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Postmenopausal Bleeding: Causes, Diagnosis, and Treatment

Once you’ve entered menopause, you start to get used to not having your period. So what happens when you experience bleeding or spotting after menopause? There are many different causes of postmenopausal bleeding, and some of them might be a sign that something more serious is going on.

A woman experiencing postmenopausal bleeding

Read this article to learn more about postmenopausal bleeding.

Is postmenopausal bleeding a reason to worry?

Menopause is the phase of your life when you’re over the age of 45 and haven’t had a period for a year. It can be a little scary if you’ve gotten used to not having your period and are unexpectedly bleeding after menopause. However, not all causes of postmenopausal bleeding are serious.

No matter what, make sure to talk to your doctor about your postmenopausal bleeding. Regardless of what’s causing your symptoms, you’ll need to go in for a checkup to get a definitive diagnosis.

Perimenopausal bleeding or spotting

Perimenopause is the period that leads to menopause. It’s usually characterized by menopausal symptoms and irregular periods. Perimenopause can last up to 10 years. During perimenopause, it’s normal to experience heavier periods or irregular spotting due to hormonal changes.

Talk to your doctor if your perimenopausal bleeding:

  • lasts longer or is heavier than expected
  • occurs more often than normal (three weeks or less between periods)
  • occurs after intercourse

Vaginal bleeding after menopause: main causes 

There are many conditions that can cause bleeding after menopause. Here we’ve listed the most common causes of postmenopausal bleeding.

Endometrial atrophy

The endometrium is the innermost layer that covers your uterus. This is the same layer that sheds each month during menstruation. Once you’re going through menopause, hormonal changes tend to make this layer thinner. If it becomes too thin, it can become unstable and trigger postmenopausal spotting or bleeding.

Endometrial hyperplasia

This condition is the opposite of endometrial atrophy. It occurs when your estrogen levels are too high and your progesterone is too low, which can be caused by hormone replacement therapy. The thickened endometrium is more prone to bleeding; if left untreated, the endometrial cells can proliferate abnormally and lead to cancer. However, an early diagnosis is very effective in preventing endometrial cancer.

Polyps

Polyps are non-cancerous tissue growths that usually attach to the uterine wall and develop from the endometrium. Polyps can also develop on the cervix, causing bleeding after sex. Polyps can cause irregular and brown bleeding after menopause.

Vaginal atrophy

As your estrogen levels drop, the tissues in your vagina can change and become brittle, thin, dry, and inflamed. This can cause painful intercourse, urinary symptoms, discharge, and bleeding or brown spotting after menopause.

Cancer

Vaginal bleeding after menopause is one of the first symptoms of certain types of cancer. The most common types of gynecological cancers include endometrial and uterine cancer; however, cervical and vaginal cancer also affect many women. Although postmenopausal spotting or bleeding is a common symptom of cancer, only 9 percent of women who experience postmenopausal bleeding have cancer.

An early diagnosis can make a world of difference when treating cancer. So if you’re bleeding after menopause, going to the doctor quickly can ensure that you get the right diagnosis as soon as possible.

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A woman is discussing postmenopausal bleeding with her doctor

No matter the cause of your postmenopausal bleeding, it’s important to visit the doctor. In most cases, this symptom is caused by a minor condition; however, all possible causes must be ruled out. There are several different tests and/or procedures your doctor might recommend to discover the cause of postmenopausal bleeding.

Transvaginal ultrasound

An ultrasound will allow your physician to look closely at any abnormal or new growths inside your uterus that might be causing the bleeding. A transvaginal ultrasound can also determine the thickness of your endometrium. This procedure is carried out by placing a small ultrasound probe inside your vagina, which allows the ultrasound machine to produce images of your reproductive organs. Keep in mind that a thickened endometrium doesn’t automatically mean that you have endometrial cancer.

Endometrial biopsy

If your doctor suspects your endometrium could be causing your postmenopausal bleeding, they might order an endometrial biopsy. The doctor will use a thin tube to take a small amount of endometrial tissue from your uterus. They will then send this tissue to a pathology lab to check for any unusual findings in your sample.

Hysteroscopy

A hysteroscope is a small, flexible, thin tube with a light on the end. The doctor uses this device to look inside your uterus and check for any lesions or abnormal growths. Your doctor might also insert small surgical tools into the hysteroscope tube to remove any polyps. This procedure is typically done with some anesthesia. 

Sonohysterography

During this procedure, your physician will fill your uterine cavity with saline solution. This allows a sonogram transducer to produce a clear image of your uterine cavity. This procedure is safe and completely painless.

D&C (dilation and curettage)

During a D&C, your cervix will be dilated slightly. Then, a thin tool is used to scrape or suction tissue from your endometrium. This tissue will be sent to a lab for further tests. This procedure requires some form of anesthesia, but it’s usually performed as an outpatient procedure.

Postmenstrual bleeding treatment options

Treatment options for postmenopausal bleeding will largely depend on what’s causing your symptoms. Estrogen therapy can be used to treat conditions such as vaginal and endometrial atrophy. Progestin therapy, on the other hand, is used to treat endometrial hyperplasia.

Polyps can be removed during a hysteroscopy, or they might require surgery. Cancer and severe cases of endometrial hyperplasia can require a hysterectomy. If you’re diagnosed with cancer, your doctor will discuss several options with you, including chemotherapy, radiotherapy, and hormonal treatments.

As with most other conditions, the most important step when it comes to postmenopausal bleeding is to get an early diagnosis. Once you know what’s causing your symptoms, you and your doctor will be able to discuss treatment options and decide on the best course of action for your individual case.

Discovering that you’re bleeding after menopause can be scary, but in most cases, the underlying condition can be treated with simple therapeutic options. Ensuring your wellbeing and overall health should always be your main concern.

https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288

https://www.acog.org/Patients/FAQs/Perimenopausal-Bleeding-and-Bleeding-After-Menopause

https://www.medicalnewstoday.com/articles/317624.php

https://www.webmd.com/menopause/guide/postmenopausal-bleeding

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