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Can You Get Your Period Again After Menopause

Possible Causes Of Periods After Menopause

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Menopause is the final stage of a woman’s reproductive life cycle. Though it marks the end of menstruation, some women may experience postmenopausal bleeding or a period after menopause. Given below is some information on the causes of postmenopausal bleeding.


Menopause is the final stage of a womans reproductive life cycle. Though it marks the end of menstruation, some women may experience postmenopausal bleeding or a period after menopause. Given below is some information on some of the causes of postmenopausal bleeding.

  • Since menopause marks the end of menstruation, having a period after menopause can cause stress. There are underlying causes of postmenopausal bleeding. Lets first look the reproductive life cycle of women. After the onset of puberty, women undergo a series of physiological changes throughout their reproductive years. The duration of the menstrual cycle ranges from 28 to 35 days. These changes are brought about by changes in the levels of hormones called estrogen and progesterone. The beginning of the menstrual cycle begins the rupture of uterine lining or the endometrium. The menstrual bleeding cycle lasts for a period of 3 to 5 days.

What Causes Postmenopausal Bleeding?

Women are said to be in menopause, if they have not gotten a single period for a year.

Will I Start Menopause If I Have A Hysterectomy

During a hysterectomy, your uterus is removed. You wont have a period after this procedure. However, if you kept your ovaries removal of your ovaries is called an oophorectomy you may not have symptoms of menopause right away. If your ovaries are also removed, you will have symptoms of menopause immediately.

Bleeding After Menopause: How To Get A Diagnosis

No matter the cause of your postmenopausal bleeding, its important to visit the doctor. In most cases, this symptom is caused by a minor condition however, all possible causes must be ruled out. There are several different tests and/or procedures your doctor might recommend to discover the cause of postmenopausal bleeding.

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How Is Postmenopausal Bleeding Treated

Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments.

Medications include:

  • Antibiotics can treat most infections of the cervix or uterus.
  • Estrogen may help bleeding due to vaginal dryness. You can apply estrogen directly to your vagina as a cream, ring or insertable tablet. Systemic estrogen therapy may come as a pill or patch. When estrogen therapy is systemic, it means the hormone travels throughout the body.
  • Progestin is a synthetic form of the hormone progesterone. It can treat endometrial hyperplasia by triggering the uterus to shed its lining. You may receive progestin as a pill, shot, cream or intrauterine device .

Surgeries include:

Woman’s Day: Bleeding After Menopause

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Womans Day recently interviewed Jessica Chan, MD, assistant professor of OB-GYN at Cedars-Sinai, about bleeding after menopause and why women should never ignore that symptom.

As the Womans Day story details, transitioning out of menopause comes with uncomfortable yet common side effects like hot flashes, mood swings and weight gain. But, if your body is suddenly experiencing period-like bleeding after menopause, its time to call your doctor’s office and make an appointment.

Menopause is considered official when a women does not have a menstrual period for one year. Typically, women enter menopause around 51 years of age, but it can range from as young as 40 to 58 years old. And before menopause begins, most women experience changes in their menstrual cycle.

During this transitionary time, your bleeding pattern may start to change due to some wild fluctuations in your hormone levels, Chan told Womans Day. At first, you usually have a shortening of the cycle. Then you may have a change in bleeding pattern. It can be lighter. Then theres a lengthening of the cycle. You may skip some periods before you stop altogether.

But If bleeding occurs after menopause, doctors need to rule out other conditions. Post-menopausal bleeding can be a symptom of endometerial cancer — also called uterine cancer. About 10% of postmenopausal bleeding experience is due to cancer, the Woman’s Day article states.

Read the complete story here.

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What Is The Most Common Cause Of Postmenopausal Spotting

Having a period after menopause can be alarming, but theres not one most common cause. Theres a range of causes of postmenopausal spotting not all of them serious but all requiring a check-in with your doctor.

Causes of postmenopausal bleeding include:

  • Polyps these are non-cancerous tissue growths that can form anywhere in your cervix, uterus, or cervical canal.

  • Endometrial Hyperplasia This is the thickening of your uterine lining caused by an imbalance of hormones, specifically too much estrogen and not enough progesterone. Cells in the uterine lining can become abnormal, and can sometimes lead to cancer.

  • Endometrial Atrophy This is the thinning of the uterine lining, caused by very low hormone levels.

  • Vaginal atrophy This is the thinning of the vaginal walls, again, caused by low hormone levels experienced after menopause. The lining of the vaginal walls can become dry and inflamed, especially after sex.

  • Cancer Postmenopausal bleeding is the most common symptom of certain types of cancers, including endometrial, uterine, cervical, and vaginal cancers. Although serious, only around 9% of postmenopausal women who sought medical advice for vaginal bleeding were diagnosed with cancer. So you dont have to assume the worst.

  • HRT treatment spotting can be a common side effect of Hormone Replacement Therapy which can be a common cause in itself for endometrial hyperplasia.

  • Other factors including STIs, medications, and vaginal infections.

What Is A Typical Postmenopausal Bleeding Workup

Routine interventions include a bimanual pelvic examination, a pap smear if you are due, and an ultrasound for the evaluation of the lining of the uterus. And then often an endometrial biopsy is recommended, as quickly as possible. Through these procedures, a practitioner might discover on occasion that the bleeding is the result of a tear in the vaginal wall or from the urethra instead of the uterus. The ultrasound can evaluate the thickness of the uterine wall and lining, and confirm that the ovaries and fallopian tubes look the way they should. What does that all mean? While you are probably familiar with what a pelvic exam, pap smear and even ultrasound are, an endometrial biopsy might sound alarming but it shouldnt scare you. Lets take a look at whats involved.

Endometrial biopsy

The word biopsy can strike fear in your heart but remember that a biopsy is often one of the best ways to evaluate a situation. In this case, your provider needs to look at the intrauterine tissue to determine the cause of postmenopausal bleeding. The procedure isnt terribly complicated often it can be performed right at your gynecologists office. Sometimes, an endometrial biopsy is also used after a particular type of abnormal Pap test, if there are endometrial cells on the pap, for example.

How is an endometrial biopsy done and how can I prepare for one?

What happens after the biopsy?

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Im Experiencing Postmenopausal Bleeding What Should I Do

First and foremost, you should make an appointment with your health care practitioner. All bleeding after menopause is considered abnormal until evaluated its the old better safe than sorry adage at work. This standard of care is important early identification of abnormal uterine tissue, precancerous tissue, and especially uterine cancer is critical to saving lives.

Most abnormalities in the uterus can be easily treated with great success when identified early. And while some of these cases turn out to be very serious and require immediate consultation with a cancer specialist, that certainly isnt the reality in all cases of postmenopausal bleeding or discovery of abnormal tissue. Fear can be a powerful deterrent in seeking help, but a delayed evaluation due to the possibility of something serious happening could very well make a difference in the success of treatment. I certainly understand the reluctance to face a possible crisis particularly if you are already dealing with emotional trauma of some kind but I urge you to seek help promptly if you see bleeding or spotting after menopause.

How Do I Manage Bleeding After Menopause

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Your doctor will want to do some investigations to find the cause of your bleeding. Let them know if you have noticed any changes going to the toilet, whether you have pain, have lost weight or whether you are on HRT. You may also want to check whether you need a cervical screening test.

Some women may need to have an ultrasound, blood test or may be referred to a gynaecologist for further tests.

Treatment will depend on what is causing the bleeding. It may involve medicines to control problems with the lining of the uterus, or surgery to remove polyps.

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How Much Bleeding Is Normal After Menopause

You may think you have reached menopause if you have not had a period for a few months. However, it is still possible to have a period up to a year after your last one. After 12 months without a period, any bleeding at all is not normal.

Up to 1 in 10 women experience bleeding or spotting after their menopause. In most cases the bleeding is not serious and a cause may not be found. However, it needs to be checked because sometimes it can be a sign of cervical or uterine cancer, so it is always important to see a doctor if you notice any vaginal bleeding after menopause.

What Can Cause Bleeding After Menopause

There can be several causes for vaginal bleeding after menopause, including:

  • inflammation and thinning of the lining of the vagina
  • thinning of the lining of the uterus
  • thickening of the lining of the uterus, often caused by hormone replacement therapy
  • polyps or other abnormalities in the cervix or uterus

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Should You Get Tested For Perimenopause

The short answer: No.

The blood tests that measure your ovarian reserve are rarely accurate during perimenopause. FSH and estrogen change by the day and throughout the day so they are generally not helpful.

We do consider testing these hormones if you experience perimenopausal symptoms under the age of 45. We generally will also check other pituitary hormones, like TSH and prolactin, if you are experiencing these symptoms prematurely.

Keeping a menstrual diary is generally the best test you can do. This will give you and your OBGYN insight into what your body is doing and for how long.

Any time you experience abnormal uterine bleeding , checking in with your doctor is a good idea to make sure it is normal and that no other work-up is needed.

Symptoms Of Postmenopausal Bleeding

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Many women who experience postmenopausal bleeding may not have other symptoms. But symptoms may be present. This can depend on the cause of bleeding.

Many symptoms that occur during menopause, like hot flashes, often begin to decrease during the postmenopausal time period. There are, however, other symptoms that postmenopausal women may experience.

Symptoms postmenopausal women may experience include:

  • vaginal dryness

A doctor may conduct a physical exam and a medical history analysis. They may also conduct a Pap smear as part of a pelvic exam. This can screen for cervical cancer.

Doctors may use other procedures to view the inside of the vagina and the uterus.

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The Significance Of Bleeding After Menopause

Bleeding after menopause or “postmenopausal bleeding” can be defined as the resumption of vaginal bleeding at least 6 months after a woman experiences her last menstrual period. This assumes of course that she is indeed menopausal ie. in her late 40’s, perhaps having hot flashes and night sweats, mood swings, insomnia, perhaps experiencing some vaginal dryness.

Bleeding after menopause or “postmenopausal bleeding” can be defined as the resumption of vaginal bleeding at least 6 months after a woman experiences her last menstrual period. This assumes of course that she is indeed menopausal ie. in her late 40’s, perhaps having hot flashes and night sweats, mood swings, insomnia, perhaps experiencing some vaginal dryness. The bleeding pattern most women experience as they approach menopause is one where the periods become lighter, shorter in duration, and the interval between periods changes so that the periods are either somewhat closer together or intervals greater than her customary 28 days. Cycles may be missed entirely for a couple of months.

Polyps and fibroids are common benign growths that develop in the uterine cavity. The former is most often associated with irregular light spotting, staining or actual light bleeding. The latter may also present this way, but in fact may be associated with much heavier bleeding.

Cancer obviously requires a much more aggressive surgery, namely hysterectomy.

How Can I Prevent Postmenopausal Bleeding

In some circumstances, there is nothing a woman can do to prevent bleeding after menopause. It can be a crucial message your body is sending that something just isnt right. But often, there are steps you can take to avoid the conditions that cause these bleeding events.

Maintaining hormonal balance

When hormones are at play, there are some relatively simple lifestyle changes that can keep your hormones balanced, thus avoiding one of the most common conditions that leads to bleeding after menopause:

  • Eat as well as you can. Make sure your body is getting the nutrients it needs by choosing fresh vegetables, lean protein, and healthy fats.
  • Get up and move. Staying active can be instrumental in keeping your body balanced and healthy.
  • Relax. Taking time for self-care is crucial. Find ways to relieve the stress of everyday life. Yoga, meditation, deep breathing, or regularly indulging in activities you love can go a long way towards stress reduction.
  • Supplementation. You can prevent on overabundance of estrogen by giving your body some natural endocrine support.
  • Minimize exposure to xenoestrogens. Pay attention to how often you expose your body to chemicals that can wreak havoc on your hormones. Perfumes, cleaning products, even cash register receipts may impact your hormonal balance, so go natural any chance you can.

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How Is It Treated

That depends on whatâs causing the bleeding.

Estrogen therapy: This hormone is used to treat vaginal and endometrial atrophy. Your doctor may prescribe it in one of the following forms:

  • Pills: Youâll take them by mouth.
  • Vaginal cream: Youâll use an applicator to get it inside your body.
  • Vaginal ring: You or your doctor can put it in place. It releases a steady dose of estrogen for about 3 months.
  • Vaginal tablet: Youâll insert it using an applicator. You may need to do it daily, or a few times a week.

Progestin therapy: This lab-made version of progesterone is used to treat endometrial hyperplasia. Your doctor may prescribe it in a pill or shot, a vaginal cream, or intrauterine device.

Hysteroscopy: This procedure can remove polyps. Doctors also use it to remove thickened parts of the uterine lining caused by endometrial hyperplasia. Theyâll insert a hysteroscope into your vagina and pass tiny surgical tools through the tube.

D& C : In this surgery, the doctor opens your cervix. . They use a thin tool to remove polyps or thickened areas of the uterine lining caused by endometrial hyperplasia.

Hysterectomy: This surgery removes part or all of your uterus. Itâs a treatment for endometrial or cervical cancer. Some people with a precancerous form of endometrial hyperplasia may also need it. In some cases, the doctor may also take out your ovaries, fallopian tubes, or nearby lymph nodes.

Can Menopause Affect Sleep

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Some women may experience trouble sleeping through the night and insomnia during menopause. Insomnia is an inability to fall asleep or stay asleep at night. This can be a normal side effect of menopause itself, or it could be due to another symptom of menopause. Hot flashes are a common culprit of sleepless nights during menopause.

If hot flashes keep you awake at night, try:

  • Staying cool at night by wearing loose clothing.
  • Keeping your bedroom well-ventilated.

Avoiding certain foods and behaviors that trigger your hot flashes. If spicy food typically sets off a hot flash, avoid eating anything spicy before bed.

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What Is Hormone Therapy

During menopause, your body goes through major hormonal changes, decreasing the amount of hormones it makes particularly estrogen and progesterone. Estrogen and progesterone are produced by the ovaries. When your ovaries no longer make enough estrogen and progesterone, hormone therapy can be used as a supplement. Hormone therapy boosts your hormone levels and can help relieve some symptoms of menopause. Its also used as a preventative measure for osteoporosis.

There are two main types of hormone therapy:

  • Estrogen therapy : In this treatment, estrogen is taken alone. Its typically prescribed in a low dose and can be taken as a pill or patch. ET can also be given to you as a cream, vaginal ring, gel or spray. This type of treatment is used after a hysterectomy. Estrogen alone cant be used if a woman still has a uterus.
  • Estrogen Progesterone/Progestin Hormone Therapy : This treatment is also called combination therapy because it uses doses of estrogen and progesterone. Progesterone is available in its natural form, or also as a progestin . This type of hormone therapy is used if you still have your uterus.

Hormone therapy can relieve many of the symptoms of menopause, including:

  • Hot flashes and night sweats.
  • Vaginal dryness.

Can I Get Pregnant During Menopause

The possibility of pregnancy disappears once you are postmenopausal, you have been without your period for an entire year . However, you can actually get pregnant during the menopause transition . If you dont want to become pregnant, you should continue to use some form of birth control until you have gone fully through menopause. Ask your healthcare provider before you stop using contraception.

For some women, getting pregnant can be difficult once theyre in their late 30s and 40s because of a decline in fertility. However, if becoming pregnant is the goal, there are fertility-enhancing treatments and techniques that can help you get pregnant. Make sure to speak to your healthcare provider about these options.

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