What Other Conditions Can Cause Bleeding After Menopause
Some other conditions can cause abnormal uterine bleeding after menopause.
- Endometrial hyperplasia, or the overgrowth of the cells lining the uterus
- Infection of the uterine lining
- Injury or trauma to the pelvic area
- Certain medications, including hormone therapy and tamoxifen
- Endometrial cancer, or uterine cancer
- Cervical cancer
In most cases of postmenopausal bleeding, the cause is harmless. However, medical experts still recommend visiting your doctor to rule out more serious causes of abnormal bleeding, such as endometrial carcinoma.
Not Sure What To Do Next
If you are still concerned about bleeding after menopause, use healthdirects online Symptom Checker to get advice on when to seek medical attention.
The Symptom Checker guides you to the next appropriate healthcare steps, whether its self care, talking to a health professional, going to a hospital or calling triple zero .
Frequently Asked Questionsexpand All
Yes. Although its normal for periods to change as you near menopause, you should still talk with your obstetriciangynecologist about bleeding changes. Abnormal bleeding sometimes can be a sign of health problems. Its especially important to tell your ob-gyn if you have bleeding after menopause.
If you have any bleeding after menopause, or if you have any of the abnormal changes in your monthly cycle listed above, its important to see your ob-gyn to find out the cause. Many things can cause abnormal bleeding, including
Polyps are noncancerous growths that attach to the wall of the uterus. They also may develop on the endometrium . These growths may cause irregular or heavy bleeding. Polyps also can grow on the cervix or inside the cervical canal. Polyps on the cervix may cause bleeding after sex.
After menopause, the uterine lining may become too thin. This can happen when a woman has low levels of estrogen. The condition is called endometrial atrophy. As the lining thins, a woman may have abnormal bleeding.
The risk factors for endometrial cancer include
early age when periods started
older age at menopause
long-term use of medications containing high doses of estrogen
treatment with a drug called tamoxifen
certain tumors of the ovaries
Read Also: Is Dizziness A Symptom Of Menopause
What Is Vaginal Bleeding
Vaginal bleeding can have a variety of causes. These include normal menstrual cycles and postmenopausal bleeding. Other causes of vaginal bleeding include:
- trauma or assault
- cervical cancer
- infections, including urinary tract infections
If youre experiencing vaginal bleeding and are postmenopausal, your doctor will ask about the duration of the bleed, the amount of blood, any additional pain, or other symptoms that may be relevant.
Because abnormal vaginal bleeding can be a symptom of cervical, uterine, or endometrial cancer, you should get any abnormal bleeding evaluated by a doctor.
Theres Nothing Wrong With Needing Help In The Lubrication Department
Whether you decide to opt for extra hormones or not, using vaginal moisturizers like Replens and regular ol lube can help ease vaginal discomfort. In fact, Tami Rowen, M.D. an obstetrician and gynecologist specializing in sexual health at the University of California San Francisco, highly recommends using a lubricant to help make sex more enjoyable if you experience vaginal dryness. If youre new to lube, its important to know that there are several types: silicone-based, oil-based, water-based, and hybrids. Generally, water-based lubes that dont contain glycerin are a good choice because theyre suitable for people with sensitive skin. Further, Dr. Rowen suggests buying a lube that mimics the natural pH of your vagina. Changes to its natural state can cause an overgrowth of bacteria and lead to infections like bacterial vaginosis, according to the Cleveland Clinic. . Before heading to the store, you can do research online to find a product that fits within this scale. Dr. Rowen recommends lubes like Almost Naked by Good Clean Love . This one falls between 4.2 – 4.7 on the pH scale, according to the manufacturers website.
Also Check: Early Menopause After Tubal Ligation
There Are Several Potential Causes But Some Are More Serious Than Others
In most cases, postmenopausal bleeding is caused by issues such as endometrial atrophy , vaginal atrophy, fibroids, or endometrial polyps. The bleeding could also be a sign of endometrial cancera malignancy of the uterine lining, but only in a small number of cases. A 2018 study by the National Cancer Institute found that only about 9 percent of postmenopausal women who saw a doctor for bleeding later received a diagnosis of endometrial cancer.
Still, we want the option to intervene early if it is cancer, since treating it sooner leads to better outcomes, Mantia-Smaldone said.
If endometrial cancer is found early, a woman has a 95 percent chance of surviving the cancer for at least 5 years.
Postmenopausal Bleeding Is Never Normal
Whether its light spotting or a heavier flow, vaginal bleeding after menopause can signal potential health problems.
It should always be brought up with your provider, said Gina M. Mantia-Smaldone, MD, a gynecologic oncologist at Fox Chase Cancer Center. And the sooner, the better. Rather than waiting for your next planned checkup, give your gynecologist a call quickly to schedule an evaluation.
Read Also: Is There A Pill For Menopause
How Do Doctors Diagnose Bleeding After Menopause
To find the cause of abnormal vaginal bleeding, your doctor will perform a physical exam and ask about your family and health history. He or she may also order a transvaginal ultrasound or an endometrial biopsy.
Transvaginal ultrasonography allows your doctor to assess your uterine cavity and endometrial thickness. He or she can also examine your fallopian tubes and ovaries. During this procedure, your doctor or an ultrasound technician will place an instrument into the vagina to examine the uterine cavity and endometrial lining. This instrument will emit sound waves that bounce off the pelvic organs. These sound waves get sent to a nearby computer and create a picture called a sonogram.
Endometrial biopsy, or endometrial sampling, involves removing a small piece of the endometrial lining. After taking the sample, the doctor will send it to the lab. There, the scientists will look for anything abnormal, including signs of infection or cancer.
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.
Don’t Miss: Sweet Potato Menopause
How Your Doctor Will Investigate Postmenopausal Bleeding
If you do experience unusual or postmenopausal bleeding, make an appointment with your doctor to have the problem investigated, says Dr. Berkowitz. Your doctor will likely recommend an ultrasound, a biopsy, or both. Ultrasound can measure the thickness of the lining inside the uterus. In some women with endometrial cancer, this lining becomes thicker than usual, which alerts doctors to the possibility that it is cancerous. Not all thickened linings mean cancer, though. The ultrasound should be followed by a biopsy, even if the ultrasound doesnt show any thickening of the uterine lining, says Dr. Berkowitz. A biopsy can often be done as an in-office procedure, in which the doctor uses a thin tube with a collection device on the end to gather some uterine cells. The sample is then examined under a microscope to check for cancer or precancerous changes.
Getting To The Bottom Of It
Postmenopausal bleeding can range from light spotting that is pinkish-gray or brown, all the way to a heavy flow, like a regular period. Most of the time, there is no pain with the bleeding. No matter your exact symptoms, youll want to get in touch with your ob-gyn right away if this happens to you.
Any evaluation should start with a detailed conversation, either in person or via telehealth . Your ob-gyn should ask questions such as:
- When did you go through menopause? The longer its been, the greater cause for concern and the more testing we might need to do.
- Are you taking any new medications? Some drugs, such as blood thinners and some mental health medications, can have vaginal bleeding as a side effect.
- What else is going on with your health? Other medical conditions could be relevant.
A pelvic exam usually is needed when were talking about unexplained vaginal bleeding. During the exam, your ob-gyn may look at your vagina and cervix and feel the size of your uterus.
The next steps will depend on your age, how long it has been since you reached menopause, and how much bleeding youre experiencing. Your ob-gyn might suggest a pelvic ultrasound to look at your uterus more closely or a biopsy to take a tissue sample from the lining of your uterus. You might even need both.
Don’t Miss: Dr Yael Swica
Polycystic Ovary Syndrome And Menopause
Polycystic ovary syndrome is a hormonal disorder in which a womans ovaries produce more androgens, commonly known as male hormones, than she needs. As a result, a woman can have irregular menstrual cycles , body-hair growth in unwanted places, thinning scalp hair, weight gain, and insulin resistance, according to the Department of Health and Human Services .
Some of these symptoms, such as excessive body-hair growth and thinning scalp hair, may get worse after menopause.
On the other hand, after menopause you no longer need treatments to bring on your period, says , an assistant professor of obstetrics and gynecology at University of Chicago Medicine.
However, PCOS puts women at greater risk for cardiovascular disease, diabetes, high blood pressure, and sleep apnea, notes HHS. Aging also increases your risk for these conditions. Thats why as women with PCOS grow older and go through menopause, they need to be even more vigilant about managing risk factors for these other serious health issues, Dr. Siddiqui says.
If you have PCOS, ask your doctor about screening for high cholesterol and diabetes. Also, keep tabs on your blood pressure and weight.
What You Can Do
Consider keeping a journal to track your periods. Include information such as:
- when they start
- whether you have any in-between spotting
You can also log this information in an app, like Eve.
Worried about leaks and stains? Consider wearing panty liners. Disposable panty liners are available at most drugstores. They come in a variety of lengths and materials.
You can even buy reusable liners that are made of fabric and can be washed over and over again.
A skipped period can also cause the lining to build up, leading to heavy bleeding.
Bleeding is considered heavy if it:
- soaks through one tampon or pad an hour for several hours
- requires double protection such as a tampon and pad to control menstrual flow
- causes you to interrupt your sleep to change your pad or tampon
- lasts longer than 7 days
When bleeding is heavy, it may last longer, disrupting your everyday life. You may find it uncomfortable to exercise or carry on with your normal tasks.
Heavy bleeding can also cause fatigue and increase your risk for other health concerns, such as anemia.
You May Like: What Antidepressant Is Best For Menopause
Is An Energy Vampire Draining Your Lifes Blood
While targeted treatments and lifestyle changes may be your first steps toward healing from abnormal bleeding, you also need to address the other factors at play, including your emotions, thoughts, beliefs, and relationships. Thats because, in my professional and personal experiences, bleeding is always indicative of something that is going on in your life.
Whenever a woman tells me she is experiencing abnormal bleeding, I always ask if she is leaking her lifes blood into a dead-end job or relationship that doesnt fully meet her needs.
When you give more than you receive on a regular basis, you are most likely in an energy vampire relationship.
I have experienced bleeding that was not normal for me on several occasionsmost recently when I was visiting a Buddhist monastery in Thailand. I had bleeding very much like a period brought on by the fact that I was attempting to conform to a code of conduct that included living in complete silence, waking at dawn, eating only two meals per day , standing in line to wash our plates, and meditating 4 to 5 hours per day. None of this was bad in any way. People travel great distances for this kind of authentic spiritual experience. But truth be told, it didnt suit me.
Now, putting yourself first when youve been in an energy vampire relationship can take some time. Start by shifting your perspective of yourself by saying this aloud every morning:
I pledge allegiance to myself
and to my Soul for which it stands.
Bleeding After Menopause: Get It Checked Out
Bleeding after menopause can be disconcerting, but the good news is, more than 90% of the time its not caused by a serious condition, according to a study in JAMA Internal Medicine. That said, the study also reinforces the idea that postmenopausal bleeding should always be checked out by your doctor to rule out endometrial cancer, a cancer of the uterine lining, says Dr. Ross Berkowitz, William H. Baker Professor of Gynecology at Harvard Medical School. This is because the study also found more than 90% of women who did have endometrial cancer had experienced postmenopausal bleeding. And screening all women who experience bleeding after menopause for endometrial cancer could potentially find as many as 90% of these cancers, which are highly curable if found early.
Perimenopausal Bleeding Or Spotting
Perimenopause is the period that leads to menopause. Its usually characterized by menopausal symptoms and irregular periods. Perimenopause can last up to 10 years. During perimenopause, its normal to experience heavier periods or irregular spotting due to hormonal changes.
Talk to your doctor if your perimenopausal bleeding:
- lasts longer or is heavier than expected
- occurs more often than normal
- occurs after intercourse
There are many conditions that can cause bleeding after menopause. Here weve listed the most common causes of postmenopausal bleeding.
How Is It Diagnosed
To find the cause of your bleeding, the doctor will do a physical exam and review your medical history. You may need one or more of the following tests:
Transvaginal ultrasound: This image helps your doctor check for growths and look at the thickness of your endometrium. Theyâll place a small probe into your vagina. It sends off sound waves to create a picture of the inside of your body.
Endometrial biopsy: The doctor uses a thin tube to take a small sample of the tissue that lines your uterus. Theyâll send it to a lab where scientists will look for anything unusual, like an infection or cancerous cells.
Sonohysterography: Your doctor may use this test to measure the size of a polyp. Theyâll put a saltwater solution inside your uterus to create a clearer ultrasound image.
Hysteroscopy: When the doctor needs to look inside your uterus, theyâll use a hysteroscope. This thin, lighted tube has a camera on one end.
D& C : During this procedure, the doctor opens your cervix. They use a thin tool to scrape or suck a sample of the uterus lining. They send this to a lab that will check for polyps, cancer, or a thickening of the uterine lining .
Ultrasound and biopsy are usually done in your doctorâs office. Hysteroscopy and D& C require anesthesia on one part of or your whole body. Youâll either go to a hospital or an outpatient surgical center.
Read Also: What Causes Vaginal Odor After Menopause
How To Use Tamoxifen Citrate
Take this medication by mouth with or without food, usually once or twice daily for 5 years, or as directed by your doctor. Daily dosages greater than 20 milligrams are usually divided in half and taken twice a day, in the morning and evening, or as directed by your doctor. If you are using the liquid, measure the dose carefully using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.
Dosage is based on your medical condition and response to treatment. The duration of treatment to prevent cancer from returning may be between 5 to 10 years, depending on your medical condition and response to treatment.
Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.
If you have breast cancer that has spread to other parts of the body, you may experience increased bone/cancer pain and/or disease flare-up as you start taking tamoxifen. In some cases, this may be a sign of a good response to the medication. Symptoms include increased bone pain, increased tumor size, or even new tumors. These symptoms usually disappear quickly. In any case, report these symptoms right away to your doctor.
Inform your doctor right away if your condition worsens .
Is Bleeding After Menopause Always Cancer
While cancer isnât the only or even the most common cause of postmenopausal bleeding, itâs still important to see your doctor if you have bleeding after menopause. More than 90% of women who have endometrial cancer experience abnormal vaginal bleeding and early diagnosis greatly increases the likelihood of successfully treating cancer.