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What Causes Heavy Bleeding After Menopause

Is Spotting Between Periods Normal

Is postmenopausal bleeding normal?

Is spotting normal during perimenopause? If you observe small amounts of blood on your underwear between cycles , its considered spotting.

Aside from hormonal changes, perimenopause spotting is also the direct result of endometrial buildup. It happens either before your period starts or near the end of it. If youre spotting between periods, however, it might be an indication of hormonal imbalance and should be discussed with your doctor.

The Diagnostic Process May Involve Multiple Steps

Even though postmenopausal bleeding can have a number of different causes, your doctors first objective is to rule out potential cancers.

Well usually do a physical exam to look for blood or masses, such as fibroids, followed by an ultrasound to see how thick a patients uterine lining is, Mantia-Smaldone explained. A postmenopausal womans uterine lining should be quite thin, since she isnt menstruating.

Endometrial cancer can cause the lining of the uterus to thicken. If your uterine lining appears thicker than normal, your doctor will recommend a biopsy, in which a sample of your uterine lining is removed and examined under a microscope.

What Is Considered Abnormal Perimenopause Bleeding

Typical irregularities aside, certain cases of perimenopausal bleeding could require closer medical attention. The following are considered abnormal perimenopausal bleeding patterns:

  • Very heavy menstrual bleeding, particularly with clotting
  • Bleeding after sexual intercourse

Approximately 25 percent of women experience heavy perimenopausal bleeding, also referred to as menorrhagia, flooding, or hypermenorrhea. Potential reasons for increased menstrual flow include:

  • An imbalance of estrogen and progesterone hormones
  • Fibroids: benign tumors, which may grow larger and cause heavy perimenopausal bleeding
  • Endometrial hyperplasia: a thickening of the uterine lining that leads to irregular bleeding
  • Endometrial polyps: small, noncancerous tissue growths in the uterine lining enlarged by the onset of perimenopause
  • Thyroid problems: heavy perimenopausal bleeding is sometimes brought on by an underactive thyroid, or hypothyroidism
  • Polycystic ovarian syndrome: an endocrine disorder that produces irregular periods along with abnormal bleeding in the uterus

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Do I Still Need A Pap Smear Now That I Am Menopausal

Even if you are menopausal or postmenopausal, you should continue to have Pap or HPV tests. Women who have had a total hysterectomy for a noncancerous condition and have not had a previous history of precancerous Pap tests may be able to stop Pap screening depending on their medical history and risk of contracting human papilloma virus . Screening may also be discontinued at ages 65 or 70 if women have had at least three normal Pap tests in a row and no abnormal Pap tests in the previous 10 years.

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What Can I Expect If Ive Been Diagnosed With Vaginal Atrophy

Bleeding After Menopause: Causes, Symptoms, Diagnosed ...

You dont have to just live with vaginal atrophy. Even if youre in menopause or postmenopausal, that doesnt mean you should have to deal with UTIs, endure itching or burning, or painful sex. Treatment not only helps with symptoms, but it helps restore a healthy pH and bacterial balance back to your vagina.

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How Is Cervicitis Treated

If your doctor determines that you have cervicitis, you will usually be prescribed an antibiotic to treat any bacterial infections that may be causing the condition. Women under age 25 or who engage in high-risk behaviors may be treated with antibiotics even if bacteria are not detected in the diagnosis. Some bacteria can be hard to detect but may still be present. You should abstain from intercourse until treatment is done.

Antibiotics successfully treat cervicitis in most cases. If cervicitis is not successfully treated by antibiotics, laser therapy or surgery may be required. Your doctor can best determine the treatment for your cervicitis based on your age, habits, diagnostic tests, and the length of the condition.

What Are The Types Of Endometrial Hyperplasia

Doctors classify endometrial hyperplasia based on the kinds of cell changes in the endometrial lining. Types of endometrial hyperplasia include:

  • Simple endometrial hyperplasia : This type of endometrial hyperplasia has normal-looking cells that arent likely to become cancerous. This condition may improve without treatment. Hormone therapy helps in some cases.
  • Simple or complex atypical endometrial hyperplasia: An overgrowth of abnormal cells causes this precancerous condition. Without treatment, your risk of endometrial or uterine cancer increases.

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What Causes Vaginal Bleeding After Menopause

Spotting after menopause and bleeding that mirrors a period after menopause is not normal. Four of the main causes of vaginal bleeding after menopause include uterine polyps, endometrial hyperplasia, endometrial atrophy, and cancer, but they are not the only related health conditions. Even if you are simply spotting after menopause, University Park OBGYN recommends consulting your physician or gynecologist to rule out any serious health issues and determine the cause of your spotting or bleeding.

Causes of vaginal bleeding after menopause:

  • Pelvic Trauma or injury to the pelvis may cause vaginal bleeding or spotting.
  • Uterine polyps or fibroids are benign growths that may appear in your cervical or uterine canal or on the cervix itself. Polyps and fibroids may cause spotting after menopause or heavy bleeding after intercourse.
  • Endometrial atrophy occurs when the uterine lining begins to thin. This happens because the endometrium is affected by our estrogen and progesterone hormones, and the decline in these hormones during menopause can make the endometrium thin and cause vaginal bleeding after menopause.
  • Endometritis is an infection of the uterine lining.
  • Bleeding stemming from the urinary tract or rectum
  • Cancer of the vagina, uterus, endometrium, or cervix is signified by irregular spotting or vaginal bleeding after menopause.
  • Medications such as hormone therapy, blood thinners, and more can trigger vaginal bleeding after menopause.
  • Make Your Health A Priority

    Menopause & You: Bleeding After Menopause

    Women are known to focus on their families first and put their own health second. But you cant care for loved ones if youre not healthy yourself. Listen to your body. Alert your doctor to any changes or abnormal issues such as postmenopausal bleeding as soon as possible.Dont stop seeing your general gynecologist for an annual exam when you hit menopause. Just because your reproductive years have ended doesnt mean those body parts go away! Your cancer risk increases as you age, and your gynecologist can screen for the disease and help you manage any conditions caused by hormone changes.If youre experiencing postmenopausal bleeding or have any concerns about your gynecologic health, request an appointment online or by calling .

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    What About Conventional Medicine

    Your doctor will discuss which treatment would be most effective for you. He may suggest a contraceptive pill or HRT which would influence your hormones in order to regulate your periods. However, it is important to be aware of the side effects of these treatments. He may also give you medication to stop flooding quickly, if your periods are very heavy or prolonged.

    If you are worried that your heavy periods are caused by an underlying health issue or are resulting in anaemia, then it is also important to visit your doctor. Heavy periods are not something which should be ignored, as loss of blood can be detrimental to health.

    What Causes Vaginal Atrophy

    During menopause, your body makes less estrogen. Without estrogen, the lining of the vagina can become thinner and less stretchy. The vaginal canal can also narrow and shorten. Less estrogen lowers the amount of normal vaginal fluids. It also changes the acid balance of the vagina. Women who have just had a baby and are breastfeeding also have a drop in estrogen. These symptoms also occur in women who have had their ovaries removed or are taking certain medications .

    The first sign of vaginal atrophy is usually a decrease in vaginal lubrication.

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    Is My Heavy Bleeding Just A Normal Part Of Menopause

    The most common cause of heavy periods during menopause is hormonal imbalance. During the beginning of a normal menstrual cycle, a hormone called follicle stimulating hormone rises which stimulates follicles to mature in the ovaries. Many follicles are stimulated during a cycle and these follicles produce oestrogen which is required to thicken the lining of the womb . Only one follicle will be mature enough to be ovulated.

    As there is a decline in the number of follicles at perimenopause, the body tries to recruit as many as possible at the beginning of the cycle. It does this by increasing FSH levels. This part of the cycle can take longer than usual as it becomes harder to recruit eggs. There is an increase in oestrogen from the many follicles stimulated. These higher levels of oestrogen act on the endometrium during the long stimulation period, making it thicker and resulting in heavy periods.2

    Ovulation is required for a period to occur. The progesterone produced by the ovulated egg, and its subsequent withdrawal, is what causes a period. During the perimenopause, anovulation becomes more frequent. Thus there is still oestrogen production by the follicles causing the endometrium to thicken, but no progesterone. The endometrium only continues to thicken. Eventually the lining outgrows its blood supply and breaks down, resulting in shedding which women see as irregular and/or prolonged and/or heavy bleeding.

    Can Fibroids Cause Bleeding After Menopause

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    Dr. Jessie: Yes, although this is unusual. Most fibroids shrink after menopause and become less symptomatic than they were prior to menopause.

    Fibroids that are pushing in to the cavity of the uterus can certainly cause post-menopausal bleeding, but I usually see this in patients who are in their early 50s they think they are not menopausal because they continue to bleed, but the bleeding is actually coming from the fibroid and not a hormonal cycle.

    I dont usually see bleeding from fibroids starting up when a woman is already well in to menopause. If you know you have fibroids and are having bleeding after menopause, I would definitely recommend a visit to your doctor rather than writing the symptoms off as coming from the fibroids. Very rarely, women can develop a fibroid-related uterine cancer called a sarcoma.

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    Fifth: Increase Intake Of Key Nutrients

    A combination of nutrient deficiencies can really keep you trapped in the cycle of heavy bleeding. Even if you try to get all your nutrients through food alone, you WILL come up short.Here are the top 3 supplements I recommend for women in perimenopause who are consistently experiencing heavy bleeding:

    • Magnesium Magnesium is the PERFECT tool to give you quick wins during your period and throughout the month. It acts as a gentle muscle relaxant to reduce pain during your period and it may even help lighten your flow! Plus it helps you sleep, handle stress better, and keep your hormones in an ideal balance. Not all magnesium supplements are effective, so !
    • IronIf you bleed heavily for more than a couple of cycles in a row, adding iron supplements can help ward off anemia due to blood loss. If you feel especially tired and lethargic, or if you have symptoms like thinning hair, reduced thyroid function, or cold hands and feet, you should definitely consider adding iron to your daily regimen!
    • Vitamin DIf you are a typical woman in the US, you arent getting enough vitamin D. And if you are dealing with heavy or painful periods, adding vitamin D is an easy fix to get you feeling better, faster! Studies show that vitamin D deficiency and menstrual problems go hand-in-hand, and especially during perimenopause, this vitamin becomes essential to help govern your energy, mood, sleep, immunity, hormones, and more. Get my recommended vitamin D supplement here .

    Can Vaginal Atrophy Be Prevented

    A womans body naturally secretes less estrogen with age. This cannot be prevented. Without intervention, its unlikely that the ovaries will make more of the hormone.

    However, there are ways to keep vaginal atrophy from getting worse. Avoid tight-fitting clothing, panty liners, perineal pads and any of the following that you may find irritating to your vagina:

    • Perfumes.

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    How Are Uterine Polyps Treated

    Treatment may not be necessary if the polyps do not cause any symptoms. However, polyps should be treated if they cause heavy bleeding during menstrual periods, or if they are suspected to be precancerous or cancerous. They should be removed if they cause problems during pregnancy, such as a miscarriage, or result in infertility in women who want to become pregnant. If a polyp is discovered after menopause, it should be removed.

    Methods of treatment include the following:

    Its Always Disconcerting To Have Unexpected Vaginal Bleeding But Its Particularly Unsettling When It Occurs Years After Your Uterus And Ovaries Have Closed For Business And You No Longer Possess A Pad Or A Tampon Its Not Just About Making The Midnight Run For Sanitary Products Its That Stomach

    Bleeding After Menopause

    Its always disconcerting to have unexpected vaginal bleeding, but its particularly unsettling when it occurs years after your uterus and ovaries have closed for business and you no longer possess a pad or a tampon. Its not just about making the midnight run for sanitary products, its that stomach-dropping fear that blood equals cancer that causes women to spend hours searching the Internet for reassurance. In spite of the fact that most women imagine the worst, in the majority of cases, postmenopausal bleeding is not an indication of anything serious.

    So, if you see red and youre not supposed to what next?

    The first step is to determine where the blood is coming from. Blood on the toilet paper can be coming from the vagina, rectum or bladder, and while it seems as if the source should be obvious, its not always easy to know. When in doubt, put a tampon in . If the tampon stays white but there is blood in the toilet bowl, its most likely coming from the rectum or bladder and a visit to your primary care doctor is in order.

    So, short of cancer, what causes most postmenopausal bleeding?

    A bloody vaginal discharge is commonly due to dryness and thinning of vaginal tissue from lack of estrogen. Vaginal infections such as yeast or bacterial vaginosis are another culprit.

    Since uterine cancer is usually diagnosed in its early stages , there is a high cure rate. In fact, the five-year survival for women diagnosed with a Stage I cancer is 96%.

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    How Exercise Affects The Uterus

    Then she switches gears a bit, and explains further. Your uterus is a muscle. It can sense dehydration. It can cramp like other muscles. When you do strenuous exercise, you can cause your uterus to cramp, and this causes the spotting. Wow. Im embarrassed that I hadnt known that the uterus was a muscle. Then again, I never had a health or science class cover this material which would have been great to know, as a woman. But, I know this now, and am grateful.

    Then Dr. Wright addresses the CrossFit. Take something like CrossFit. CrossFit is lots of motion, so even in that friction that motion can result in some spotting. This makes sense. She continues, Other patients have cramping after exercise. That can just be a normal uterine muscle response.

    The connection that I had noticed years ago is completely accurate, but not for the reasons I understood. Wright is able to help me see that strenuous exercise isnt making my endometriosis worse exercise is not causing the endometriosis to grow faster or in greater amounts.

    Rather, the exercise was simply putting a strain on the muscles of the uterus, which form a lining of blood and mucosal tissue every month. Agitation of those muscles disrupts that natural process.

    How Is Endometrial Hyperplasia Diagnosed

    Many conditions can cause abnormal bleeding. To identify whats causing symptoms, your healthcare provider may order one or more of these tests:

    • Ultrasound: A transvaginal ultrasound uses sound waves to produce images of the uterus. The images can show if the lining is thick.
    • Biopsy: An endometrial biopsy removes tissue samples from the uterus lining. Pathologists study the cells to confirm or rule out cancer.
    • Hysteroscopy: Your provider uses a thin, lighted tool called a hysteroscope to examine the cervix and look inside the uterus. Your provider may perform this procedure along with a dilation and curettage or biopsy. Its most advantageous to couple this with a visually directed dilation and curettage of the endometrium. With hysteroscopy, your provider can see abnormalities within the endometrial cavity and take a targeted biopsy of any suspicious areas.

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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.


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