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What Causes Menstrual Bleeding After Menopause

What Is Postmenopausal Bleeding

Bleeding After Menopause

Postmenopausal bleeding is bleeding that occurs after menopause. Menopause is a stage in a womans life when reproductive hormones drop and her monthly menstrual periods stop. Vaginal bleeding that occurs more than a year after a womans last period isnt normal. The bleeding can be light or heavy.

Postmenopausal bleeding is usually due to benign gynecological conditions such as endometrial polyps. But for about 10% of women, bleeding after menopause is a sign of uterine cancer . Uterine cancer is the most common type of reproductive cancer Talk to your healthcare provider if you experience any bleeding after menopause.

What Is The Menopause And What Is Menopause Age

Menopause is when a womans menstrual cycle stops permanently. Once in this stage, a woman can no longer become pregnant. The time leading up to this event is actually called perimenopause. During perimenopause, periods grow infrequent.

Menopause is confirmed 12 months after your last period. Bleeding after this point is called postmenopausal bleeding and it is considered abnormal bleeding. This stage usually occurs between the ages of 45 and 55.

Postmenstrual Bleeding Treatment Options

Treatment options for postmenopausal bleeding will largely depend on whats causing your symptoms. Estrogen therapy can be used to treat conditions such as vaginal and endometrial atrophy. Progestin therapy, on the other hand, is used to treat endometrial hyperplasia.

Polyps can be removed during a hysteroscopy, or they might require surgery. Cancer and severe cases of endometrial hyperplasia can require a hysterectomy. If youre diagnosed with cancer, your doctor will discuss several options with you, including chemotherapy, radiotherapy, and hormonal treatments.

As with most other conditions, the most important step when it comes to postmenopausal bleeding is to get an early diagnosis. Once you know whats causing your symptoms, you and your doctor will be able to discuss treatment options and decide on the best course of action for your individual case.

Discovering that youre bleeding after menopause can be scary, but in most cases, the underlying condition can be treated with simple therapeutic options. Ensuring your wellbeing and overall health should always be your main concern.

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Rare Causes Of Postmenopausal Spotting

Other potential causes of postmenopausal bleeding include:

  • Infection of the uterine lining, known as endometritis
  • Injury to the vagina from the insertion of foreign objects or sexual trauma
  • Some medications, such as tamoxifen for breast cancer or blood-thinning medications
  • Sexually transmitted infections such as chlamydia, gonorrhea, and herpes can cause postmenopausal bleeding.
  • Menopausal hormone replacement therapy
  • In some cases, cancer of the cervix and vagina can also cause postmenopausal spotting.

What You Should Know About Bleeding After Menopause


How can this be? You thought your periods ended long ago. Youve been through menopause and moved to the next chapter of your life. But now youre bleeding again.

If youre experiencing any type of bleeding or spotting after youve reached menopause, its wise to consult your doctor for answers, says Jerrid Neeley, D.O., OB-GYN with Riverside. Bleeding after menopause is not normal. You may be having certain medical issues that we can treat fairly easily. In other cases, bleeding after menopause is a sign of cancer, and we cant ignore it.

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Bleeding After Menopause: Its Not Normal

    Too often I see women with advanced endometrial cancer who tell me they experienced postmenopausal bleeding for years but didnt think anything of it. This shows we need to do a better job educating our patients about what to expect after menopause.

    Women need to know postmenopausal bleeding is never normal, and it may be an early symptom of endometrial cancer. Any bleeding, even spotting, should trigger a visit to your doctor as soon as possible. Dont wait to make an appointment until after the holidays or even next week. Do it today.

    Why Am I Bleeding Between My Periods

    Bleeding between periods can be caused by serious or benign causes. The most dangerous causes often involve pregnancy. A failed pregnancy, a pregnancy in which the egg implants in the fallopian tube, disconnection of the placenta from the uterus, or damage to the uterus can all cause bleeding. If you suspect any of these causes, you should seek medical evaluation as soon and as safely as possible. Otherwise, uterine fibroids, tumor, blood thinners, ruptured ovarian cysts and gynecological infections, and changes in contraceptive drugs can cause spotting.

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    Why Am I Experiencing Vaginal Bleeding After Menopause

    Vaginal bleeding after menopause may be due to medications, hyperplasia of the uterus, or some types of uterine cancer. Certain medications containing estrogen or progesterone can cause either hyperplasia or an increase in the amount of tissue in the uterus, which may cause bleeding or an excess sloughing off of tissue both of which will be seen as vaginal bleeding.

    Is Spotting Between Periods Normal

    Menopause & You: Bleeding After Menopause

    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.

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    How Do Doctors Treat Abnormal Bleeding After Menopause

    If you do not have cancer, doctors can use a variety of methods to treat your bleeding depending on the cause.

    If bleeding is caused by polyps, doctors can remove them with surgery. If the lining of the uterus is too thin, medications can help. If the uterine lining is too thick, doctors might prescribe a synthetic hormone called progestin, which causes the lining to shed. Or, your doctor may treat a thick uterine lining with a D& C procedure.

    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.

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    What Tests To Expect During Diagnosis

    As mentioned, you should visit your doctor if you experience postmenopausal bleeding. Mostly, you will be referred to a hospital for testing, which will help to ascertain the exact cause of the bleeding. Some tests to expect can include:

    • An ultrasound scan of the vaginal region
    • An examination of the pelvic region
    • Endometrial biopsy, which involves testing samples of your uterus lining
    • Hysteroscopy, a test involving the use of a camera

    Prevention Of Bleeding After Menopause

    Unusual Vaginal Bleeding

    In order to prevent bleeding after menopause, the best way is to reduce the risk factors that lead to it. The other preventive methods are:

    • Use of pads and regular change of pads during menstruation which reduce the chances of infection.
    • Safe and hygienic sexual intercourse and use of condoms to avoid sexually transmitted diseases that can cause bleeding after menopause
    • Constantly watching over vaginal dryness and maintaining accurate pH levels
    • Maintaining a healthy body to avoid obesity by exercise and healthy diet
    • Regular checkups with gynecologists to ensure a healthy uterus
    • Treatment for Postmenopausal bleeding should be done early to prevent cancer.

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    Why You Should See A Gynecologic Oncologist

    When postmenopausal bleeding is diagnosed as endometrial cancer, most cases can be cured with a hysterectomy. However, because endometrial cancer can spread into the lymph nodes, many patients also should have a lymph node dissection at the time of hysterectomy. Gynecologic oncologists are specifically trained to perform this procedure when it is indicated.If only a hysterectomy is performed and it turns out the lymph nodes are at risk, were left with difficult decisions. Should the patient start radiation therapy, or should she go back into the operating room to perform the lymph node dissection? Seeing a gynecologic oncologist immediately after diagnosis can avoid these complications, simplifying care and improving the chance of survival.Its not always easy to travel to a gynecologic oncologists office. Dallas-Fort Worth residents are lucky in this respect, as there are a number of us in the area. I have patients who come from several hours away because were the closest available clinic. While making the trip to see a gynecologic oncologist may be inconvenient, its important for your care.

    What Causes Abnormal Uterine Bleeding

    A variety of things can cause abnormal uterine bleeding. Pregnancy is a common cause. Polyps or fibroids in the uterus can also cause bleeding. Rarely, a thyroid problem, infection of the cervix, or cancer of the uterus can cause abnormal uterine bleeding.

    In most women, abnormal uterine bleeding is caused by a hormone imbalance. When hormones are the problem, doctors call the problem dysfunctional uterine bleeding, or DUB. Abnormal bleeding caused by hormone imbalance is more common in teenagers or in women who are approaching menopause.

    These are just a few of the problems that can cause abnormal uterine bleeding. These problems can occur at any age, but the likely cause of abnormal uterine bleeding usually depends on your age.

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    Bleeding In A Woman Taking Mht

    Bleeding on cyclical MHT

    In the woman who is taking cyclical MHT, a withdrawal bleed is expected and the patient should be counselled to expect it. It should come toward the end of or after the progestogen containing phase of the cyclical regimen. Bleeding which is unpredictable, occurring not at the expected time, or excessively heavy should be investigated.

    Bleeding on continuous combined MHT

    Continuous combined MHT contains oestrogen and progestogen throughout the month and is designed to eliminate vaginal bleeding. Continuous exposure to progestogen downgrades oestrogen receptors in the endometrium whilst treating menopausal symptoms with oestrogen. In the postmenopausal woman taking CCMHT, the significance of breakthrough bleeding depends upon the recency of her LMP and on how long she has been taking CCMHT. A similar diagnostic and therapeutic approach applies to tibolone.

    Within 12 months of the last menstrual period

    Women who are within 12 months of the last natural menstrual period often do not achieve amenorrhoea with CCMHT, presumably because some residual endogenously oestrogen-stimulated endometrium is present. Unpredictable breakthrough bleeding is common in this situation and does not need investigation. To avoid this, it is recommended that cyclical MHT be used for the first 12 months at least following the LMP.

    After 12 months since the LMP and within six months of the institution of CCMHT

    After 12 months since the LMP and after six months of CCMHT

    There Are Several Potential Causes But Some Are More Serious Than Others

    Managing Abnormal Uterine Bleeding after Menopause – Dr. Mukta Nadig | Cloudnine Hospitals

    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.

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    How To Treat Postmenopausal Bleeding

    It is important to remember that bleeding at 60+ years old, bleeding after menopause bright red in color, having a period after menopause, and irregular spotting or vaginal bleeding after menopause are not normal occurrences and should be evaluated by your doctor. Depending on the cause of your spotting or bleeding, your doctor can assist in finding the right treatment or therapy for you or refer you to a gynecological oncologist.

    Treatments may include:

    The key to treating postmenopausal bleeding is preventative care and reducing your risk factors for the conditions that may cause it. For example, by treating endometrial atrophy early, you can prevent it from progressing into cancer, or you can have your doctor screen for conditions early before postmenopausal bleeding may even begin. University Park OBGYN recommends maintaining a healthy diet, regular exercise routine, and yearly visits to the doctor to prevent various health conditions and complications.

    Are You Really In Menopause What Is Perimenopause

    One possible explanation of a post-menopausal period is that youre still in perimenopause.

    During perimenopause, your menstrual cycles and periods gradually come to an end. The average length of perimenopause is 4 years and, during that time, your period can become irregular and there can also be irregular bleeding between periods.

    Just as periods maybe started out irregularly when you went through the changes of puberty, so they become irregular as you go through the changes of perimenopause. From a hormonal standpoint, perimenopause is characterized by irregular estrogen and progesterone levels.

    Because of this gradual change, many individuals are unsure when perimenopause ends. In medical terms, menopause is confirmed 12 months after a woman’s last period.

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    Why You Shouldnt Ignore Postmenopausal Bleeding

    A woman is considered to be in menopause after 12 consecutive months without a period. You may experience irregular bleeding leading up to menopause, a stage known as perimenopause. But once youre in menopause, all vaginal bleeding should stop.There are benign causes of postmenopausal bleeding. For 10 percent of women, however, the cause is endometrial cancer.Early diagnosis offers the best chance to beat endometrial cancer. I urge women to treat postmenopausal bleeding as cancer until proven to be something else. I dont say this to scare people, but a healthy amount of worry in this situation is warranted.

    What Changes In Menstruation Can You Expect

    6 Causes of Vaginal Bleeding after Menopause

    During perimenopause, your body undergoes a shift in progesterone and estrogen levels. Estrogen, specifically, rises and falls in an arbitrary manner, which in turn affects ovulation and menstrual cycles. Expect to see irregular periods, spotting, missed periods, and certain perimenopausal bleeding patterns.

    Major hormonal changes are largely to blame for symptoms, such as night sweats, hot flashes, sleep disturbances, and perimenopausal bleeding.

    Occasionally, youll notice heavier and longer periods , while at other times, youll notice lighter and shorter periods . Early perimenopause tends to produce shortened menstrual cycles as well as periods lasting 2 to 3 days less. In contrast, late perimenopause creates longer cycles , often associated with anovulatory menstruation .

    Furthermore, missed periods might sometimes be followed by normal periods as perimenopausal bleeding patterns and cycles are highly irregular. In this phase, menstrual blood ranges in color from dark brown to bright red. You might notice brown discharge or perimenopause brown spotting throughout the month. The texture of your discharge will also vary from thin and watery to thick and clumpy.

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    How Do I Manage Bleeding After Menopause

    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.

    How Do You Know The Cause Of Postmenopausal Bleeding

    • Identifying the cause of the bleeding can include the following:
    • Exam by your provider of the vagina and cervix.
    • Pap smear to check the cervical cells.
    • Ultrasound, usually using a vaginal approach, which may include the use of saline to make it easier to see any uterine polyps.
    • Biopsy of the endometrium or uterus. In this procedure, your healthcare provider gently slides a small, straw-like tube into the uterus to collect cells to see if they are abnormal. This is done in the office and can cause come cramping.

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    Causes Of Postmenopausal Bleeding

    There can be several causes of postmenopausal bleeding.

    The most common causes are:

    • inflammation and thinning of the vaginal lining or womb lining caused by lower oestrogen levels
    • cervical or womb polyps growths that are usually non-cancerous
    • a thickened womb lining this can be caused by hormone replacement therapy , high levels of oestrogen or being overweight, and can lead to womb cancer

    Less commonly, postmenopausal bleeding is caused by cancer, such as ovarian and womb cancer.

    What Happens At Your Gp Appointment

    Menopause Symptoms: Bleeding

    The GP should refer you to hospital or a special postmenopausal bleeding clinic. You should not have to wait more than 2 weeks to see a specialist.

    What happens at your hospital or clinic appointment

    A specialist, who may be a nurse, will offer you tests to help find out what’s causing the bleeding and plan any necessary treatment.

    The tests may include:

    • a small device being placed in your vagina to scan for any problems
    • an examination of your pelvis and vagina a speculum may be inserted into your vagina to hold it open, so the inside of the vagina and the cervix can be seen
    • a thin, telescope-like camera being passed up your vagina, through the cervix and into your womb to look for any problems and to take a tissue sample for testing under local or general anaesthetic
    • the specialist may press on your tummy and inside your vagina to check for lumps, tenderness or other abnormalities

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