Bleeding After Menopause

Light bleeding after menopause may not seem like a big issue, but it's important to tell your doctor if it happens. Once a woman’s periods have subsided, there should be no bleeding and if it occurs, it can be a sign of more significant underlying health issues.

Post-menopausal bleeding can be caused by a wide array of complications including cancer. In this guide, we’ll take a closer look at bleeding after menopause and what exactly might be causing it.

Effects of The Change of Life

When a woman does not have her periods for twelve months or more, this is a sign of menopause and indicates she is not reproductive anymore. It typically occurs in women between the ages of 45-55 and in certain circumstances, it can start as early as your thirties or not until your late fifties.

Once a woman has menopause, there can be instances of bleeding which can happen to at least 4 percent of women with postmenopause. Still, vaginal bleeding during this period is considered a health risk and can occur as spotting, pinkish discharge, or period-like bleeding. 

While there are simple explanations of postmenopausal bleeding, you should look to visit your GP if you experience the following: 

• A small amount of spotting 
• You don’t have any other symptoms 
• Bleeding happened once
• You are not sure if its blood

You should be able to tell your GP the amount of blood, any feeling of discomfort, duration of bleed, and other symptoms which may help. Common symptoms associated with menopause like hot flashes begin to reduce during this time. 

Other symptoms that may occur during the postmenopausal stage in women include: 

• Decreased libido 
• Weight gain 
• Vaginal dryness
• Increased urinary tract infections 
• Insomnia 
• Stress 

Symptoms of postmenopausal bleeding

In most cases, postmenopausal bleeding does not come with other symptoms. 

However, in some cases, symptoms may still be present and a doctor needs to triage the cause of bleeding and determine the best course of action for your health and wellbeing.

What causes postmenopausal vaginal bleeding?

Even with these possible causes of postmenopausal bleeding, it is still important to consult your doctor whenever you experience abnormal vaginal bleeding. 

It is also important to be checked if you are above 55 years and are still experiencing periods. During menopause, many Irish women experience bleeding.

The most common causes for this bleeding include: 

Cervical or womb polyps

Uterine polyps (also known as endometrial polyps) are non-cancerous growths that occur in the lining of the uterine cells which usually cause spotting or light bleeding, and sometimes pelvic pain. 

Over time, polyps may grow and become cancerous but may be removed surgically if diagnosed during its early stages.

Genitourinary syndrome of menopause (GSM)

GSM is usually caused by the after-effects of menopause in a postmenopausal woman. Once a woman reaches this stage there is fluctuation in activities in the vagina which leads to dryness of the uterine lining, less elasticity, vaginal atrophy, and other symptoms.

Such symptoms often result in a genitourinary syndrome of menopause (GSM). This is a common condition in postmenopausal women and can be treated with simple over-the-counter products like moisturisers or lubricants. 

Endometrial atrophy or hyperplasia

This condition is prevalent in women who use Hormone Therapy (HT) for a long period of time. Endometrial hyperplasia is the thickening of the uterine lining which in most cases causes abnormal bleeding. 

The condition is not cancerous but sometimes can be an indicator of uterine cancer, which is why it’s important to check with the doctor to know the state. But with the right management, endometrial hyperplasia can be treated with blood thinning medication. 

Endometrial cancer

Endometrial (or womb cancer) also affects the lining of the uterus and may start as mild symptoms like endometrial hyperplasia which may grow over time and lead to serious health issues such as cancer.

Studies show that up to 10 percent of postmenopausal bleeding may be symptomatic of endometrial cancer and over 90 percent of women who did have endometrial cancer had experienced postmenopausal bleeding at some stage.

There are two main variations of endometrial cancer; endometrioid adenocarcinoma and uterine carcinosarcoma. The majority of women diagnosed with endometrial cancer in the early stages have undergone successful surgical procedures. 

Cervical Cancer

Like endometrial cancer, vaginal bleeding after menopause may be a sign of cervical cancer. 

The best way to identify cervical cancer is through regular monitoring and smear tests. 

Early detection is vital to keep things in order and treat them as soon as possible, so that visit to the doctor is crucial. Treatment options for cervical cancer may include radiotherapy, chemotherapy, or surgery. 

Other causes of abnormal bleeding include: 

• Use of some medications
• Infections of the cervix/uterus
• Other types of cancer 
• Thyroid problems 

Hormone replacement therapy (HRT) and postmenopausal bleeding

After menopause, some women prefer to take oestrogen and progesterone to relieve vaginal dryness and hot flashes occurring during this stage. Having oestrogen alone is risky and increases the likelihood of uterine cancer. Having both hormones is a better option although it still has some side effects. 

Research suggests that almost 50% of women who take both hormones experienced postmenopausal bleeding (PMB) within the first six months. 

When taken daily, it should stop within this time but it still depends on the type of Hormone Replacement Therapy (HRT), the dosage and the length of time between menopause and when a woman starts this therapy. 

HRT is administered in several ways and your gynaecologic oncologist (OB-GYN) may prescribe either orally, vaginally, or through the skin. 

Hormonal Replacement Therapy is usually taken in two ways - continuous-combined therapy and cyclic therapy. In continuous-combined therapy, the two hormones are taken daily and irregular bleeding can occur within the first few months. 

Cyclic therapy involves giving oestrogen throughout the cycle and adding progestin on certain days within the month. PMB can occur on days where there is too much oestrogen administered in the uterus.

Diagnosing postmenopausal bleeding 

To check abnormal PMB, the doctor will check your family and personal health history, blood tests, normal biopsy, and physical exam as well. 

The following tests may be taken during diagnosis of PMB: 

• Ultrasonography - This method uses ultrasound to get a view of the pelvic organs by placing the device on the vagina or the abdominal area. 
• Sonohysterography - A small fluid is injected into the uterus and an ultrasound is used to get a picture of the uterus which may detect abnormal changes. 
• Hysteroscopy - A thin tube is inserted into the vagina to look at the inside of the womb. You can insert the thin tube yourself or the doctor can do it.
• Endometrial biopsy - Here, a small tube is used to wipe the uterine lining and a tiny sample is then viewed under a microscope to check components in the endometrial lining. 
• Dilation and curettage - This is where the cervix opening is widened and tissue is gently scraped and a tissue sample is taken under a microscope for examination. 

Postmenopausal bleeding treatment

The treatment process of postmenopausal bleeding depends on a couple of factors such as how severe the bleeding is and other symptoms.

Some cases won’t require treatment and in others, you might need a few rounds of treatment using a variety of menopause support options. If cancer is ruled out, you may have the following treatments for abnormal bleeding after menopause. 

• Oestrogen creams - If the bleeding is caused by thinning of the uterus lining, oestrogen creams may help heal the tissues.
• Progestin - Progestin is a type of HT and is commonly administered when your endometrial tissue is bigger than normal. It helps the inflammation of the tissue caused by your body producing too little progesterone.
• Polyp removal - This is a surgical procedure removing growths in your vagina lining. 
• Hysterectomy - In cases where conventional treatment does not relieve, doctors may recommend a hysterectomy. Here, the entire uterus is removed in an abdominal surgical procedure or laparoscopically. Most OB-GYN recommend hysterectomy surgery after a biopsy. 

In cases where patients report bleeding as a result of cancerous cells, there are several ways the doctors can approach treatment. 

Treatment of cancerous cells is usually a complex procedure and will depend on a lot of factors, but common options include chemotherapy, surgery, ultrasound, radiotherapy, and other tests.  

Postmenopausal bleeding prevention

Typically, there are few prevention options for postmenopausal bleeding. That’s because there are some non-conditional factors that trigger hormone changes such as age, sex, family, history, etc. 

However, you can lower the risk of severe cases of heavy bleeding through: 

• Weight loss plans
• Taking birth control 
• Having synthetic progesterone if you are already taking oestrogen

The best you can do to prevent vaginal bleeding during menopause is to have regular check-ups with your gynaecologic oncologist (GP) and see them whenever you experience such symptoms. 

The Meaghers Verdict on Menopause Bleeding

Bleeding after menopause should not be a serious problem if detected and addressed early. The moment you find out about it, please consult your local GP or qualified medical specialist for a proper diagnosis. 

The cause might be a simple women's health issue or at times it can be a symptom of a severe condition like cervical cancer. So, to ensure you don’t rule out anything, a visit to the doctor is a must.

Recent studies have shown that women who have vaginal bleeding have a lower risk of getting endometrial cancer, although a majority of women with endometrial cancer have reported bleeding as a common symptom. This report is not to scare you, but just to make you aware of the importance of getting checked out.

We recommend Revive Meno Active or A. Vogel Menopause Support to anyone seeking relief from mild menopause symptoms. Some gynaecologic oncologists may also suggest treatments like Menopace and Menomin which really help women in both perimenopausal bleeding and post-menopause light spotting stages. 

But before going for any treatment option, make sure your general anaesthetic specialist or OB-GYN has considered it safe to use as everyone reacts differently to medication. 

The first step is usually the hardest, but once you go through it you will be more confident about your body, your wellbeing and the next wonderful chapter of your life. 

Contact Us to Discuss Your Menopause Health

We hope this guide has equipped you with the information needed to understand some of the complications associated with menopausal bleeding and what course of action you can follow to remedy it. It’s important to know that you're not alone on this journey and professional help is on hand to assist you at all times throughout the Change of Life.