Is Vaginal Bleeding Normal After Menopause?

Is Vaginal Bleeding Normal After Menopause?

Menopause is a once in a lifetime event that has to be faced by every aging woman. While some women are able to cross the menopausal phase with strong courage and determination and live a healthy life, some others may face difficulties after menopause. One of the problems they might face is post-menopausal bleeding.

Post-menopausal bleeding

If you have gone through the menopausal phase, you wouldn’t be having monthly menstrual bleeding after that. Menopause means you have not had a period in at least once in a year. In other words, once a woman has gone without menstrual period for 12 months, she is considered to be in menopause.

But on the other hand, if you are experiencing abnormal bleeding, even if it’s a small spot, then it’s not a thing that has to be taken lightly. You must talk to a doctor; she might want to rule out any possibility of cancer or any other disease.

What causes bleeding after menopause?

Vaginal bleeding after menopause could be due to a variety of reasons. Such as:

Endometrial atrophy 

It’s the thinning of the uterine lining. The endometrium is a tissue that lines the uterus of a woman. This tissue responds to progesterone and estrogen hormone. When hormone levels lowers down after menopause, they can cause this uterus lining to become too thin. This may cause bleeding.

Endometrial hyperplasia 

Quite the opposite of the above mentioned, this condition thickens the lining of the uterus. It occurs when there is too much of estrogen as compared to too little progesterone hormone. This can thicken the uterus lining, resulting in bleeding.

Besides, long-term use of estrogen in the form of oral contraceptive pills or to treat menopausal disorders is harmful. It can not only increase the risk of endometrial hyperplasia, but could also lead to cancer of the uterus.

Polyps 

These are non-cancerous tissues that grow inside the uterus or cervical canal. Though these tissues are benign in nature, they can become cancerous and the bleeding is the only symptom that occurs in patients with polyps. So women after menopause should not ignore any abnormal bleeding. Polyps can also affect younger woman.

Vaginal atrophy 

It means thinning of the vaginal tissue. Typically, estrogen keeps vaginal tissue healthy but when estrogen levels goes down after menopause, it can cause this tissue to become thin, dry or inflamed. This causes bleeding, especially after sexual intercourse.

Cancer 

Nearly 10 percent of women who face bleeding after menopause, have endometrial cancer and the most common symptom is bleeding. The bleeding can also indicate towards cervical cancer. However, it’s rare but it does demand early consultation with a gynecologist.

Other causes 

Sometimes sexually transmitted disease such as gonorrhea and chlamydia might cause bleeding after sex. Bleeding may also occur due to herpes sores and certain medications such as hormone therapy and blood thinners.

Symptoms that may accompany bleeding

Woman with postmenopausal bleeding might not experience any other symptoms. However, symptoms might be present and often unnoticed. These are:

  • Vaginal dryness
  • Insomnia
  • Decreased libido or sexual interest
  • Weight gain
  • Increased in urinary tract infection
  • Stress incontinence

Diagnosis of bleeding after menopause

The doctor, typically conducts a physical examination and review your medical history. He may ask you to follow one or more of these tests:

Transvaginal ultrasound 

In this method, a probe or instrument is inserted into the vagina to view uterus, ovaries, and cervix and check for any growth tissue.

Hysteroscopy 

This procedure allows the doctor to see endometrial tissue. A thin light tube with an optic scope on one end is inserted into the vagina and cervix. The doctor will then pump carbon dioxide gas through this scope. This expands the uterus and makes it easily visible.

Sonohysterography 

This test measures the size of the polyps. For this, the doctor will put a saltwater solution inside the uterus in order to create a clearer image of the uterus.

Endometrial biopsy 

A thin tube is inserted into the vagina to take a small sample of the uterine tissue. This sample will be lab tested to find out any signs of infection or cancer.

What treatments are available?

The treatment will vary upon the cause of the bleeding, whether light or heavy. In some cases, the doctor would just do a physical checkup and no treatment would be required. While in some other situations, where cancer has been ruled out, following treatment might be recommended:

Estrogen therapy 

This therapy can be prescribed in four forms:

  • Pills - It will be taken via mouth
  • Vaginal cream - It will be applied using an applicator
  • Vaginal ring - Either you or your doctor will put this in place. It steadily releases estrogen hormone for about 3 months
  • Vaginal tablet -This too will be inserted with the help of an applicator. You will have to do it either daily or few times a week, depending on the severity of  the condition

Progestin therapy 

This hormonal therapy is often recommended in case of endometrial tissue overgrowth (endometrial hyperplasia). It is given in the form of pill, cream, injection or intrauterine device. It reduces the bleeding and decreases the overgrowth of the tissue.

Polyp removal 

This is a surgical procedure that removes polyps. The doctor may also use this technique to remove the thickened parts of the uterine lining. In this procedure, a thin tube fitted with a camera also known as hysteroscope is inserted into the vagina. Through this, tiny surgical tools are passed to perform the operation.

Hysterectomy 

This surgical procedure removes part or the complete uterus. The procedure is done either through convention abdominal surgery or using a laparoscope.

Medication 

Anti-biotics are usually prescribed in case the cause of bleeding is sexually transmitted disease. These medicines can also treat uterine or cervical cancer.

Bottom Line

Treating some of the conditions such as endometrial atrophy can prevent the condition from turning into cancer. The ideal way is to consult a gynecologist as soon as you spot the bleeding. Moreover, maintaining a healthy weight and eating a balanced diet can avert many complications we might not know, nurturing inside our body.

So, irrespective of the bleeding, we must continue visiting the doctor and take appropriate measures as advised.

Sources

1. Burbos, N., Musonda, P., Giarenis, I., Shiner, A. M., Giamougiannis, P., Morris, E. P., & Nieto, J. J. (2010). Predicting the risk of endometrial cancer in postmenopausal women presenting with vaginal bleeding: The Norwich DEFAB risk assessment tool. British Journal of Cancer, 102(8), 1201–1206  read more 
2. Per vaginal (PV) bleeding read more
3. Menopause: Treatment for Symptoms Tips from the National Institute on Aging(October 2016) 
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