What Does It Mean If You’re Bleeding After Menopause?
Menopause involves the end of an individual’s period, so experiencing bleeding or spotting after the menopausal transition can be concerning. But is postmenopausal bleeding anything to worry about? How can it be addressed? There are several potential causes of bleeding following menopause. While, typically, it does not signal the existence of a serious concern, postmenopausal bleeding is not normal. And experts recommend consulting with a healthcare professional if it happens to you. In this article, we’ll cover some of the common reasons people experience postmenopausal bleeding, various methods of identifying these complications, and steps that may be taken manage underlying sources.
Causes of postmenopausal bleeding
During the menopausal transition, decreases in the hormones estrogen and progesterone and the end of ovulation can lead to hot flashes, night sweats, weight fluctuations, and other symptoms. These menopausal symptoms may persist into postmenopause, which starts one year after an individual’s final period.
Postmenopausal bleeding can have several different sources, some of which may be dangerous if left unaddressed. Below are several potential causes of postmenopausal bleeding.
Polyps
These are growths that can appear in areas of the reproductive area, such as your uterus or cervix. Despite often causing heavy bleeding—including after sex—polyps are usually benign. In some cases, however, they may be cancerous or grow in such a way as to complicate important functions, which would necessitate their removal.
Endometrial atrophy
The endometrium is the tissue that lines the inside of the uterus. It reacts to the presence of estrogen and other hormones, which is how it plays a key role in menstruation. Since menopause involves a steady decline in estrogen levels, the lining of the endometrium can thin and cause bleeding over time.
Endometrial hyperplasia
This is the opposite of atrophy; it involves the lining of your uterus getting too thick. Sometimes, menopause can cause the body to produce excess estrogen and an insufficient amount of progesterone, which can cause the endometrium to grow in abnormal ways. Endometrial hyperplasia is considered a precancerous condition, potentially leading to the development of endometrial cancer.
Vaginal atrophy
The reductions in estrogen that often occur during and after menopause can cause changes in the vaginal tissue. Vaginal walls may become thinner, dryer, or inflamed, which may result in frequent bleeding, particularly after sex.
Cancer
In some cases, postmenopausal vaginal bleeding can be a sign of cancer, particularly endometrial, vaginal, cervical, or uterine cancer. While cancer is considered the most serious cause of bleeding post menopause, it is also thought to be the most unlikely.
Sexually transmitted infections
Sexually transmitted infections (STIs) can cause vaginal bleeding at any age. Chlamydia, gonorrhea, herpes, and other STDs can lead to inflammation and other complications that may cause postmenopausal bleeding.
Side effects of medication
The adverse effects of some medications can include postmenopausal bleeding. Research shows that up to 70% of women taking blood thinners experience vaginal bleeding. Additionally, the drug tamoxifen—which is typically used to treat breast cancer—can create several different complications that may lead to postmenopausal bleeding. And forms of treatment that may be used during menopause, such as hormonal therapy, can themselves cause vaginal bleeding. Always consult with a healthcare professional prior to starting or stopping any medication.
Diagnosing postmenopausal bleeding
To pinpoint the potential sources of postmenopausal bleeding, your doctor may conduct a series of tests using various diagnostic tools, including:
- Transvaginal ultrasound: This involves looking for growths as well as examining the endometrium for signs of thickness. During a transvaginal ultrasound, a healthcare professional typically places a small probe inside of the individual’s body to create sound waves that can help map out their internal anatomy.
- Endometrial biopsy: This involves the use of a thin tube to gather a small sample of tissue from the uterus. The tissue will then typically be sent to a lab where it will be checked for signs of cancer or infection.
- Saline infusion sonogram: Also called a sonohysterogram, this test helps doctors spot polyps and determine their size. It involves putting a saltwater mix in the uterus to make it easier to conduct a detailed ultrasound that can reveal potentially problematic polyps.
- Dilation and curettage: Also known as D&C, this procedure involves opening the cervix and scraping the lining of the uterus in order to obtain a sample, which can then be sent to a lab to test for any irregularities.
Treating postmenopausal bleeding
If your doctor has determined what may be causing your postmenopausal bleeding, they may recommend a treatment plan that will address the root of the problem. Below are some common forms of treatment you may encounter.
Estrogen therapy
Often, vaginal bleeding is caused by elevated or reduced estrogen levels. Estrogen therapy can help balance these levels to avoid complications like vaginal thinning or endometrial hyperplasia. Estrogen can be taken in different ways, including:
- Estrogen pills, which can be taken orally
- Vaginal creams, which can deliver the estrogen as directly as possible
- Vaginal rings, which can release estrogen into the body for several months
- Vaginal tablets, which can be inserted on a regular basis to deliver a dose of estrogen
Hysteroscopy
If polyps are causing bleeding and need to be removed, a hysteroscopy is a common next step. This involves using a telescoping tool known as a hysteroscope to remove the tissue in question. For those with endometrial hyperplasia, a hysteroscope can also be used to remove the excess lining and help the endometrium return to its normal state.
Dilation and curettage
As with the diagnostic procedure of the same name, when dilation and curettage is employed to remove potentially harmful growths, it typically involves opening up the cervix. Here, though, a healthcare professional typically uses a tool to help get rid of polyps or the thickened growth of an individual’s uterine lining.
Hysterectomy
A hysterectomy is a surgery that removes the uterus or at least part of it. This is typically how cervical or endometrial cancers are treated. A hysterectomy may also be required in cases of endometrial dysplasia that may develop into cancer. It can involve removing lymph nodes, ovaries, fallopian tubes, and so on.
Chemotherapy and other cancer treatments
If bleeding arises due to cancer, treatment may consist of common methods like chemotherapy. Depending on the type of cancer and how advanced it is, other options may also be available.
Medicine
If postmenopausal bleeding is due to an infection or an STD, certain medications may be able to help. Antibiotics, for instance, may be used to kill the bacteria that can cause an infection.
How online therapy can help
Research suggests that online therapy can help individuals better manage the challenges of menopause. For example, in one study, researchers found that online therapy led to reductions in the perceived impact of menopausal symptoms while also improving participants’ sleep quality. The study also notes the ability of online therapy to avoid common barriers to treatment, including geographical limitations and time constraints.
Online therapy can provide you with comprehensive, flexible mental health care as you address the emotional and practical concerns that can accompany menopause. With an online therapy platform like BetterHelp, you can work with a therapist remotely, which may be helpful if you’re not comfortable discussing potentially sensitive topics like menopause in person. BetterHelp can match you with a therapist based on your needs and preferences, so you’ll have a good chance of connecting with someone who understands what you’re going through and can provide you with the support and guidance you deserve.
Takeaway
What are the top reasons for bleeding after menopause?
There are several possible causes for bleeding after menopause. Some examples include:
- Uterine polyps: Uterine polyps, such as endometrial polyps, can grow in the uterus and other areas of the reproductive system, causing bleeding. Although polyps are usually harmless, they can sometimes be made of cancerous cells.
- Endometrial hyperplasia: Endometrial hyperplasia causes the uterine lining to get too thick, which can lead to bleeding. This is usually due to having too little of the hormone progesterone and too much of the hormone estrogen.
- Vaginal atrophy: Changes in reproductive hormones after menopause can cause vaginal dryness. This may lead to irritation and bleeding.
- Sexually transmitted diseases: Some STDs, like gonorrhea and chlamydia, can cause vaginal bleeding, even after menopause.
- Hormone replacement therapy: Some people may take hormone therapy to manage the side effects of menopause, like hot flashes and trouble sleeping. In some cases, these treatments can cause bleeding.
Is it normal to bleed a few years after menopause?
Although bleeding after menopause isn’t typically a sign of something serious, it is not considered normal, even if it’s only light spotting. For this reason, it is usually recommended to see a doctor to rule out anything serious and, if needed, get the postmenopausal bleeding treated.
When should I go to the doctor for bleeding after menopause?
Bleeding after menopause, although often nothing serious, can also be a sign of something more concerning. That’s why, if you notice any bleeding after menopause, it is generally recommended not to wait to see a doctor. Your doctor might want to perform a pelvic exam, including a careful evaluation of the vagina, uterus, and cervix. They might also want to take a tissue sample to check for abnormal cells or use an ultrasound to get a better view of your reproductive system.
What color is postmenopausal bleeding?
Postmenopausal bleeding can vary in color. It may be bright or dark red, like during a regular period, but it can also be brown, maroon, pink, or black.
What is the best treatment for postmenopausal bleeding?
The best treatment for postmenopausal bleeding depends on what’s causing it. Once your doctor diagnoses the cause, they might refer you to a specialist, like an endocrinologist (for hormone-related issues) or a gynecologic oncologist (for certain types of cancer). A specialist may recommend treatments such as:
- Hysteroscopy: A hysteroscopy is a procedure used to remove uterine polyps. It is also sometimes used to treat endometrial hyperplasia.
- Antibiotics: Antibiotics are a medication that may be used to treat STDs or infections.
- Hysterectomy: A hysterectomy is a type of surgery that removes all or part of the uterus.
If you are experiencing postmenopausal bleeding, a trained medical professional may be able to recommend the best course of action.
How much bleeding is normal during menopause?
To answer this question, it may be worth clarifying the difference between perimenopause and menopause.
Perimenopause is the period of time leading up to menopause, which tends to come when a woman is in her mid to late forties. Many of the symptoms often associated with menopause, like irregular menstrual periods and hot flashes, are actually happening during perimenopause.
Menopause is the period of time after a woman’s reproductive years have ended. You know you’ve officially reached menopause when more than 12 months have passed since your last menstrual period.
Unlike perimenopausal bleeding, which can sometimes be normal if you still get periods, bleeding is not considered normal once you have reached menopause.
What is abnormal uterine bleeding in old age?
“Abnormal uterine bleeding” describes any irregular form of uterine bleeding. In general, any amount of uterine bleeding after menopause is considered abnormal.
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