Bleeding after menopause accounts for two-thirds of gynecological visits during this period and affects at least 10% of women. Known as postmenopausal bleeding, it affects the majority of this demographic and usually stems from benign causes that are easily manageable.
For a few women, however, postmenopausal bleeding could be a sign of a more serious underlying issue. To be on the safe side, any postmenopausal bleeding must be brought to the attention of your OB-GYN immediately.
In doing so, you will gain clarity regarding your health concern and take the appropriate actions in response. This guide also provides information about potential causes, accompanying symptoms, and possible solutions to help you understand your situation better.
Reasons You’re Bleeding After Menopause
As mentioned, postmenopausal bleeding can occur for various reasons that range from the most common and manageable to the most difficult to treat. No matter the case, awareness of serious symptoms is essential to addressing them promptly. We categorize and discuss these below.
Common Causes
1. Hormonal Imbalances
Hormonal imbalances that occur naturally with menopause are one of the primary causes of postmenstrual bleeding.
When you enter menopause, estrogen and progesterone (hormones responsible for regulating the menstrual cycle) significantly decrease and cause changes in your reproductive system. These changes might include unexpected bleeding that is typically light or similar to your period bleeding. Other symptoms of menopause and hormonal imbalance you can expect are:
- Hot flashes
- Night sweats
- Mood swings
- Vaginal dryness
Altogether, these symptoms should not cause concern unless they feel uncomfortable and disruptive. To manage these, your OB-GYN will recommend a regimen for hormone replacement therapy (HRT) that can be tailored to fit your exact needs.
2. Vaginal Atrophy (Atrophic Vaginitis)
Vaginal atrophy, also known as atrophic vaginitis, occurs when the vaginal walls thin and become inflamed due to a lack of estrogen. This condition is common after menopause and can lead to bleeding, particularly after sexual intercourse.
In this case, bleeding can occur as the thinning of vaginal tissues makes it more susceptible to injury and infection, which can cause spotting or bleeding. Some accompanying symptoms that point to vaginal atrophy are:
- Vaginal dryness
- Itching or burning
- Discomfort during intercourse
- Increased urinary frequency or urgency
Since vaginal atrophy is linked to estrogen loss, it can also be similarly addressed with HRT. Additional methods of management can also involve the use of lubrication aids during sexual intercourse and maintaining good reproductive hygiene practices.
3. Endometrial Atrophy
Endometrial atrophy is another condition related to the decrease in estrogen levels after menopause. In this condition, the endometrial lining (the part that thickens and sheds during your menstrual cycle) becomes very thin, making blood vessels more fragile and prone to bleeding.
This condition is typically benign; however, you must monitor any profuse bleeding. Other than that, some symptoms you may experience:
- Light spotting
- Vaginal dryness
- Mild pelvic discomfort
As the atrophy results from hormonal changes, it can also be easily managed through hormone replacement therapy, as prescribed by your OB-GYN.
Other Potential Causes
4. Polyps
Polyps are benign growths that can develop in the uterus, cervix, or cervical canal. Hormonal changes often cause these growths and can lead to postmenopausal bleeding.
Uterine and cervical polyps are usually non-cancerous. However, significant bleeding can occur if they are irritated or grow large enough to disrupt your reproductive organs’ normal functioning. Symptoms related to polyps include:
- Irregular bleeding or spotting
- Heavy menstrual-like bleeding
- Pelvic pain or discomfort
- Discharge, which can be transparent or tinged with blood
Small, asymptomatic polyps may be monitored for any changes without immediate treatment. Your doctor may also recommend hormonal therapies to try and shrink the polyps and alleviate symptoms. As a last resort for more extensive and disruptive polyps, they may suggest removal procedures like hysterectomy, dilation, and curettage.
5. Infections
Postmenopausal bleeding can also occur as a result of infections of the reproductive tract. Some diseases that cause bleeding and inflammation include bacterial vaginosis, yeast infections, or sexually transmitted infections (STIs).
Postmenopausal women are particularly susceptible to infections due to changes in the vaginal environment, such as decreased acidity and dryness. If you suspect that the bleeding is due to an infection, you may also be experiencing:
- Unusual vaginal discharge (thick, white, yellow, or green)
- Foul-smelling odor
- Itching or burning sensation in the vaginal area
- Pain during urination or intercourse
Treating any form of bleeding that results from infections involves killing the pathogen causing it. Depending on the infection, your doctor might prescribe antibiotics or antifungal medications that you must adhere to until it is fully resolved.
6. Medications
Certain medications can cause postmenopausal bleeding as a side effect. While HRTs are used to manage menopause and postmenopause symptoms, they can also cause bleeding due to their impact on the uterine lining. Similarly, other medications, such as blood thinners and some types of chemotherapy, can also contribute to unexpected bleeding.
The following symptoms typically accompany bleeding caused by medications:
- Bruising easily
- Prolonged bleeding from minor cuts or injuries
- Blood in urine or stool (in cases of anticoagulant use)
- General fatigue or weakness (possible side effect of chemotherapy)
When medications cause postmenopausal bleeding, you must discuss it immediately with your doctor so that adjustments or alternatives can be recommended by your doctor.
Serious Conditions
7. Endometrial Hyperplasia
Endometrial hyperplasia is a condition in which the endometrial lining becomes abnormally thickened due to excess estrogen and an absence of progesterone to balance it.
This overgrowth causes irregular and heavy bleeding, even after menopause, and is not cancerous. However, leaving it untreated might lead to endometrial cancer. You might suspect your bleeding to be caused by endometrial hyperplasia if you also experience:
- Heavy or prolonged menstrual-like bleeding
- Pelvic pain or discomfort
- Unusual discharge
The primary treatment for endometrial hyperplasia involves progesterone HRT to counterbalance the estrogen in your body, reducing the thickness of the lining. In more severe cases, surgical procedures like dilation and curettage are needed to thin the endometrial lining directly. If there is a significant risk of cancer, a hysterectomy, which involves the removal of the uterus, might be recommended.
8. Endometrial Cancer
Endometrial cancer is a type of cancer that starts in the lining of the uterus and is the most common type of uterine cancer that can cause significant postmenopausal bleeding. Bleeding occurs because cancerous cells invade and disrupt the normal structure and function of the endometrial lining. Other symptoms that might present with endometrial cancer are:
- Pelvic pain or pressure
- Unintended weight loss
- Fatigue
When bleeding is related to endometrial cancer, immediate and comprehensive interventions are necessary. The primary treatment is often a hysterectomy, where the uterus and possibly surrounding tissues where the cancer might have spread are removed. Depending on the stage and spread of the cancer, additional treatments may include radiation therapy, chemotherapy, and hormone therapy to target any remaining cancer cells.
Early detection significantly improves prognosis, making regular check-ups essential to effective management and treatment.
9. Cervical Cancer
Cervical cancer originates in the cells of the cervix, the lower part of the uterus that connects to the vagina. Postmenopausal bleeding can occur if cancerous lesions develop on the cervix, causing irritation and bleeding.
Regular Pap smears and HPV testing are essential for early detection of cervical cancer, which can significantly improve treatment outcomes. Some symptoms that might point to cervical cancer include:
- Bleeding after intercourse
- Watery, bloody vaginal discharge
- Pelvic pain or pain during intercourse
- Unusual vaginal bleeding or spotting
Interventions for bleeding caused by cervical cancer may look similar to that which stems from endometrial carcinoma, involving removal of the cervix and other affected organs via hysterectomy. Radiation and chemotherapy may also be required in advanced cases, further emphasizing the importance of vigilant monitoring of cervical health through Pap smear tests.
Final Thoughts
Postmenopausal bleeding must be reported to your OB-GYN immediately, even if you suspect the cause to be benign conditions. If not, you become more vulnerable to conditions that are complicated to treat, causing more strain on your health and other aspects of life.
Thankfully, medical science emphasizes helping women live more comfortable and healthy lives during and beyond their menopausal years. But it is only through open communication with your OB-GYN can you ensure that you live your best years yet, even in this advanced stage.
