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What Does It Mean If Your Bleeding After Menopause

What Causes Abnormal Uterine Bleeding

What Does Spotting During Menopause Mean?

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.

Menopause Symptoms Can Feel Like Pms

Some women develop symptoms of Premenstrual Syndrome for the first time or have more acute;levels of their normal;PMS. These symptoms can be physical, psychological, or emotional. Most of us will have had some level of PMS during the second half of the monthly cycle over the years. Symptoms may have been getting stronger during your 30s and 40s, approaching menopause. Most common symptoms are irritability, aggression, tearfulness, mood swings, breast pain;and fluid retention.

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What Is Postmenopausal Bleeding

Vaginal bleeding any time more than 12 months after your last period counts – although obviously not if you’re taking hormone replacement therapy .

If you’ve been taking HRT, you shouldn’t bleed more than four weeks after you stopped it. If you do, this too is postmenopausal bleeding . It can also be surprisingly difficult to work out where the bleeding is coming from – many women are found to have bleeding from their back, not their front, passage, and blood in the urine can also cause confusion.

Whatever the cause, it’s always worth getting PMB checked out. Fortunately, the vast majority of women can be reassured that there’s nothing to worry about. But PMB can be a symptom of cancer of the lining of the womb. If it is, getting treatment early can make all the difference to your likelihood of a long and healthy survival.

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What Underlying Conditions May Cause Prolonged Menstrual Bleeding

A visit with your gynecologist or other healthcare professional is the first step in determining the cause of your prolonged menstrual bleeding. Your doctor will make a diagnosis after performing a series of tests.

Depending on your age and other symptoms, your doctor may test your blood for pregnancy, hormone levels, and thyroid function. Other diagnostic tests may include Pap smears, endometrial biopsies, ultrasounds, and other procedures.

Medical conditions that could be the cause of abnormal menstrual bleeding include:

Why Is Sex Painful For Some Women After Menopause

What Does it Mean If You

When sex is painful after menopause, it’s usually because of dryness or vulvovaginal atrophy. Mild dryness that is only bothersome during intercourse can be treated with increased use of vaginal lubricants. More significant pain or dryness may require treatment with local estrogens or other medications.

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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.

Bleeding After Menopause Dont Ignore It

Before you reach menopause, chances are youll experience some irregular bleeding patterns. After menopause, any bleeding is reason to see your healthcare provider. Heres why.

Bleeding after menopause or postmenopausal bleeding is when vaginal bleeding resumes at least six months after a woman experiences her last menstrual period. If it happens to you, see your healthcare provider to determine the cause, since bleeding in post-menopausal women can sometimes be a sign of endometrial cancercancer in the lining of the uterusand its critical to catch it early.

Causes of bleedingNot all post-menopausal bleeding signals cancer. Still, if you experience it, see your healthcare provider, who will review your health history, do an exam and perform tests to explore all the potential causes of bleeding, including:

  • PolypsUsually noncancerous growths that attach to the uterine wall or develop on theuterine lining. Polyps can also grow on the cervix the narrow end of the uterus that protrudes into the vagina and may cause bleeding after sex.
  • Endometrial hyperplasiaExcess estrogen without enough progesterone can lead to a thickening of the uterine wall that can also cause bleeding. In some cases, the cells of the lining become abnormal and can lead to cancer of the uterus.
  • Endometrial atrophyLower estrogen levels can result in uterine wall thinning that can cause bleeding.

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Whats The Difference Between Vaginal Atrophy And A Yeast Infection

Both vaginal atrophy and yeast infections can have symptoms of dryness, itching, redness and pain. However, vaginal atrophy is caused by a lack of estrogen while a vaginal yeast infection is caused by a fungal infection. Consult with your healthcare provider regarding symptoms so that you, together, can determine what condition you have.

The Diagnostic Process May Involve Multiple Steps

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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.

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Bright Red Blood After Menopause

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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.

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What Can I Expect If Ive Been Diagnosed With Vaginal Atrophy

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.

What Causes Vaginal Atrophy

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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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What Are The Complications Of Endometrial Hyperplasia

All types of hyperplasia can cause abnormal and heavy bleeding that can make you anemic. Anemia develops when your body doesnt have enough iron-rich red blood cells.

Untreated atypical endometrial hyperplasia can become cancerous. Endometrial or uterine cancer develops in about 8% of women with untreated simple atypical endometrial hyperplasia. Close to 30% of women with complex atypical endometrial hyperplasia who dont get treatment develop cancer.

Hormonal Changes In Menopause

As people with ovaries age, they have fewer and fewer eggs over time. They also have fewer ovarian follicles, which produce hormones that help regulate the menstrual cycle and other reproductive systems. Early on in perimenopause, the body can compensate for the loss of follicles. Over time, however, that becomes less possible.

During the early stages of menopause, there are intense fluctuations in estrogen. These fluctuations cause many of the symptoms associated with menopause, including sleep problems and hot flashes. As menopause proceeds and people move into postmenopause, estrogen levels permanently drop and stabilize at a lower level.

Testosterone levels also drop during and after menopause. However, this decline occurs more slowly than the changes in estrogen. Therefore, changes associated with reduced testosterone levels may not be as noticeable.

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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.

How To Bring It Up To A Healthcare Professional

Menopause Bleeding HELP!

Mention symptoms of perimenopause to a healthcare professional as soon as you begin noticing them. This can go a long way toward helping you get relief.

That said, theres no denying many professionals dismiss milder symptoms or seem disinterested in making the effort to understand your distress. This can be disheartening but dont feel obligated to continue seeing a doctor who doesnt respect your understanding of your own body.

If possible, consider seeking out a healthcare professional you can trust who truly listens and works to help you find relief.

If thats not an option, keep restating your concerns until they listen. Be clear and specific about:

  • symptoms you experience
  • how symptoms affect your life
  • the methods youve tried to find relief

It may help to keep a daily diary, noting:

  • physical symptoms
  • mood changes and mental health symptoms
  • self-care strategies or home remedies youve tried

Bring this diary to your appointments, so you can show your doctor.

The most important tool for navigating thoughts of death and suicide is connection and support, Botnick says.

Support might include:

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When To See A Doctor

If your period lasts longer than a week, consider calling a doctor for advice. Depending on your symptoms, they may suggest setting up an in-person appointment for a physical exam.

On the other hand, if you think youre showing symptoms of a rare cause or if youre pregnant, see a doctor immediately.

If you experience severe heavy bleeding and youre soaking through four or more pads and tampons in a 2-hour period, go to an emergency room right away.

How Can Birth Control Or Menopause Affect The Duration Of Your Period

Birth control pills generally help with prolonged menstrual bleeding, but on occasion may cause it. IUDs, especially copper IUDs, sometimes cause prolonged bleeding, especially in the first year after insertion.

Women in perimenopause, the years leading up to menopause, frequently find their periods changing. Still, even if youre perimenopausal, you want your doctor to check things out. Long or irregular bleeding may just be from perimenopause. But it is also often our first clue of endometrial cancer or cervical cancer, she says.

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What Treatments Are Available To Help With Postmenopausal Bleeding

The treatments for bleeding after menopause vary depending on whatâs causing the issue, which is why itâs so important to get the right diagnosis.

  • Doctors can remove polyps using a minimally invasive procedure called hysteroscopy.
  • Medications and hormone replacement therapy can treat vaginal and endometrial atrophy.
  • Progesterone hormone therapy is an effective treatment for endometrial hyperplasia.
  • Dilation and curettage can also help with endometrial hyperplasia by removing the excess tissue from inside the uterus.

If cancer is responsible for the abnormal bleeding, your doctor can treat it with a hysterectomy. This surgical procedure involves removing the uterus. In some cases, your doctor may also recommend removing the cervix, fallopian tubes, and ovaries as part of the hysterectomy.

Related: The benefits of progesterone after menopause

Learn more about your postmenopausal health with the Everlywell at-home Postmenopause Test. This postmenopause test can help you to understand if your postmenopausal bleeding is caused by imbalanced hormone levels by allowing you to easily check your estradiol and progesterone levels from the comfort of home.


1. What Is Menopause?. National Institute of Aging. URL. Accessed March 25, 2021.

2. Bleeding after menopause: Is it normal?. Mayo Clinic. URL. Accessed March 25, 2021.

3. Bleeding after menopause: Get it checked out. Harvard Medical School. URL. Accessed March 25, 2021.

Estrogen And Skin Health

Endometriosis brown discharge + Cppc2013 Menopause 3Cc2c2

During your reproductive years, the hormone estrogen helped keep your skin healthy and supple. Once estrogen production slows down, your skin thins and dries out, especially in sensitive areas like your face.

The loss of estrogen can show on your skin starting in perimenopause, which is the period leading up to menopause when hormone levels start to decline.

During this time, your body becomes more sensitive to temperature. You may have episodes in which you suddenly feel hot and sweaty, and your face gets red and flushed. This common menopause symptom is called a hot flash.

A lack of estrogen can also make your skin itch or cause it to be more sensitive than usual. This sensitivity makes you more likely to get a rash or hives when youre exposed to irritating substances like itchy fabrics, perfumes, and dyes.

A lack of estrogen also prevents your skin from

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Are There Any Complications From Having A Long Menstrual Period

Often, the biggest problem from having a long menstrual period is the way it impacts your quality of life. If this is the case, dont be shy about exploring ways to change your cycle with your doctor.

Its okay to treat something simply because its a bother. Women dont have to live that way, Thielen says

And since blood is rich in iron, women who bleed a lot are at risk of anemia, she says.

Is It Normal For A Period To Not Stop

For some women it may seem as if the bleeding literally doesnt stop, continuing through the entire month. But this isnt usually the case.

Since the time between cycles is counted from the first day of your period, a woman who has a 24-day cycle with eight days of bleeding will experience only 16 days period-free. It may seem like youre always having your period even though youre within a standard timetable.

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Vaginal Bleeding After Menopause

Once menopause;begins, vaginal bleedingwhether occasional spotting or more significant in volumeis;considered;abnormal.;;

To identify the cause of the bleeding, your;doctor will likely perform a speculum exam;and;a pelvic ultrasound.;Because most;causes of postmenopausal bleeding are identified via tissue,;he or she will;take a;small;sample;from;the affected area.;;

What;causes;abnormal;vaginal bleeding?;There are;many;potential;reasons for;post-menopausal vaginal bleeding, including these;common causes:;

Endometrial Atrophy:;Menopause naturally causes a decrease in estrogen and progesterone levels. This drop;leads;to a thinning of the endometrium. While this thinning is normal, it can sometimes;become too severe,;which results in;vaginal bleeding.;

Bleeding caused by endometrial atrophy is often treated with estrogen. For women already on hormone replacement therapy;,;a simple;adjustment in dose;may;prevent further;issues.;

Benign Cervical or Uterine Polyps:;Benign polyps can grow in the uterus or cervix;at any time, but due to the;changes in estrogen levels that;occur;during perimenopause and early menopause, these;polyps are more;common;for;women in their 40s and 50s.;;

Atypical Endometrial Hyperplasia:;While;decreased estrogen and progesterone levels can cause excessive thinning of the endometrium,;increased;levels of these hormones;may;cause the endometrium to thicken.;;

What Can A Gynecologic Oncologist Offer That My Ob/gyn Does Not

Menopause and You: Abnormal Bleeding

Gynecologic oncologists treat cancer exclusively. That means they have experience a regular OB/GYN doesnt.

A lot of our surgeries require you to do a little more, King said. Take, for example, cervical cancer. It requires a careful dissection of areas around the organs. It requires technical skills that a general OB/GYN doesnt have. Sometimes theres a lot of bowel surgery involved too.

Couldnt a surgeon do this procedure with the assistance of a gynecologist?

They could, King said. But they might not know the right time to do the surgerywe know when to do it and when to hold off and not do it. We understand the disease, and we weigh the risks and benefits, she said. If you dont deal with a particular cancer all the time, you dont know. We have a better feel for what to do in certain situations because we do this every day.

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