Postmenopausal Bleeding: Causes, Symptoms & Treatment

Many women experience bleeding after menopause. It can be unsettling, which can cause worry or confusion. If your periods have stopped for a year or more, any spotting or bleeding should be evaluated by a doctor.

This is known as postmenopausal bleeding. It isn’t always a sign of a serious condition. At times, it indicates underlying issues such as hormonal changes, fibroids, uterine polyps, and more. We must, however, understand the potential causes and be aware of what to look out for. This helps with timely action and minimises the risk of complications in the future.

Remember, you are not alone. Many women experience this, and with proper medical guidance, most causes can be identified and effectively treated. This ensures peace of mind and overall well-being.

What is Postmenopausal Bleeding?

Vaginal bleeding that happens after menopause is known as postmenopausal bleeding. When a woman has not had her period for a full year, she is said to be in menopause. After menopause, vaginal bleeding is abnormal.

Postmenopausal bleeding is typically caused by benign (noncancerous) disorders and should not be taken seriously. However, bleeding following menopause is an early indicator of uterine cancer (cancer in the lining of your uterus) in 10% of women. If you have any bleeding after menopause, consult your doctor. To rule out major medical issues, they will want to do testing.

Symptoms of Postmenopausal Bleeding

Let’s check out the most common postmenopausal bleeding symptoms:

• Vaginal bleeding after menopause: This is the most common symptom, where you observe minor spotting or bleeding following a year without menstruation.
• Blood-stained discharge: Watery, pink, or brown vaginal discharge.
• Pelvic pain or pressure: Pain or pressure in the pelvic region or lower abdomen.
• Body pain: Pain in the lower back or hips that is dull or chronic.
• Unusual vaginal odour: Occasionally accompanied by changes or an infection.
• Vaginal dryness: You will observe tissue thinning (atrophy) or dryness that can cause pain during sexual activity.
• Weakness or fatigue: Due to unexpected blood loss, you can feel sudden weakness or fatigue.

Causes of Postmenopausal Bleeding

Since bleeding after menopause is not considered normal, it is essential to understand the causes or reasons that may result in it. Here are the common causes of postmenopausal bleeding:

• Inflammation and thinning of the lining in your vagina. This is also known as atrophic vaginitis.
• Thinning of the lining of your uterus is the most common cause of postmenopausal bleeding.
• Polyps are growths in the uterus or cervix that are typically not malignant
• Endometrial hyperplasia, or thicker endometrium, is frequently caused by abnormalities in the uterus or cervix brought on by hormone replacement therapy (HRT).

These issues can be cured relatively easily. However, there are some extreme cases (about 8-10%) where postmenopausal bleeding is linked to cancer of the cervix or uterus. Hence, any symptom needs to be investigated properly.

How is Postmenopausal Diagnosed

The differential diagnosis of postmenopausal bleeding begins with a thorough review of your medical history. It is followed by a physical examination by a gynecologist, in which experts review your menstrual history and medications. They also check for previous medical conditions that may affect hormone levels or the uterus.

A pelvic examination is performed to check for abnormalities in the vagina, cervix, or uterus. The doctor may then recommend several diagnostic tests:

1. Transvaginal Ultrasound – Also known as TVS, this imaging test helps doctors measure the thickness of the endometrial lining. In cases of a thickened lining, there is a risk of endometrial hyperplasia or cancer.
2. Endometrial Biopsy – In this test, a small tissue sample is collected from the endometrium, the inner layer of the uterus. Post that it is sent for analysis and to check for abnormal or cancerous cells.
3. Pap Smear – This test is used to screen for cervical cancer or precancerous changes, if any.
4. Blood Tests- Doctors recommend blood tests to confirm the imbalance in the hormone levels to rule out other diagnoses, such as ovarian issues or thyroid.

By identifying the underlying source of bleeding, these diagnostic procedures guarantee precise and prompt therapy. Postmenopausal bleeding can occasionally be a warning sign of serious disorders; thus, early evaluation is crucial.

Risk Factors in Postmenopausal Bleeding

There are some risk factors that can lead to postmenopausal bleeding in women. These include:

• Hormone Replacement Therapy (HRT)– If you are using estrogen or progesterone therapy, then it can, at times, lead to uterine bleeding.
• Endometrial Hyperplasia– In this condition, the uterine lining is thickened due to excess estrogen. This imbalance occurs due to the imbalance between progesterone and estrogen.
• Obesity- Women who are overweight are at high risk of postmenopausal bleeding because high fat levels can lead to increases estrogen production.
• Polycystic Ovary Syndrome (PCOS)- Women with a PCOS history may have prolonged exposure to unopposed estrogen.
• Diabetes and Hypertension- These conditions are linked with a higher risk of uterine abnormalities.
• Late Menopause- Women who have gone through menopause after age 55 have a longer lifetime exposure to estrogen, which can result in postmenopausal bleeding
• Family history of cancer- A history of uterine or ovarian cancer increases susceptibility.

Recognising these risk factors facilitates early detection and management of postmenopausal bleeding, leading to improved reproductive and overall health outcomes.

How Common is Postmenopausal Bleeding

Many women ask whether bleeding after menopausal is normal. In actuality, only 4–10% of women experience postmenopausal bleeding beyond menopause. Although vaginal dryness or hormonal changes might occasionally cause mild spotting, any bleeding after a year without periods should be examined by a physician. In rare instances, it may point to more serious illnesses like endometrial cancer or benign causes like polyps.

To rule out underlying problems and start timely therapy if necessary, early evaluation is essential. Although the majority of postmenopausal bleeding sources are not malignant, neglecting the symptom may cause dangerous diseases to go undiagnosed. Better reproductive health and peace of mind can be ensured through regular gynaecological examinations and an understanding of your body’s changes during menopause.

Treatment of Postmenopausal Bleeding

The reason for postmenopausal bleeding determines the course of treatment. The most popular postmenopausal bleeding treatments are medication and surgery.

Among the medications are:

• Antibiotics- The majority of illnesses are treated with antibiotics.
• Estrogen- Taking more estrogen reduces vaginal atrophy-related bleeding. Estrogen can be applied directly to your vagina as an insertable pill, ring, or cream. Pills and patches are two possible forms of systemic estrogen treatment. When you have systemic estrogen therapy, the hormone is distributed throughout your body.
• Progestin– Progestin causes your uterus to shed its lining in order to cure endometrial hyperplasia. Progestin can be administered as an intrauterine device (IUD), pill, injection, or cream.

Surgical treatment includes:

• Hysteroscopy– This procedure enables medical professionals to identify and address growths or polyps that are causing uterine haemorrhage. To gain a clearer view of your uterus, your doctor will put a hysteroscope—a tiny, illuminated tube into your vagina.
• Dilation and curettage- The surgery known as dilation and curettage (D&C) involves removing the lining and contents of your uterus. Your doctor might combine a hysteroscopy with a D&C. Certain forms of endometrial hyperplasia can be treated with a D&C.
• Hysterectomy- A hysterectomy is a surgical procedure in which the uterus and cervix are removed. If you have uterine cancer, you might require a hysterectomy. You can learn about the various hysterectomy techniques from your healthcare provider.
• Sonohysterography- It is another name for saline infusion ultrasound, which is a technique where your doctor fills your uterus with saline and then uses an ultrasound to see any abnormalities inside.

Key Takeaway

Even if postmenopausal bleeding seems minor or sporadic, it should not be disregarded. It can occasionally indicate more serious illnesses, including endometrial hyperplasia or uterine cancer, even though the majority of causes are benign, such as hormonal fluctuations or uterine polyps. In order to ensure successful therapy and peace of mind, early diagnosis is essential.

In order to rule out underlying problems, women who experience any bleeding after menopause should see a gynaecologist immediately. You may considerably lower risks and preserve general well-being by getting regular checkups and being aware of your reproductive health.

Expert gynaecologists and state-of-the-art diagnostic facilities at Birla Fertility & IVF guarantee precise assessment and individualised treatment for postmenopausal issues. Women can protect their health, efficiently manage symptoms, and continue to live confidently and healthily beyond menopause with prompt management and appropriate support.