Vaginal Bleeding After Menopause | Postmenopausal Bleeding

Vaginal bleeding after menopause or postmenopausal bleeding is not normal, so take it seriously. There can be many causes of vaginal bleeding after menopause including inflammation and thinning of vaginal linings called atrophic vaginitis, and thinning of womb linings called endometrial atrophy.  Bleeding after menopause is generally caused due to low estrogen levels after menopause. Uterine polyps also can cause bleeding they are generally benign (non-cancerous) but in many cases, cancer can be a cause of bleeding after menopause.

What is Menopause

Menopause is a natural process of biological aging, it can be defined as the cessation or stopping of the menstrual cycle of a woman after a certain age. It’s usually diagnosed in women over 45 years of age who have not had a period for more than 12 months. Menopause also indicates the end of reproductive age. The level of estrogen hormone declines in the bloodstream. A woman cannot have pregnancy after menopause, except in rare cases.

The menopausal transition can be gradual and usually begins with changes in the menstrual cycle of a woman. Initial changes in the menses cycle and symptoms are called the premenopausal stages. Menopause can be a consequence of surgical procedures.

Some women experience menopause earlier even before the age of 40 years of age. This premature menopause may be because of certain autoimmune disorders, diseases, and chromosomal abnormalities.

Symptoms of Menopause

• Hot flushes and night sweats – Sudden feeling of heat in the face, neck, and chest
• Changes in regularity and flow of the menstrual cycle
• Sweating and Palpitations
• The feeling of physical discomfort
• Vaginal Dryness
• Pain during sexual intercourse
• Difficulty in sleeping
• Changes in mood
• Depression and anxiety

Vaginal Bleeding after Menopause

Postmenopausal bleeding is vaginal bleeding that occurs a year or more after your last menstrual period. It can be a symptom of other changes in your reproductive system including vaginal dryness or noncancerous growth (Polyps). The bleeding can be light, just a spotting, or heavy bleeding; it depends on the cause of the postmenopausal bleeding.

Vaginal bleeding after menopause is usually due to noncancerous or benign gynecological conditions like endometrial polyps and low levels of estrogen. However, in about 10% of women, bleeding after menopause is a sign of uterine cancer.

Postmenopausal Bleeding Causes

The most common causes of vaginal bleeding after menopause includes:

• Vaginal or endometrial atrophy – The lining of the uterus or vagina becomes dry and thin which causes spotting or vaginal bleeding after menopause.
• Endometrial hyperplasia – The lining of the uterus gets too thick that can contain abnormal cells
• Uterine Polyps – Growth in the uterus and polyps also causes bleeding after menopause
• Hormonal Replacement Therapy – Estrogen and progesterone supplements
• Cervical cancers
• Infections and inflammations – Cervicitis, endometritis
• Bleeding from other nearby areas, bladder, rectum, or bleeding from the skin of the vulva

Postmenopausal Bleeding and Pain

Most of the time there is no pain with bleeding after menopause but if there is pain with bleeding, it can be associated with infection or inflammation. There can be several causes of postmenopausal bleeding with pain including cervicitis, endometritis, or vaginitis.

Diagnosis and Tests to Know the Cause of Postmenopausal Bleeding

• Go to your doctor for an examination of the cervix and vagina
• PAP smear to check the cervical cells
• Vaginal Ultrasound
• Biopsy of the endometrium of the uterus

Postmenopausal Bleeding Treatment

Treatment of postmenopausal bleeding depends on the causes of the bleeding; it may include medication or surgical treatment.

Medical Management

Medication includes:

Antibiotics

Antibiotics are used for most infectious causes of the cervix and uterus

Hormonal Therapy

Estrogen may help with bleeding due to vaginal dryness. You can apply estrogen directly to your vagina in the form of cream, ring, or vaginal tablets. Systemic estrogen can also be taken in the form of a pill or patch.

Progestin can treat endometrial hyperplasia by triggering the uterus to shed its lining. Progestin is the form of the hormone progesterone. You may receive progestin as a pill, shot, cream, or intrauterine device (IUD)

Surgical Management

It may include:

Hysteroscopy

A procedure is done to examine your cervix and uterus with the help of a camera-guided device, called hysteroscopy. This can be done in the doctor’s office or hospital for diagnosis. To remove any growths, hysteroscopy is often done in the operating room under general anesthesia.

Dilatation and Curettage (D&C)

D&C can be performed with a hysteroscopy; a D&C can treat some types of endometrial hyperplasia.

Hysterectomy

It is a surgical procedure that is done to remove the uterus and cervix. A hysterectomy is done when a patient has uterine cancer or big uterine polyps. Hysterectomy can be vaginal hysterectomy or abdominal hysterectomy.

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