Bleeding After Menopause

What is postmenopausal bleeding?

Postmenopausal bleeding occurs in a woman’s vagina after she goes through menopause. A woman is considered to have reached menopause after a period of 12 months.

To rule out serious medical problems, women with postmenopausal bleeding should always see a doctor.

What is vaginal bleeding?

Vaginal bleeding can have various causes. These include the normal menstrual cycle and postmenopausal bleeding. Other causes of vaginal bleeding include:

  • trauma or attack
  • cervical cancer
  • infections, including urinary tract infections

If you are experiencing vaginal bleeding and it is post-menopausal, your doctor will ask about the duration of the bleeding, the amount of blood, any additional pain, or any other symptoms that may be related.

You should get any abnormal bleeding evaluated by a doctor, as abnormal vaginal bleeding can be a sign of cancer of the cervix, uterus, or endometrium.

What causes postmenopausal bleeding?

Postmenopausal women can bleed for a variety of reasons. For example, women on hormone replacement therapy may have vaginal bleeding for several months after starting the hormones. It is also possible for a woman who thinks she is in menopause to start ovulating. In this case, bleeding may also occur.

There are a variety of other conditions that can cause postmenopausal bleeding.

Some common causes are: polyps, endometrial hyperplasia, and endometrial atrophy.

uterine polyps

Uterine polyps are noncancerous growths. Although benign, some polyps can eventually become cancerous. The only symptom most patients with polyps will experience is irregular bleeding.

Uterine polyps are common, especially in women going through menopause. However, younger women can get them too.

Endometrial hyperplasia

Endometrial hyperplasia is the thickening of the endometrium. It is a potential cause for postmenopausal bleeding. It often occurs when there is excess estrogen without adequate progesterone. It is common in postmenopausal women.

Long-term use of estrogen can lead to an increased risk of endometrial hyperplasia. If left untreated, it can eventually lead to uterine cancer.

endometrial cancer

Endometrial cancer starts in the uterus. The endometrium is the lining of the uterus. In addition to abnormal bleeding, patients may experience pelvic pain.

This condition is usually detected early. It causes easily noticeable abnormal bleeding. In many cases, the uterus can be removed to treat cancer. About women with postmenopausal bleeding in 10 percent have endometrial cancer.

Endometrial atrophy

This results in very thinning of the endometrial lining. It can occur in postmenopausal women. Bleeding may occur as the lining becomes thinner.

cervical cancer

Postmenopausal bleeding is usually harmless. However, it can also be a rare symptom of cervical cancer. Cervical cancer tends to progress slowly. Doctors can sometimes identify these cells during a regular exam.

Annual visits to the gynecologist can be helpful in early detection and even prevention of cervical cancer. This can be done by watching for abnormal Pap smears.

Other symptoms of cervical cancer, including postmenopausal women, may include pain during sex or abnormal vaginal discharge.

Postmenopausal bleeding symptoms

Many women who experience postmenopausal bleeding may not have any other symptoms. However, there may be symptoms. This may depend on the cause of the bleeding.

Many symptoms, such as hot flashes during menopause, often begin to subside in the postmenopausal period. However, there are other symptoms that postmenopausal women may experience.

Symptoms experienced by postmenopausal women may include:

  • vaginal dryness
  • decreased libido
  • insomnia disease
  • stress incontinence
  • increased urinary tract infections
  • gaining weight

How is postmenopausal bleeding diagnosed?

A doctor may perform a physical examination and medical history analysis. They may also do a Pap smear as part of a pelvic exam. This can screen for cervical cancer.

Doctors may use other procedures to view the inside of the vagina and uterus.

Transvaginal ultrasound

This procedure allows doctors to view the ovaries, uterus, and cervix. In this procedure, a technician inserts a probe into the vagina or asks the patient to insert itself.

hysteroscopy

This procedure shows endometrial tissue. A doctor inserts a fiber optic scope into the vagina and cervix. The doctor then pumps carbon dioxide gas through the scope. This helps to expand the uterus and makes it easier to see the uterus.

How is postmenopausal bleeding treated?

Treatment depends on the cause of the bleeding, whether the bleeding is heavy, and whether additional symptoms are present. In some cases, bleeding may not require treatment. In other cases where cancer has been ruled out, treatment may include:

  • Estrogen creams: If your bleeding is due to thinning and atrophy of your vaginal tissues, your doctor may prescribe estrogen cream.
  • Polyp removal: Polyp removal is a surgical procedure.
  • Progestin: Progestin is a hormone replacement therapy. If your endometrial tissue is overgrown, your doctor may recommend it. Progestin can reduce tissue overgrowth and reduce bleeding.
  • Hysterectomy: Bleeding that cannot be treated by less invasive means may require a hysterectomy. During a hysterectomy, your doctor will clean the patient’s uterus. The procedure can be performed laparoscopically or with conventional abdominal surgery.

If the bleeding is due to cancer, treatment will depend on the type and stage of the cancer. Common treatment for endometrial or cervical cancer includes surgery, chemotherapy, and radiation therapy.

Prevention

Postmenopausal bleeding can be benign or the result of a more serious condition such as cancer. While you can’t prevent abnormal vaginal bleeding, whatever the cause, you can seek help quickly to come up with a diagnosis and treatment plan. When cancers are detected early, the chances of survival are high. The best strategy for preventing abnormal postmenopausal bleeding is to reduce your risk factors for conditions that can cause it.

What can you do

  • Treat endometrial atrophy early to prevent its progression into cancer.
  • Visit your gynecologist for regular scans. This can help detect conditions before they become more problematic or result in post-menopausal bleeding.
  • Follow a healthy diet and exercise regularly. This alone can prevent various complications and conditions throughout the body.
  • If your doctor recommends it, consider hormone replacement therapy. This may help prevent endometrial cancer. However, there are cons that you should discuss with your doctor.

What is the outlook for bleeding after menopause?

Postmenopausal bleeding is often successfully treated. If your bleeding is due to cancer, the outlook depends on the type of cancer and the stage at which it was diagnosed. The five-year survival rate is about 82 percent.

Whatever the cause of the bleeding, maintain a healthy lifestyle and continue to visit your gynecologist regularly. They can help detect all other conditions early, including cancer.

Resources:

Endometrial hyperplasia. (2011, May)

Kerr, S. (2015). bleeding after menopause

Per vaginal (PV) bleeding. (2014, October 22)

Perimenopausal bleeding and bleeding after menopause. (Nd)

SEER stat case notes: Endometrial cancer. (Nd)

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