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Bleeding after menopause: Why it happens and what to do about it

Noticing bleeding after menopause can be scary for anyone. Here's what causes it and how it can be managed.
menopause
Know why you may bleed even after menopause. Image courtesy: Adobe Stock
Dr Swetha M.P Published: 5 Apr 2023, 17:00 pm IST
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Menopause is the process where a woman’s reproductive hormones decline, resulting in a natural cessation of her menstrual cycle. Most women undergo menopause from the 40s to the mid-50s or later. Menopause is said to be complete when menstrual periods stop for one continuous year. However, post menopause, many women undergo postmenopausal bleeding and vaginal bleeding which can occur a year or more after a woman’s last menstrual period. Noticing bleeding after menopause can make anyone worried. We are here to help you understand why this happens.

Causes of postmenopausal bleeding

Bleeding post menopause condition poses as a symptom of causes that require medical attention. The common conditions which cause bleeding or spotting after menopause include:

1. Endometrial atrophy

The endometrium responds to hormones like estrogen and progesterone. Since the production of hormone levels is low after menopause, the uterine lining results in thinning which triggers bleeding. This is a common condition especially when a woman’s body stops producing estrogen, a hormone that plays an important role in sexual and reproductive development.

bleeding after menopause
Always consult with a doctor if you notice bleeding post-menopause. Image courtesy: Shutterstock

2. Vaginal atrophy

A condition that involves thinning of the vaginal tissue. After menopause, low levels of estrogen cause the vaginal walls to become thin, dry, and inflamed which may result in bleeding.

3. Endometrial hyperplasia

A condition where the lining of the uterus grows too much and becomes thick due to the presence of abnormal cells. After menopause, the body may either have too much estrogen or too little progesterone. Due to this imbalance, the endometrium gets thicker and may bleed. At times, the cells in the endometrium can become abnormal leading to cancer if not treated earlier.

4. Endometrial polyps

Endometrial polyps are non-cancerous growths that develop on the lining of the uterus. Some polyps also grow inside the cervical canal causing pain. These polyps cause unusual or heavy bleeding.

bleeding after menopause
Endometrial polyps impact fertility, but removing polyps is always a choice. Image courtesy: Shutterstock

5. Uterine fibroids

Uterine fibroids or leiomyomas are benign non-cancerous tumours that grow during the reproductive years or after menopause. These fibroids develop in the walls of the uterus which may not develop symptoms but may result in pain and bleeding.

Treatment for postmenopausal bleeding

Causes of postmenopausal bleeding vary from one another hence treatment depends upon the underlying cause which affects or results in postmenopausal bleeding. Listed below are the procedures or medications for postmenopausal bleeding:

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1. Antibiotics: Antibiotics can be taken to treat most infections in the cervix or uterus.

2. Estrogen therapy: For bleeding due to vaginal dryness, estrogen therapy helps treat vaginal and endometrial atrophy. Estrogen can be taken in different forms such as pills, vaginal creams, vaginal rings, or vaginal tablets.

3. Progestin: Progestin is a synthetic form of the hormone progesterone which helps treat endometrial hyperplasia by triggering the uterus to shed its lining. Your health specialist may prescribe progestin which is available as a pill, cream, or intrauterine device (IUD).

bleeding after menopause
IUDs can be used to stop bleeding after menopause. Image courtesy: Shutterstock

4. Hysteroscopy: A hysteroscope, a thin, illuminated tube, is introduced into your vagina to remove polyps or other abnormal growths that cause bleeding. This treatment is performed to remove polyps or thicker areas of the uterine lining caused by endometrial hyperplasia. Another treatment is dilation and curettage (D&C), which removes polyps or thicker portions of the uterine lining brought on by endometrial hyperplasia using a thin instrument.

Takeaway

Menopause is a biological transition among women that marks the end of a woman’s ability to conceive. Whether it is a light spotting or a heavier flow, vaginal bleeding after menopause can signal alarming health problems. Bleeding after menopause is a concern and if you experience one, it is important to consult a doctor for further guidance.

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About the Author

Dr Swetha MP is a gynaecologist who completed her MBBS from MS Ramaiah Medical College (2008) and DGO from M S Ramaiah Medical College (2012). With her experience of over a decade, she is well-versed in simple and complex gynaecological and obstetric surgeries. Her legacy in handling several complicated cases independently make her among the best gynaecologists and IVF doctors in Bangalore. She has a special interest in High-Risk Pregnancy Care, Normal Vaginal Delivery (NVD), Menopause, Infertility Evaluation, Laparoscopy, Hysterectomy, Ovarian surgery, Vaginal Surgery, PCOD screening, and Adolescent counselling. She is a consultant obstetrician and gynaecologist at Motherhood Hospitals.

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