A Woman’s Guide: Understanding Postmenopausal Bleeding

Thought you were done with periods? Postmenopausal bleeding is vaginal bleeding after menopause which can be surprising. While it’s often harmless, it’s important to understand what’s going on.

It could be due to hormone fluctuations and vaginal dryness or more serious conditions such as endometrial hyperplasia or even uterine cancer.

Regular check-ups and paying attention to changes in your body are important to maintain good health during this stage of life.

In this blog, we will cover the causes and symptoms of bleeding after menopause and how to treat it.

A] What Is Postmenopausal Bleeding? 

When a woman is in her 40s, she approaches menopause and her hormone level changes. The ovaries produce less oestrogen during this time and this stage is the perimenopausal phase and menstrual periods may become irregular or less frequent.

Once a woman has gone through an entire year with no periods, she has entered menopause. The approximate age at which a woman goes into menopause is in her 50s. Postmenopausal bleeding refers to any vaginal bleeding that occurs in menopausal women. According to a study, less than 11% of the female population experiences bleeding after menopause. Since postmenopausal bleeding is considered abnormal, it is important to contact your gynaecologist.

If you want to have a better understanding of the reasons behind your vaginal bleeding after menopause, you can contact our private gynaecologist in London.

B] Causes For Postmenopausal Bleeding 

1. Atrophic Vaginitis 

Atrophic Vaginitis is a common cause of postmenopausal bleeding. This condition occurs when the vaginal tissue becomes thin, dry and inflamed due to reduced oestrogen levels. Oestrogen helps maintain the health of vaginal tissues. Without enough oestrogen, the tissues can become fragile and prone to bleeding. Symptoms of atrophic vaginitis can include itching, burning and discomfort during intercourse. Talking to your healthcare provider if you face any of these symptoms is important.

2. Endometrial Atrophy

Similar to atrophic vaginitis, endometrial atrophy happens when the uterus lining becomes thin due to lower estrogen levels. After menopause, the endometrium does not need to thicken each month for a potential pregnancy. Over time, after menopause, they become thin and can bleed sometimes. It is usually light bleeding or spotting. While it is not usually a cause of concern, it is important to get it checked.

3. Cervical Polyps 

Cervical polyps are small, benign, non-cancerous growths on the cervix. These polyps can cause irregular vaginal bleeding. Although they are not cancerous, it is important to have them examined. Sometimes, they can be removed if they are harmful to your body.

4. Endometrial Hyperplasia 

Endometrial hyperplasia could be a potential cause of postmenopausal bleeding. It is the thickening of the endometrium due to excess oestrogen without enough progesterone. The usage of oestrogen for a long time can lead to an increased risk of endometrial hyperplasia.

5. Cervical Cancer 

Bleeding after menopause is often harmless, but it can also be a rare sign of cervical cancer. Cervical cancer progresses slowly, and doctors can sometimes identify these cells during a regular exam. It is important to visit your gynaecologist to help with the early detection and prevention of cervical cancer. Other symptoms of cervical cancer can include pain during sex and abnormal vaginal discharge.

Symptoms

The primary symptom of post-menopausal bleeding is vaginal bleeding that occurs after you have not had your periods in a year. It could vary in amount and colour.

1. Light Spotting 

Light spotting after menopause is one of the most common symptoms. This refers to small amounts of blood that might appear on your underwear or when you wipe after using the bathroom. Spotting can range in colour from pink to brown to bright red. While spotting is often not serious, it’s still important to get it checked by a healthcare provider to rule out any issues.

2. Heavy bleeding 

In some cases, postmenopausal bleeding can be heavier, similar to regular menstrual periods. This type of bleeding can be concerning and uncomfortable. If you experience heavy bleeding, you should see your gynaecologist immediately. Heavy bleeding can be a sign of conditions like endometrial hyperplasia (thickening of the uterine lining) or even endometrial cancer, which requires immediate attention.

3. Lower Abdominal Or Pelvic Pain 

Pelvic pain could be due to postmenopausal bleeding. This pain can vary from mild to severe and may be constant or come and go. Pelvic pain, along with bleeding, can indicate several conditions, such as infections, uterine fibroids, or endometrial issues.

4. Fatigue 

If the bleeding is heavy or for a longer duration, it can lead to symptoms like fatigue and weakness due to blood loss. Anaemia can develop when you lack healthy red blood cells to carry adequate oxygen to your body’s tissues. This can make you feel unusually tired, weak, or short of breath. If you notice these symptoms with heavy bleeding, it’s important to seek medical help immediately.

5. Pain During Intercourse

Experiencing pain during intercourse is another symptom that can be associated with postmenopausal bleeding. This pain can be due to conditions like atrophic vaginitis, where the vaginal tissues become thin and dry due to decreased oestrogen levels. If sex becomes painful and is accompanied by bleeding, it’s important to discuss this with your doctor to find appropriate treatments and improve your comfort.

6. Other Symptoms 

Other symptoms can sometimes accompany postmenopausal bleeding. These may include:

• Fever
• Dizziness
• Pale skin
• Low back pain
• Constipation

C] How Is It Diagnosed  

If you notice bleeding after menopause, it is safer to visit your gynaecologist and have a regular check-up to rule out any diseases.

A doctor may conduct a physical exam and a complete medical history analysis. They may also perform a pelvic exam to rule out cervical cancer. Some of the ways how doctors diagnose is via:

1. Transvaginal Ultrasound 

It is a non-invasive imaging test that allows doctors to view the ovaries, uterus and cervix. In this procedure, a technician would insert a probe into the vagina or ask the patient to do so that the doctors can have a better look at the cause of the bleeding.

2. Hysteroscopy 

This procedure shows endometrial tissue. The doctor inserts a fibre optic scope into the vagina and cervix. The doctor then pumps carbon dioxide gas through the scope. This helps to expand the uterus and relax it so that the doctors can examine it better. This procedure helps identify abnormalities like polyps, fibroids, or uterine adhesions.

3. Endometrial Biopsy 

An endometrial biopsy is a procedure in which a small sample of the uterine lining is removed and examined under a microscope. This procedure uses a thin, flexible tube known as a pipelle. The doctor inserts the pipelle through the cervix into the uterus and uses suction to collect the sample. It is then sent to a laboratory for analysis to check for abnormal cells, signs of cancer or any other issues.

D] Treatments 

Bleeding after menopause can be due to various reasons, as discussed above. It is treated using medications and surgery if necessary.

1. Medications include:

• Antibiotics

If the bleeding is due to an infection, antibiotics can be prescribed to eliminate the bacteria causing the infection. This treatment helps reduce inflammation and stop the bleeding.

• Oestrogen

For conditions like atrophic vaginitis or endometrial atrophy, where the vaginal or uterine lining becomes thin due to low oestrogen levels, oestrogen therapy can be beneficial. Oestrogen can be administered in various forms, such as creams, pills, or patches, to help restore the health of the vaginal and uterine tissues.

• Progestin 

In cases of endometrial hyperplasia, where the uterine lining becomes excessively thick, progestin therapy can help. Progestin is a synthetic form of progesterone, a hormone that helps regulate the growth of the endometrium. This treatment helps reduce the thickness of the uterine lining and prevent further abnormal bleeding.

2. Surgical treatments include:

• Hysterectomy 

A hysterectomy is a surgical procedure to remove the uterus. This treatment is considered when there are severe or recurrent issues, such as significant fibroids, endometrial hyperplasia, or cancer. Removing the uterus eliminates the source of the bleeding and any potential risks associated with it.

• Dilation and Curettage 

D&C is a surgical procedure in which the cervix is dilated, and the uterine lining is scraped to remove abnormal tissues. This procedure can diagnose and treat conditions like endometrial hyperplasia or polyps. It can also help stop the bleeding by removing the problematic tissue.

Conclusion 

Postmenopausal bleeding can be concerning, but it’s important to remember that it’s often harmless. However, it’s always best to schedule an appointment with your gynaecologist. They can help diagnose the cause of your bleeding and recommend the most appropriate treatment. Early detection and intervention are key to maintaining good health during menopause. Our experts at Womens Health can help you treat your postmenopausal conditions.  Contact us today and book your appointment!