests:
- Transvaginal ultrasound: This is an imaging test that uses sound waves to create a picture of your uterus and other pelvic organs. The doctor will insert a small probe into your vagina to perform the test.
- Endometrial biopsy: This is a procedure that involves taking a small sample of tissue from your endometrium using a thin tube. The sample will be sent to a lab for analysis.
- Sonohysterography: This is a type of ultrasound that uses a saline solution to fill your uterus and make it easier to see any polyps or other abnormalities.
- Hysteroscopy: This is a procedure that uses a thin, lighted tube with a camera (called a hysteroscope) to look inside your uterus. The doctor will insert the tube through your vagina and cervix.
- D&C (dilation and curettage): This is a procedure that involves dilating (opening) your cervix and scraping out the tissue from your uterus using a spoon-shaped instrument (called a curette). It can remove polyps, fibroids, or abnormal cells.
How Postmenopausal Bleeding Is Treated
The treatment for postmenopausal bleeding depends on the cause and severity of the condition. Some possible treatments include:
- Medications: These can include hormones, antibiotics, anti-inflammatory drugs, or other drugs to treat the underlying condition or stop the bleeding.
- Surgery: This can involve removing polyps, fibroids, abnormal cells, or the entire uterus (hysterectomy) if cancer is present or other treatments fail.
- Radiation therapy or chemotherapy: These are treatments that use high-energy rays or drugs to kill cancer cells or shrink tumours.
- Watchful waiting: This means monitoring your condition without any active treatment, especially if the bleeding is mild and the cause is benign.
When to See a Doctor
You should see a doctor if you have any of the following symptoms:
- Vaginal bleeding that occurs more than a year after your last period
- Heavy or prolonged bleeding
- Bleeding that is accompanied by pain, fever, discharge, or weight loss
- Bleeding that interferes with your daily activities or quality of life
Postmenopausal bleeding is not something to ignore. It can be a sign of a serious condition that needs prompt diagnosis and treatment. By seeing a doctor and following their recommendations, you can protect your health and prevent complications.
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Sources
- Cleveland Clinic. (2022). Postmenopausal Bleeding: Causes, Diagnosis & Treatment. Retrieved from https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding
- WebMD. (2022). Postmenopausal Bleeding: Causes and Treatments. Retrieved from https://www.webmd.com/menopause/postmenopausal-bleeding
- Mayo Clinic Health System. (2023). Is postmenopausal bleeding a concern? Retrieved from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/postmenopausal-bleeding-should-you-be-concerned