Postmenopausal Bleeding: Explore Causes, Diagnosis and Treatments

Are you done with all the night sweats, hot flashes, and mood swings? You’re probably finished with your menopause and at the last stage of it, i.e., postmenopause. If you’re still seeing some spots or bleeding on your pants, it’s a sign of postmenopausal bleeding. Here comes a question: Is it normal?

If you still find yourself reaching out for the pads even after you are past your menopause, you should be concerned. It’s natural to feel anxious or uncertain when you face something unfamiliar, especially when it comes to health. 

Many women experience bleeding after menopause, but it is crucial to understand the hidden reasons and, most importantly, the signs for seeking immediate help from your doctor. 

In this blog, you’ll learn everything about postmenopausal bleeding, including if it’s normal, the causes, treatment options, and when you should see your doctor. Let’s learn together!

Postmenopause 

Postmenopause is the last stage of your transition; this starts after you have no periods for a year and your menopause symptoms begin to calm down. When you are in your 50s, you may reach postmenopause.

At this stage, your body adjusts to its low oestrogen levels, and the symptoms caused by hormonal fluctuations begin to subside. Here are some signs that you are in your postmenopause era. And for better understanding read what are the signs of coming to the end of menopause?

• Hot flashes diminish.
• No periods
• Sleep quality improves.
• Stable Weight 
• Vaginal dryness improves.
• Your libido returns

The symptoms of menopause may not vanish, but they do become less severe. So remember, if you still experience severe symptoms, it’s time to talk to your doctor for better management.

Bleeding in Women After Menopause

Postmenopausal bleeding refers to the vaginal bleeding that occurs after a year without menstruation. The National Library of Medicine states that it is not menstrual bleeding, and 10% of postmenopausal people complain about it. The blood can come from anywhere in your pelvic region. It could come from your uterus, inner or outer vagina, urethra, or rectum.

You may experience it as spotting, light bleeding, or heavier menstrual-like flow, and it may occur continuously or just sometimes. 

Is it normal?

No; postmenopausal bleeding is abnormal. If you have not had your periods for 12 consecutive months and received a menopausal diagnosis, the return of bleeding indicates a hormonal imbalance.

The causes of bleeding after menopause may be non-serious, but sometimes they may indicate the presence of cancer. Seeking medical attention when you notice any spotting or bleeding is crucial for prompt management.

Causes of Postmenopausal Bleeding

Vaginal bleeding after menopause is also referred to as postmenopausal bleeding. Out of every 10 women experiencing bleeding after menopause, 1 has cancerous cells in her uterus that are causing her to bleed. 

For a better understanding, here are the causes of bleeding from the vagina after menopause mentioned by the National Library of Medicine:

Changes in the walls of the vagina or uterus

During menopause, when your vagina and uterus walls thin as a result of a decrease in oestrogen hormone, they become fragile. This causes dryness, irritation, and discomfort down there, especially during sex. You may notice spots after sex, or sometimes without sex, when the atrophy gets severe. 

Infections

Any infection in your reproductive or urinary systems can cause postmenopausal bleeding. Infections like tuberculosis of the uterus wall, vaginal or cervix swelling, and bladder infections can hurt and irritate the tissues that lead to bleeding. 

Abnormal growth of uterine wall

Endometrial hyperplasia is the abnormal growth of cells that make up your uterus’ wall. The uterus wall gets thicker and causes bleeding from the vagina. It is not considered cancer, but if not treated promptly, it may lead to cancer. This abnormal growth may result from hormonal imbalances like oestrogen and progesterone. 

Cancer of the uterine wall

Cancer can develop as a result of abnormal cell growth in the uterine lining or walls. According to the National Cancer Institute, 90% of the women who have endometrial cancer complain about postmenopausal bleeding. 

According to the National Library of Medicine, cancer is the fifth most common cause of death in the United States. The abnormal growth thickens the wall, then sheds, causing bleeding. Early diagnosis increases the woman’s 5-year cancer survival rate by 95%.

Cancer in reproductive organs

The presence of cancerous cells anywhere in the female reproductive system, such as the vagina, vulva, uterus, cervix, and ovaries, can also cause vaginal bleeding, pelvic pain, and discomfort after menopause.

Polyps in the Uterus and Cervix

Polyps are abnormal non-cancerous tissue growths. The presence of any polyps in the uterus or cervix (part of the vagina) can cause postmenopausal bleeding. 

Medications

Postmenopausal bleeding could be a side effect of medicines like oestrogen, blood thinners, and tamoxifen. Moreover, hormone replacement therapy, which supplements oestrogen and other important hormones to ease the bothersome symptoms of menopause transitions, can also cause this bleeding.

Risk Factors for Postmenopausal Bleeding 

There are a few factors that may trigger abnormal cell growth in your uterus wall and lead to vaginal bleeding. They include:

• Having Diabetes
• Being Obesity
• Issues with the thyroid gland
• Smoking 
• Reaching your menopause late
• Having polycystic ovarian syndrome

Diagnostic Tests for Postmenopausal Bleeding 

Here are a few measures that your doctor may take to diagnose what is causing this bleeding: 

Medical history and examination 

When evaluating vaginal bleeding during postmenopause years, doctors start by understanding your medical history and current symptoms. They ask about the nature of the bleeding, including how heavy it is, and if there are any associated symptoms, such as pelvic pain or vaginal dryness. 

They also investigate any past medical procedures, such as surgeries or pelvic infections, that may have contributed to the bleeding. Additionally, factors such as age of menstruation onset and family history of cancer are considered, as they can impact the risk of developing endometrial cancer. 

Your doctor may also do a physical examination to see if there is any redness, swelling or rashes around the intimate areas.

Endometrial Biopsy

A common test to evaluate postmenopausal bleeding is an endometrial biopsy. It entails taking a small tissue sample from the uterus lining to check for abnormalities or signs of cancer in the lab. 

It is done if there is persistent or recurrent bleeding after menopause or risk for endometrial cancer, such as obesity or exposure to oestrogen without progesterone, doctors often recommend this test. 

Different methods can perform endometrial biopsy, such as dilation and curettage (D&C) or outpatient procedures using thin plastic devices. 

Imaging Studies

Ultrasound imaging is another important tool for evaluating postmenopausal bleeding. People commonly use transvaginal ultrasound to measure the thickness of the endometrial lining in the uterus. A thickness of less than 4 millimetres is usually considered normal and has a very low risk of endometrial cancer. 

However, further evaluation with endometrial sampling may be necessary to rule out the presence of cancer if the uterine lining appears thickened on ultrasound. Ultrasound can also detect other pelvic abnormalities like fibroids or ovarian masses, which may contribute to this bleeding.

Laboratory Studies

The evaluation for postmenopausal bleeding may also involve laboratory studies. This can include:

1. A complete blood count (CBC): to check for signs of anaemia due to heavy bleeding.
2. Thyroid function tests
3. Coagulation studies to assess blood clotting. 
4. Vaginal cultures:  to check for sexually transmitted infections or other genital infections

Postmenopausal Bleeding Treatment

According to the NHS UK, the treatment of abnormal vaginal bleeding depends on treating the underlying causes. Depending on the cause, the following treatment options are available:

Oestrogen creams or pessaries 

To treat postmenopausal bleeding that is occurring because of dryness and thinning of the walls inside and outside of the vagina, your doctor may prescribe you creams and pessaries that will supplement your reproductive system with oestrogen hormones to replenish it. 

 Removal of polyps

If there is abnormal tissue growth inside your uterus or on your vagina that is causing postmenopausal bleeding, your doctor will surgically remove it. To remove them, they may perform a procedure known as hysteroscopic polypectomy, which enables them to take samples and remove the polyps all at once.

Surgical removal of the uterus

If you are experiencing vaginal bleeding due to abnormal cell growth in your womb or cancer, your doctor may consider surgically removing the uterus. Depending on the severity, they may prefer a total hysterectomy (removing the uterus, ovaries, and cervix). You will get hormone replacement therapy, chemotherapy or radiotherapy after surgery.

Surgical removal of the ovaries

Your doctor may decide to surgically remove your ovaries if they have cancer that is causing bleeding after menopause. After the surgery, you will get chemotherapy. 

Treatment of the infection

Your vaginal cultures will inform your doctor about the infection causing postmenopausal bleeding. Your healthcare provider will give you medicine to treat the infections. For a swollen uterine wall, they may prescribe oral doxycycline.

Discontinuing hormonal medications

Moreover, if hormone replacement therapy is diagnosed as the cause of bleeding, discontinuing the therapy may be a treatment option. 

Long-Term Complications of Postmenopausal Bleeding 

If abnormal vaginal bleeding stays untreated, it can cause the following complications:

• Secondary anaemia—affecting 10% of females
• Compromised sex life
• Life quality is reduced.
• Pelvic discomfort
• Cancer

Talk to your doctor

As postmenopausal bleeding is not normal, you should talk to your doctor if you experience any of its signs. 

According to the NHS, talk to your doctor even if you

• Experience it once.
• We are not sure if the discharge is bloody.
• Notice a spot or a drop of blood.
• Notice the pink or brown discharge.
• Not experiencing other symptoms. 

Talking to your doctor promptly will help them diagnose the problem early. Early diagnosis means a better prognosis and management of postmenopausal bleeding. 

Final Word

Always look out for the signs that may seem like vaginal bleeding after menopause, as it is not a normal occurrence. While it can be alarming to experience bleeding after menopause, it’s important to remember that there are various potential causes, ranging from benign to more serious conditions like cancer. Seeking prompt medical attention is crucial for proper diagnosis and treatment.

You can fight this condition on time by understanding the symptoms, risk factors, and diagnostic tests associated with postmenopausal bleeding. Early detection and treatment can significantly improve outcomes and ensure better management of any underlying conditions.

If you experience bleeding from your vagina during your postmenopause years or any concerning symptoms, don’t hesitate to reach out to your healthcare provider. Taking proactive steps towards your health and well-being is essential for maintaining a good quality of life during and after menopause.

FAQs About Postmenopausal Bleeding