What is postmenopausal bleeding?
Postmenopausal bleeding refers to vaginal bleeding that occurs a year or more after menopause. Menopause is a stage in a woman’s life (around age 51) when her reproductive hormones begin to decline and her monthly menstrual periods stop. It’s not usual for a woman to have vaginal bleeding more than a year after her last period as it can be a sign of vaginal dryness, polyps (noncancerous growths), or other reproductive system changes.
That is why you should consult a doctor if you have any bleeding, even if it’s merely spotting, to rule out any serious cause, such as cancer.
Vaginal bleeding can affect anyone, especially during perimenopause. Perimenopause, the period preceding menopause, often occurs between the age of 40 and 50. It’s the time when a woman’s hormone levels and menstrual patterns begin to change. Around 10% of women over the age of 55 experience postmenopausal bleeding.
Causes of postmenopausal bleeding
Postmenopausal bleeding can be caused by a variety of conditions, including:
- Vaginal or endometrial atrophy (when the lining of the uterus or vagina becomes thin and dry).
- Hormone replacement therapy (HRT) (estrogen and progesterone supplements that help decrease some menopausal symptoms).
- Uterine or endometrial cancer (cancer in the lining of the uterus).
- Endometrial hyperplasia (the lining of the uterus gets too thick and can have abnormal cells, and could lead to womb cancer).
- Polyps (tissue growths that can appear inside your uterus, cervical canal, or cervix, and can cause spotting, heavy bleeding, or sex-related bleeding).
Other causes can include:
- Cervical or vaginal cancer.
- Endometritis or cervicitis (infection or inflammation in the uterus or cervix).
- Bleeding from other surrounding areas, such as the bladder or rectum, or bleeding from the vulva’s skin (outside near the vagina).
- Sexually transmitted diseases (for example chlamydia and gonorrhea can cause spotting and bleeding after sex).
- Medication (certain medications, such as hormone therapy, tamoxifen, and blood thinners, might cause bleeding as a side effect).
Treatment for postmenopausal bleeding
The cause of postmenopausal bleeding determines the treatment, and the most common treatments are medication and surgery.
Medications used to treat postmenopausal bleeding include:
- Antibiotics (used to treat most infections of the uterus and cervix).
- Estrogen (used to help with vaginal dryness-related bleeding, and can be applied to the vagina as a cream, ring, or insertable tablet).
- Progestin (a synthetic form of the hormone progesterone, and can be taken as a pill, a shot, a cream, or an intrauterine device to treat endometrial hyperplasia).
The following tests also may be performed to treat postmenopausal bleeding:
- Pap smear to analyze the cervical cells.
- Pelvic or vaginal examination: a speculum, which is a plastic device, may be inserted into the vagina to open it and be able to see the inside of the vagina or cervix.
- Vaginal ultrasound: a small device is placed in the vagina to check for any problems and may include the use of saline to help see any uterine polyps.
- Endometrial or uterine biopsies a small, straw-like tube is gently inserted into the uterus by the healthcare professional to collect cells to see if they are abnormal.
- Sonohysterography: this test can be performed to determine the size of a polyp. To get a clearer ultrasound image, the doctor will put a saltwater solution within the uterus.
- Hysteroscopy: a thin, lighted tube with a camera on one end is inserted into the vagina to remove polyps or other abnormal growths that may be causing the bleeding.
- Hysterectomy: a surgery that is performed to remove the uterus and cervix. If you have uterine cancer, you may need a hysterectomy.
- Dilation and curettage (D&C): a procedure to sample the lining and contents of the uterus. Your healthcare provider may perform a
- D&C with the hysteroscopy as a D&C can treat some types of endometrial hyperplasia.
Prepare yourself for an early diagnosis at Novomed – the earlier, the better.
Postmenopausal bleeding might be benign or could be an indication of a more serious problem. Although you may not be able to prevent abnormal vaginal bleeding, you can seek help as soon as possible to receive a diagnosis and treatment plan, regardless of the cause. The earlier you start with your diagnosis, the better off you will be.