Menopause is supposed to be when your menstrual cycle stops. So, imagine the horror and anxiety when there’s bleeding during your golden years.

Is it time to panic? Why are you bleeding? What’s happening?

These are just some of the questions you might have when you’re experiencing bleeding after menopause.

Understanding Bleeding After Menopause

Before anything else, let’s make this clear - bleeding after menopause is NOT normal.

While it’s not always a sign of a serious health issue, it could be.

Postmenopausal women need to learn why bleeding after menopause happens and why medical evaluation is necessary.

What is Postmenopausal Bleeding?

As the name suggests, postmenopausal bleeding refers to any form of bleeding from light spotting to heavy flow after you’ve already had menopause. The amount of vaginal bleeding doesn’t matter - it’s an abnormal condition that needs careful evaluation by a healthcare professional.

Common Misconceptions

There are several misconceptions surrounding bleeding after menopause, such as:

• light spotting or the occasional bleeding is normal
• it’s always a sign of cancer
• it’s natural - your menstrual cycle can sometimes return after menopause
• it will go away on its own
• it’s caused by hormone replacement therapy (HRT)

But, the truth is, these common beliefs are false.

Bleeding after menopause is never normal. It also doesn’t always mean you have cancer. The cause of around 90% of postmenopausal cases is non-cancerous. Finally, you should take this type of bleeding seriously, even if it only comes and goes, which may be why some believe it goes away on its own.

Again, postmenopausal bleeding isn’t always a major problem, but you shouldn’t wait and see, either.

Medical evaluation is always recommended when you see any signs of bleeding after you’ve already gone through menopause.

Causes of Bleeding After Menopause

Hormonal Imbalances

Hormonal imbalances and fluctuations don’t always stop after menopause. They may worsen.

The most common explanation behind postmenopausal bleeding is the trace amounts of estrogen your body may still produce. Sometimes, the uterus lining thickens and sheds, causing light and irregular bleeding or spotting.

A similar explanation explains why hormone replacement therapy, a popular menopausal treatment, may also cause bleeding.

Uterine Polyps

Other than your hormones, uterine polyps, which are noncancerous (benign) growths, can develop in your uterus lining, irritating surrounding tissue and causing bleeding. In worse cases, polyps can grow large enough to protrude and become noticeable.

While almost always benign, there’s a rare chance that uterine polyps can become cancerous or precancerous.

This is why one of the primary reasons why you should get yourself checked if you’re experiencing vaginal bleeding after menopause.

Endometrial Atrophy

The sharp decrease in estrogen levels after menopause can cause a condition known as endometrial atrophy.

Otherwise known as vaginal atrophy or atrophic vaginitis, this is a condition where the thinning and more fragile uterus lining becomes more prone to bleeding and irritation.

Unlike uterine polyps, this condition is almost always benign. But it can significantly impact a woman’s quality of life. Particularly, those with active sex lives may feel the worst of this condition, as it can cause vaginal dryness, itching, or discomfort. In worse cases, women with endometrial atrophy can experience heavy bleeding after sexual intercourse.

Endometrial Hyperplasia

Without enough progesterone to balance a potential excess of estrogen postmenopause, some women will develop overgrowth of the uterine lining, causing a condition called endometrial hyperplasia.

Women with weight problems, polycystic ovary syndrome (PCOS), who have gone through estrogen-only hormone therapy or have estrogen-producing tumors, are at risk for endometrial hyperplasia.

Uterine Cancer

Roughly 90% of women with endometrial cancer have postmenopausal bleeding.

You’re at risk for endometrial cancer if you’re obese, have diabetes or high blood pressure, experience menopause at a later age, take estrogen-only hormone therapy, have a family history of uterine and colon cancer, or have never gone through pregnancy.

Other Medical Conditions

Other potential medical conditions that may explain bleeding after menopause include:

• Cervical cancer
• Infections
• Bleeding disorders
• medications
• Trauma

It’s important to remember that most reasons behind bleeding after menopause aren’t life-threatening, but they’re all equally alarming and require immediate diagnosis.

The earlier you find out why you’re experiencing bleeding after menopause, the sooner you can have the problem treated.

Symptoms Associated with Postmenopausal Bleeding

Types of Bleeding

The kind of postmenopausal bleeding you’re experiencing can clue you in on what’s causing it.

Light spotting or bleeding, for example, is the most common and may happen after having sex. Regardless of what you think may be causing the bleeding, it’s worth mentioning to your healthcare provider, even if it might seem insignificant.

For heavier bleeding, the root cause is either endometrial hyperplasia or cancer. The best way to know is to get a proper diagnosis from a healthcare professional.

Finally, if the bleeding is irregular or unpredictable, your medication or hormonal imbalances are the most likely causes.

Most postmenopausal bleeding isn’t painful, but some report experiencing cramping or pelvic pain, which is a possible sign of uterine fibroids or uterine polyps.

Accompanying Symptoms

Taking note of other postmenopausal symptoms accompanying postmenopausal bleeding gives you and your healthcare provider vital insight into your condition.

For example, vaginal dryness is usually associated with vaginal atrophy. Anemia is the most common cause of fatigue or weakness. If the pain is constant or intermittent, ranging from mild to severe discomfort, your healthcare provider may look into uterine fibroids or large polyps.

Sometimes, an infection can cause bleeding alongside foul-smelling vaginal discharge. In other instances, mood swings and anxiety go hand-in-hand with unexpected bleeding.

Your healthcare provider will exhaust other possible explanations before concluding that endometrial cancer is behind your postmenopausal bleeding.

In its earliest stages, endometrial cancer’s only symptom is bleeding. As it progresses, patients will experience other symptoms, including but not limited to unexplained weight loss, bladder habits, or pelvic pain.

Diagnosing Bleeding After Menopause

Medical History and Physical Exam

Take note of the answers to the following questions for smoother facilitation of the diagnostic process for postmenopausal bleeding:

• When did the bleeding start?
• How long have you had bleeding?
• How much do you bleed?
• Is there a pattern to the bleeding?
• Do you feel other symptoms aside from bleeding?

Also, prepare to tell your healthcare provider vital information such as past surgeries, current medications, previous history with alcohol or substance abuse, and family history, particularly with cancer.

The preliminary physical exam usually involves an external assessment of your genitalia, vagina, and cervix. A speculum can pinpoint more obvious bleeding sources. Your provider may recommend a bimanual exam to check for tenderness or masses in or around your uterus or ovaries.

Diagnostic Tests and Procedures

Ultrasound

An ultrasound checks whether your endometrial lining thickness is within the acceptable range of 4mm or less. Any thicker will require further procedures.

Endometrial Biopsy

If your endometrial lining thickness is over 4mm, your healthcare provider may recommend an endometrial biopsy to check for infections. This procedure has a sensitivity rate of over 90% when checking for endometrial cancer.

Hysteroscopy

The best way to explain this is your healthcare provider will insert a thin, lighted telescope into your uterus to identify structural abnormalities. For better visibility, professionals will use a saline solution.

An operative hysteroscopy combines diagnosis and treatment by removing any polyps or fibroids detected during the same procedure.

Sonohysterography

Similar to hysteroscopy, sonohysterography, otherwise known as saline infusion sonography, injects sterile saline into your uterus to expand the uterine cavity and make it easier to detect abnormalities.

This procedure is less invasive and arguably more comprehensive than a hysteroscopy. It’s typically performed during a transvaginal ultrasound.

Your healthcare provider may recommend sonohysterography for inconclusive initial ultrasound results.

Treatment Options for Postmenopausal Bleeding

Hormone Therapy

Delivering low doses of estrogen directly to the vaginal tissues can restore the lining’s thickness and elasticity, minimizing the risk of bleeding.

Aside from local estrogen therapy, systematic hormone therapy - your healthcare provider may recommend either a combination of estrogen and progestin or estrogen alone - can reduce irregular bleeding.

While effective for a lot of women, you’re not compatible with hormone therapy if you have a history of blood clots, liver disease, and certain cancers.

Medications

Your healthcare provider will recommend medication based on the reason for the bleeding.

For example, if the determined cause is uterine fibroids, you may have to use gonadotropin-releasing hormone (GnRH) agonists to shrink fibroids and reduce bleeding for short-term management.

However, your doctor might recommend blood clotting medications like tranexamic acid or aminocaproic acid if you have a bleeding disorder.

If an infection in the cervix or uterus is behind the bleeding, an entire course of antibiotics is the best course of treatment.

Finally, the common prescription for a thick endometrium is progestin therapy, administered either orally, through injections, or an intrauterine device (IUD).

Surgical Treatments

Hysteroscopy

As previously mentioned, hysteroscopy isn’t just a diagnostic procedure - it can also be a 2-in-1 procedure.

This minimally invasive procedure involves passing small instruments through the hysteroscope to remove polyps or fibroids or take a biopsy. This doesn’t have to be an inpatient procedure, so the recovery time is minimal.

For women with endometrial polyps, removing polyps during a hysteroscopic polypectomy can resolve postmenopausal bleeding.

Dilation and Curettage (D&C)

D&C is an invasive procedure that requires using anesthesia. It’s diagnostic and therapeutic, using a special instrument to dilate the cervix and scrape the uterine lining to remove abnormal tissues causing the bleeding.

Your healthcare provider will then analyze the larger tissue sample for more conclusive results.

Hysterectomy

When other treatments have failed, your healthcare provider may recommend removing the uterus and, sometimes, the cervix, ovaries, and fallopian tubes.

This major surgery carries several risks with a lengthy recovery period. It’s only done as a last resort or if you’re at a high risk of cancer.

Lifestyle Changes and Management

A sedentary lifestyle doesn’t directly cause bleeding after menopause, but it can contribute to a heightened risk for conditions like cancer, vaginal atrophy, and endometrial hyperplasia.

Adopting a healthier and more active lifestyle, particularly one that incorporates exercises that directly benefit menopausal and postmenopausal women, may help make underlying conditions more manageable and possibly even prevent postmenopausal bleeding.

When to See a Doctor

Warning Signs

We’ve said it before, and we’ll say it again - any kind of vaginal bleeding after menopause is abnormal.

However, if bleeding comes with sudden changes to your weight or bladder habits, or if it’s heavier than your typical menstrual period, seek medical care as soon as possible. These could be signs of a more severe condition like cancer.

Importance of Early Detection

Postmenopausal bleeding isn’t always caused by cancer, but it can be.

Early detection is critical to management and higher treatment success rates for any kind of cancer.

Endometrial cancer, for example, has a five-year survival rate of over 95% when caught early.

Even if the cause is non-cancerous, if detected earlier, treatments are usually less invasive, more straightforward, and affordable.

Preventative Measures

Regular Health Check-ups

Postmenopausal bleeding might happen all of a sudden. However, specific steps can help in preventing and detecting issues that may eventually lead to bleeding after menopause.

For women who are past their reproductive years, regular checks like pelvic exams, pap smears, endometrial samplings, mammograms, and bone density scans provide an opportunity for you and your healthcare provider to discuss your overall health and determine what adjustments you need to make.

Healthy Lifestyle Choices

Your lifestyle can determine your quality of life in your golden years.

If you take good care of your health, watch what you eat, and maintain a healthy weight with an active lifestyle, you won’t have to worry as much about health complications, including but not limited to postmenopausal bleeding.

For women, experts recommend at least 150 minutes of moderate-intensity aerobic exercises every week paired with a diet high in plant-based foods, whole grains, and lean proteins.

Limiting alcohol consumption and quitting smoking is visible. Both alcohol intake and cigarette smoking are risk factors for several cancers, including breast and digestive tract.

As a bonus, making healthy lifestyle choices makes managing chronic conditions, including those that postmenopausal women are most at risk for, like diabetes and hypertension, easier.

Coping with Postmenopausal Bleeding

Emotional and Mental Health Support

The first step to getting support for postmenopausal bleeding is to speak with your healthcare provider.

Developing a better understanding of what’s happening can relieve stress and help you make more informed decisions about your health.

If you’re experiencing significant anxiety, don’t be afraid to seek help from a mental health professional. If nothing else, they can be a safe space where you can freely express your worries and concerns.

Other ways to protect your mental health and reduce stress are to practice Yoga, which involves meditation and deep breathing exercises that help manage anxiety and promote overall well-being.

Support Groups and Resources

Many online and in-person platforms are now available for menopausal and postmenopausal women to share their experiences, gather information, and connect with other women who have the same struggle.

Examples of reputable resources of information about menopause-related health issues include:

• The North American Menopause Society (NAMS)
• The American College of Obstetricians and Gynecologists (ACOG)
• The National Cancer Institute (NCI)
• Reverse Health

Reverse Health, in particular, is more than just a 12-week weight loss program. It’s an app designed to give menopausal and postmenopausal women a wealth of resources and information, all available at their fingertips.

Conclusion

Don’t underestimate how much bleeding after menopause can affect you mentally and physically.

Stay on top of your health by learning as much as you can about postmenopausal bleeding. But be warned - self-diagnosis is just as dangerous. Only trust reliable medical sources and work closely with your health provider.

While postmenopausal bleeding is a cause for concern, it doesn’t and shouldn’t rule your life. It’s a manageable health issue that can’t prevent you from enjoying this stage of your life to the fullest.

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FAQs

Is bleeding after menopause normal?

No, bleeding after menopause is not normal and should be evaluated by a healthcare provider. It can be a sign of various conditions, some of which may require treatment.

What causes bleeding after menopause?

Bleeding after menopause can be caused by several factors, including hormonal imbalances, polyps, endometrial atrophy, and more serious conditions like endometrial hyperplasia or cancer.

Should I see a doctor if I experience bleeding after menopause?

Yes, it's important to see a doctor if you experience any bleeding after menopause. This symptom needs to be evaluated to rule out any serious underlying conditions.

How is bleeding after menopause diagnosed?

Diagnosis typically involves a pelvic exam, ultrasound, and possibly a biopsy of the uterine lining to determine the cause of the bleeding.

What are the treatment options for bleeding after menopause?

Treatment depends on the cause of the bleeding. Options may include hormone therapy, medications, or surgical procedures to address any underlying conditions.

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