Bleeding after menopause, which is often referred to as postmenopausal bleeding, is vaginal bleeding after cessation of your period for more than 1 year. It is one of the problems of women after menopause.
Any bleeding in a woman after menopause is significant and you should see your doctor if this happens. This is because about 1 in 10 women with postmenopausal bleeding are found to have cancer in the lining of the womb (endometrial cancer).
This article will explain all you need to know about the causes and cure of bleeding after menopause.
When should i get worried about my postmenopausal bleeding?
Menstruation is the cyclic monthly vaginal bleeding experienced by women of child bearing age. However, it becomes irregular towards menopause (perimenopause) and finally stops in menopause. Bleeding after menopause is abnormal. However, there are many benign causes of bleeding in women after menopause. Some can be treated with topical creams while others will require surgery.
In a woman that is not on any hormone replacement therapy (HRT), bleeding after menopause is abnormal. If you experience any bleeding, you should inform your doctor.
In addition, women on hormone replacement (HRT) may have some bleeding depending on the type of HRT and when it was started or changed. However, new, heavy, or persistent bleeding at any time should be checked.
You should always inform your doctor of any bleeding to rule out any form of cancer.
What happens during my clinic visits?
During your visit to your doctor, these are some questions you will be asked. It is important to prepare yourself for these questions.
When is the last time you saw your period?
This is to confirm if your period has actually stopped. It is common for women to experience irregular menstrual cycle towards menopause.
Do you bleed after sex?
The presence of bleeding after sex can be due to vaginal dryness/fragile tissue, cervical polyps, or (less commonly) cervical cancer. Also, some menopausal changes that occur in women will cause bleeding after sex. In women that are in menopause, the normal covering of the vagina is replaced by skin. This can result to bleeding.
When was the last time you did a pap smear?
This is important to rule out any form of cervical cancer. If your pap smear has been normal then cervical cancer is less likely, but it does not rule out cancer in the womb (endometrium).
Do you feel any mass in your abdomen?
Some women may experience swelling of their abdomen. This may be due to presence of large fibroids.
Do you experience bleeding after menopause with cramps?
Bleeding after menopause with cramps is common in women who have fibroids, endometrial polyps, and endometrial carcinoma.
What causes bleeding after menopause?
Vaginal atrophy. This is a common problem after menopause. During menopause, women experience dryness of the vagina due to lack of estrogen. Women in menopause have sub-optimum level of estrogen. This will result to breakdown of the vagina lining and replacement with skin. Vaginal atrophy is the commonest cause of bleeding after menopause and can easily be treated. Some available topical estrogen cream is used to treat this benign condition.
Uterine polyps. These are masses in the wall of the uterus that can posses a stalk and extend into the vagina through the cervix. Uterine polyps cause irregular menstrual bleeding and bleeding after menopause. However, they are removed by hysteroscopy (polypectomy).
Endometrial hyperplasia. This is an overgrowth of the cells covering the uterus. It occurs due to unopposed estrogen. Most women with endometrial hyperplasia do not develop cancer. However, a few will develop cancer. Endometrial hyperplasia is treated with progestogen therapy or by removal of the uterus.
Endometrial cancer. This is a cause of bleeding after menopause in women. About 1 in 10 women with postmenopausal bleeding will develop cancer. Risk factors for cancer include obesity, women that has not delivered before (nulliparous women), late menopause. In addition, women who develop cancer can often be cured if they present early. Treatment involves removal of the uterus with or without radio or chemotherapy.
Other causes of postmenopausal bleeding include
- Cervical cancer
- Endometriosis
- Uterine fibroids
What are postmenopausal bleeding symptoms
- Bleeding after one year of cessation of your period
- Abdominal cramps
- Body weakness due to excessive blood loss
- Weight loss
What are the tests done to diagnose bleeding after menopause?
Complete blood count. This is necessary to check your red blood cells or hematocrit levels. If low, you may requre blood transfusion or iron supplements.
Ultrasound scan. This test is done in every women than complains of postmenopausal bleeding. It will detect the thickness of the endometrium. Endometrial thickness ≤4mm is usually reassuring. However, endometrial thickness >4mm (or an irregular lining) is considered a risk and further test will require endometrial biopsy.
Endometrial biopsy. Women with abnormal ultrasound findings will require biopsy for diagnosis.
Hysteroscopy.
What is postmenopausal bleeding treatment or cure?
The treatment of postmenopausal bleeding will depend on the cause. Benign lesions like vaginal atrophy can easily be treated. Also, women with endometrial cancer have good prognosis if detected early.
Vagina atrophy is treated with estrogen cream or pessary (and sometimes vaginal moisturizers/lubricants).
Cervical polyps is removed by polyps forceps during surgery.
Endometrial hyperplasia is treated with progesterone or removal of the uterus in those at risk of cancer.
Endometrial cancer is treated with hysterectomy (removal of the uterus) with radiotherapy and/or chemotherapy.
Now its your turn
Do you experience bleeding after menopause. Share your bleeding symptoms with suggestions or questions.
Dr Akatakpo Dunn is a Nigerian medical doctor, sonologist and Medical Director of Verah Clinic & Maternity in Warri, Nigeria. He holds an MBBS from the University of Nigeria, Nsukka, a Postgraduate Diploma in Diagnostic Ultrasound (India) and a Professional Diploma in Obstetrics & Gynaecology (RCPI). Through Medplux, he explains women’s health, pregnancy, fertility and ultrasound in clear, practical language so readers can make informed decisions with their own doctors.
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