Vaginal bleeding after menopause, also called spotting after menopause or post menopause bleeding or simply menopause bleeding, is never normal.
Neither is it always caused by cancer. The bottom-line is that whenever there is menopause bleeding, a thorough medical evaluation is required to make sure serious causes are identified early and treated. Some causes however are almost entire harmless.
The most common worry I have encountered with women in the office with menopause and bleeding is the fear of cancer. On the other extreme, some women were almost unconcerned and seemed to have taken it as a normal menopause occurrence. In this article, I will present some of the relevant information which you need to know about menopause bleeding including common causes and what to do.
What Is Menopause Bleeding?
It is very important to understand what is called bleeding after menopause or post menopausal bleeding. Menopause is often mistaken for post menopause. Menopause is the time after which no menses occur for the next 12 consecutive months. After menopause, the years following are in the post menopause period. Perimenopause symptoms often precede menopause. If you are unsure about the definition of menopause and perimenopause, please read What is menopause?”
and heavy bleeding may be common during the years of perimenopause and this is entirely normal except there is an underlying medical condition. However, once menopause sets in, you should not have any more bleeding, including periods! In fact I have often been asked the about periods after menopause!
Causes Of Post Menopause Bleeding
There are multiple causes of menopause bleeding and while some are benign and easily treated, others are more serious and must be excluded. These causes can also produce spotting after menopause (mild bleeding appearing as little stain on the panties).
Common causes of bleeding after menopause include
- PolypsPolyps usually are noncancerous growths that develop from tissue similar to the inner lining of the uterus called the endometrium. They may also grow from the cervix and can also cause bleeding after sex.
- Thinning of the EndometriumAfter menopause, the endometrium may become too thin as a result of low estrogen levels. This condition is called endometrial atrophy. This thinning is associated with a higher risk of spontaneous bleeding.
- Endometrial Hyperplasia This is the thickening of the inner lining of the uterus. This also has a risk of developing to cancer which is why it should be diagnosed and treated early.
- Endometrial CancerIn the United States, endometrial cancer is the most common type of cancer of the female reproductive system. Some risk factors include smoking, use of high dose estrogen pills, history of infertility, early menarche or late menopause onset and others like obesity.
- Cancer of the cervixThis is one of the serious causes of post menopause bleedng that should be identified and treated very early.
- hormone therapyTreatment with hormone replacement therapy increases the risk of endometrial cancer.
- Infection of the uterus, cervix or vagina
- Other types of pelvic cancers
Diagnosing Spotting After Menopause
Once you notice bleeding after menopause, please see your doctor for a thorough check up, even if the results turn out that it is just thinning of your endometrium. At least more serious causes must have been ruled out.
A history and physical examination will be the first steps by your provider. Additional tests may include
- Endometrial biopsy—Using a thin tube, a small amount of tissue is taken from the lining of the uterus. The sample is sent to a lab where it is looked at under a microscope.
- Transvaginal ultrasound to check the pelvic organs. Sonohysterography—Fluid is injected into the uterus through a tube, called a catheter, while ultrasound images are made of the uterus.
- Hysteroscopy—A thin, lighted tube with a camera at the end, called a hysteroscope, is inserted through the vagina and the opening of the cervix. The hysteroscope allows the inside of the uterus to be seen.
- Dilation and curettage (D&C)—The opening of the cervix is enlarged. Tissue is scraped or suctioned from the lining of the uterus. The tissue is sent to a lab, where it is examined under a microscope.
As expected, treatment is determined by the cause of the bleeding. This may include progesterone derivative hormones for endometrial hyperplasia, or surgery to remove polyps or cancers.Whatever the case, there is no home treatment for bleeding after menopause and you will have to discuss what options are best for your specific case with your doctor.