Post Menopausal Bleeding
As you know, Menopause is defined as going 12 months without a period. It happens to most women in the United States at an average age of 52. Postmenopausal bleeding can stem from anywhere in the reproductive tract, including the uterus, vagina, and cervix.
A couple of months ago, I experienced postmenopausal bleeding. Needless to say, I was a bit alarmed. Postmenopausal bleeding is bleeding from the reproductive tract that occurs after a person has stopped having menstrual periods and has gone through menopause.
Postmenopausal bleeding is not normal, but it does happen. Research indicates that up to 10% of postmenopausal women over age 55 experience bleeding after their periods end.
Post Menopausal Bleeding Symptoms
Postmenopausal bleeding is most likely to occur in people who are in their first year after menopause. But regardless of when it occurs, symptoms can run the gamut. I have not had a cycle since 2013 so it can also happen way into your postmenopausal journey.
You may experience:
Light spotting
Heavy bleeding, like a normal period
Blood that appears pinkish
Blood that appears brownish
Most of the time there is no pain associated with postmenopausal bleeding. Get checked out by a healthcare professional even if the bleeding is very light or a one-time thing. Some causes of postmenopausal bleeding can be serious, so it’s important to get prompt medical attention.
I experienced light but noticeable spotting. Needless to say, I got the first available appointment with my gynecologists.
Causes
Most cases of postmenopausal bleeding have benign, or nonserious, causes. These include:
Atrophy
Estrogen helps keep the walls of the vagina and uterus elastic and supple. In menopause and afterward, your estrogen is declining or at very low levels. The blood vessels that line those walls can become thin and dry, making them prone to breaking. This can happen due to the friction of sex, and sometimes just spontaneously.
Endometrial Cancer
Roughly 9% of people who have bleeding after menopause are diagnosed with endometrial cancer. It is the most common gynecologic cancer in the United States.
Endometrial Hyperplasia
Progesterone also helps the uterine lining change in preparation to receive a fertilized egg. The drop in progesterone is what triggers the uterine lining to shed (menstruation). If this process isn't occurring due to lack of ovulation, this can cause the uterine lining not to shed and to continue to thicken and become endometrial hyperplasia.
Using estrogen-only hormonal replacement therapy (which may help minimize some menopausal symptoms, such as hot flashes) after menopause can raise the risk of endometrial hyperplasia.
Experts now recommend that people with a uterus who take estrogen after menopause temper its effects with a progestin, a synthetic form of progesterone
Uterine Polyps
Thirty percent of postmenopausal women complaining of uterine bleeding have uterine (also called endometrial) polyps.
Uterine polyps are an overgrowth of endometrial glands, tissue, and blood vessels. They’re usually noncancerous and are common both before and after menopause.
Uterine Fibroids
Uterine fibroids are noncancerous tumors that often cause heavy bleeding. Up to 80% of people with a uterus will have one or more uterine fibroids at some point in their lives
Because fibroids are fed by estrogen and progesterone, they’re most likely to occur before menopause. But some people can experience them after menopause. One study found that women ages 50 to 59 had the second-highest incidence of uterine fibroids
Diagnosis
Because vaginal bleeding can be an early sign of endometrial cancer, your doctor will definitely want to check for that.
For me, I had an immediate choice that day in my gynocologist office of a transvaginal ultrasound or a endometrial biopsy. I chose the biopsy because if the ultrasound found anything, they would have to do the biopsy anyway. My biopsy came back as non cancerous but there was still the question of the source of my bleeding. I then had the transvaginal ultrasound and a cat scan .
Once the cause of your bleeding is determined, your doctor can advise you about treatment options and the next steps.
Viewing inside the vagina and uterus, and in some cases taking a tissue sample, are key to determining the cause of postmenopausal bleeding. To do that, you may need to undergo a variety of tests. Some of these include:
Pelvic exam: A small plastic device called a speculum will separate the walls of the vagina so your doctor can examine the vagina and the cervix, which connects the vagina to the uterus.
Transvaginal ultrasound: A probe (called a transducer) is inserted into the vagina. Soundwaves from the transducer pass through the skin, creating echoes and electrical signals that are converted into images.11 This is often used to check the thickness of the lining of the uterus, which can help your doctor assess your risk of endometrial cancer
Hysteroscopy: This involves inserting a thin, lighted tube with a camera on the end into the vagina to view the vagina, cervix, and uterus.
Sonohysterography: A thin tube inserts fluid into the uterus so soundwaves can capture more detailed images of the uterus.
Endometrial biopsy: Your doctor will use a thin suction device to remove some endometrial tissue that is sent to a lab for analysis. The procedure is typically done in a doctor’s office without anesthesia.
Dilation and curettage (D&C): This is often done as outpatient surgery. The endometrium is scraped to remove a sample that is then sent to a lab for testing.
Treatment
Treatment for postmenopausal bleeding depends on its cause.
Atrophy: If you have a naturally occurring thinning of your uterine or vaginal lining, your healthcare professional may recommend a vaginal estrogen cream or a vaginal moisturizer, as well as using a lubricant during sex. In some cases, you may not need any treatment at all, as the bleeding often goes away on its own.
Polyps or fibroids: You may need surgery to remove the growths. This can often be done as a minimally invasive procedure, using a thin, lighted instrument called a laparoscope.
Endometrial hyperplasia: Some people with endometrial hyperplasia can be helped by taking the hormone progestin. Surgery to remove the uterus (called a hysterectomy) may be recommended for some.
Cancer: If you’re diagnosed with gynecologic cancer, you may need surgery, chemotherapy, and/or radiation.
Turns out I had endometrial fibroids that were causing my bleeding and I was treated with progesterone for 5 days and have had no more spotting.
Summary
Bleeding after menopause may be due to atrophy, endometrial hyperplasia, uterine polyps or fibroids, or gynecologic cancer. It should always be reported to your healthcare professional so they can diagnose the cause. The treatment may require medication or surgery.
source: Verywell.com