Causes Of Postmenopausal Bleeding
Medically Reviewed by Dr Sravya, MBBS, MS
Bleeding after menopause? –A concern?
Bleeding after menopause is not normal. Women attain menopause (above age 45) when they stop menstruating and it is confirmed after 12 months of their last period. Bleeding or spotting after menopause(post-menstrual spotting) is called postmenopausal bleeding (PMD).
Bleeding after menopause indicates a sign of minor health problems, but sometimes it can be a sign of a serious medical condition. Postmenopausal bleeding simply means vaginal bleeding which occurs a year or more after your last period.
According to the studies, postmenopausal bleeding is seen in 10% of women who are above the age of 55.
What causes postmenopausal bleeding?
There are several causes of Postmenopausal bleeding and one of the most common causes is due to benign (non-cancerous) gynaecological conditions like endometrial or uterine polyps.
Uterine cancer is one of the most common types of reproductive cancer which is a sign in 10% of women who bleed after menopause.
- Vaginal atrophy:During menopause, the body stops producing oestrogen hormone resulting in the thinning of the vagina and uterus lining which leads to bleeding. This condition, in medical terms, is known as vaginal atrophy.
- Endometrial/uterine polyps:Endometrial/uterine polyps are abnormal growths on the lining of the uterus. Most of them are non-cancerous but sometimes, they can grow inside the cervical canal(connects the vagina to the uterus) which causes pain and bleeding during the reproductive years and also after menopause.
- Endometrial hyperplasia:This condition occurs when the lining of the uterus becomes thicker instead of thinner, eventually resulting in bleeding. Endometrial hyperplasia sometimes can lead to endometrial cancer.
- Fibroids: Uterine fibroids are benign, non-cancerous tumours that grow on the smooth muscle. This can happen during the reproductive years or after menopause.
-
Cancer:
Bleeding after menopause can be a sign of various cancers such as:
(a) Ovarian cancer
(b) Vaginal cancer
(c) Endometrial cancer
(d)Colorectal cancer or gastrointestinal cancer
(e) Bladder cancer
Around 92% of people with endometrial cancer experience bleeding and around 1- 14% of women who bleed after menopause are due to endometrial cancer. -
Infections:
Bleeding can be a result of infections of the uterus or cervix, such as:
(a) Cervicitis– an infection of the cervix (a narrow passage at the lower end of the uterus which connects the uterus to the vagina)
(b) Cystitis– a bladder infection
(c) Endometritis–infection of the lining of the uterus
Other causes of postmenopausal bleeding may include:
(a) Clotting problems
(b) Thyroid disorders
(c) Trauma to the pelvis
Generally, menopause is caused when there is a shift in oestrogen and progesterone, but there is an extreme fluctuation of these hormones that causes some abnormal symptoms such as vaginal bleeding leading to PMD.
Physical or mental stress can also cause PMD which may indicate the presence of uterine cancer.
How would you identify the cause of postmenopausal bleeding?
- Your vagina and cervix will be physically examined to see if there’s any infection.
- A pap smear test will be done to check the cervical cells.
- Transvaginal ultrasound is a procedure which is used to examine your uterus to look for any abnormalities. This is also called Sonohysterography.
- An ultrasound test can show you whether the uterine lining is thicker or thinner than expected and if the thickness is 4 millimetres or less, then the chance is higher that endometrial cancer is not present.
- Biopsy of the endometrium or uterus can be done by using a small, straw-like tube gently passed into the uterus to see if there is anything abnormal.
- A hysteroscopy is used to examine the uterus and its lining. It can identify polys and other abnormal growths.
Signs and symptoms of postmenopausal bleeding:
Most of the women with PMD show no other symptoms but they may show few symptoms depending on the cause of bleeding.
Symptoms which postmenopausal women may experience include:
- Vaginal dryness
- Weight gain
- Increased UTIs
- Insomnia
- Stress
- Pink/brown vaginal discharge
- Blood may appear on toilet paper even using the bathroom
- The heavier flow of blood which women experience during their regular menstrual cycles (also called uterine bleeding)
- Blood clots with another bleeding may be seen
Some other signs & symptoms may include:
- Fever
- Chills
- Abdominal pain
- Dizziness
- headache
How is postmenopausal bleeding treated?
Treatment of postmenopausal bleeding depends on the underlying cause of bleeding and in a few cases, bleeding may require no treatment.
The most commonly used treatment methods are as follows:
- Estrogen creams: it is used to treat the thinning and atrophy(it’s the decrease in size of the body part, cell, organ or tissue) of vaginal tissues.
- Progestin: it’s a hormone replacement therapy. It can decrease the overgrowth of endometrial tissue and reduce bleeding.
- Hysterectomy: removal of the uterus. This procedure is done when the bleeding cannot be treated.
- Polyp removal surgery
- If the bleeding is due to cancer, the treatment depends on the type of cancer and its stage. Treatment options for endometrial or cervical cancer include chemotherapy, radiation therapy and surgery.
Things to remember about postmenopausal bleeding:
Postmenopausal bleeding is never normal:
Vaginal bleeding after menopause can indicate some serious health problems. Whether it’s light or heavier flow, it’s not normal to bleed after menopause and it’s best if you consult a doctor immediately.
There are several serious causes, but some are more serious than others:
In most cases, PMD is caused by vaginal/endometrial atrophy, fibroids or polyps. It could also be a sign of endometrial cancer.
According to the National Cancer Institute research, 9% of postmenopausal women who sought medical attention for bleeding were diagnosed with endometrial cancer.
If endometrial cancer is detected early, a woman has a probability of 95% to survive cancer for at least 5 years.
Age risks:
Postmenopausal bleeding is less likely to occur the longer you have been in menopause and according to some studies, women are much more likely to experience bleeding during the first year of menopause.
But you still need to pay attention if you’ve been postmenopausal for a while because endometrial cancer mostly affects women in their mid-60s.
See a specialist:
It’s important to see a gynaecologist even if you have missed periods once or twice after a year of your menopause phase. Early diagnosis and treatment can help you to reduce the risk of developing cancers. Even if you wish to be pregnant, your doctor will suggest some treatment options which may help you to grow your family healthily.
Do it now, not later!
Postmenopausal bleeding is successfully treatable but if the bleeding is due to cancer, then the treatment depends on the type of cancer and its stage, then the doctor will give you the treatment options and recommend the best choice for you.
Do not delay your appointments and put yourself at risk of developing other serious diseases. Get yourself treated as early as possible and make yourself free from PMD.
Frequently Asked Questions
Yes, it can stop on its own if it is caused by atrophic vaginitis. But, if the bleeding is caused by the polyps, then it will not stop on its own.
Once you are in postmenopause, it will be there for the rest of your life. But if you get diagnosed early and get treated immediately, you might be free from postmenopausal bleeding. Lifestyle changes play an important role in reducing PMD.
Contact your doctor immediately if you experience vaginal bleeding:
- More than 12 months after your menstrual period
- More than a year after Hormone Replacement Therapy (HRT)
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