Postmenopausal Bleeding: Symptoms, Causes & Treatment

A woman goes through many changes in her life, one of which is vaginal bleeding or periods. She endures periods for most of her life and thinks that once menopause hits, she will be free from that suffering. But is it possible for a woman to bleed even after menopause? Yes, this is called postmenopausal bleeding.

Postmenopausal bleeding is when a woman has vaginal bleeding for a year or more after her last period. It could mean that your reproductive system is changing, like if your vaginal lining is getting dry or if you have polyps or something else. After menopause, bleeding can indicate uterine cancer in roughly 10% of women.

What Is Postmenopausal Bleeding?

The term "postmenopausal bleeding" refers to menstrual bleeding after menopause. Menopause is the time in a woman's life (often beyond the age of 51) when her reproductive hormones begin to decline and her menstrual periods end. It's not usual for a woman to experience vaginal bleeding more than a year after her last menstruation. A person may experience spotting or excessive bleeding.

Most women who experience bleeding after menopause do so because of benign (noncancerous) gynecological disorders such as endometrial polyps. After menopause, bleeding can indicate uterine cancer in roughly 10% of women (endometrial cancer). The most prevalent reproductive cancer is uterine cancer which is more commonly found in women when compared to ovarian or cervical cancers. If you have any bleeding issues after menopause, consult your doctor.

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Symptoms Of Postmenopausal Bleeding

Some women experiencing postmenopausal bleeding may not show any other symptoms. Yet signs and symptoms of postmenopausal bleeding might be present. This may be dependent on the underlying reason of the bleeding.

Postmenopausal years are often associated with a decline in the severity of menopausal symptoms like hot flashes. Postmenopausal women may also experience a variety of other symptoms.

For women who have passed menopause, some possible symptoms are:

• Vaginal dryness

• Lessened sexual desire

• Lack of Sleep

• Stress

• Increase in Urinary Tract Infections

• Weight Gain

Causes Of Postmenopausal Bleeding

The most common causes of postmenopausal bleeding are:

1. Hormone Replacement Therapy

This therapy reduces a few menopausal symptoms through progesterone and estrogen supplements.

2. Endometrial or Uterine Cancer

Cancer that is present in the uterus lining.

3. Vaginal or Endometrial Atrophy

Thin and dry uterine or vaginal lining.

4. Uterine Polyps

This refers to the growth in the uterus.

5. Endometrial Hyperlapsia

The uterine lining becomes excessively thick and may incorporate abnormal cells.

Furthermore, there are other possible causes, such as:

• Cancer of the cervix, often known as cervical cancer.

• An infection or inflammation of the cervix or endometrium is known as cervical or endometritis, respectively.

• External vulvar bleeding, bleeds from the bladder or rectum, or bleeds from the vulvar skin (outside near the vagina).

How To Diagnose Postmenopausal Bleeding?

The following can be used to determine what's causing the bleeding:

• Your healthcare provider will examine your vagina and cervix.

• Cervical cells can be screened with a Pap smear.

• Vaginal ultrasound, which may involve the administration of saline to visualize uterine polyps better, is the standard method.

• A uterine or endometrial biopsy involves your doctor sliding a thin, straw-like tube into your uterus to collect cells to test for abnormalities. This is done at work and can lead to muscle cramps.

Prevention For Postmenopausal Bleeding

Bleeding after menopause could be caused by something minor, such as an enlarged uterus, or something more serious, like malignancy. You may not be able to stop irregular vaginal bleeding, but you can act immediately to acquire a diagnosis and start treatment for whatever is causing it. Early detection increases the likelihood of a successful treatment plan. Reducing your vulnerability to conditions that could lead to irregular postmenopausal bleeding is the most effective way to avoid this complication.

Treatment For Postmenopausal Bleeding

The causes of postmenopausal bleeding are the factors that decide its treatment. The most common treatment of postmenopausal bleeding is either surgery or medication.

The medications include:

1. Antibiotics

Antibiotics have the power to treat most cervix or uterus-related infections.

2. Estrogen

Vaginal creams, rings, and insertable tablets are all viable delivery mechanisms for estrogen. Pills and patches both exist for administering estrogen treatment systemically. When estrogen is administered in a therapy that is considered systemic, it is distributed all over the patient's body.

3. Progestin

Progestin is progesterone’s synthetic form. When used to induce uterine lining loss, it effectively treats endometrial hyperplasia. Progestin can be administered in several forms, including oral pills, injectables, topical creams, and intrauterine devices (IUD).

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Surgeries include

1. Hysteroscopy

It's a technique when a camera is used to look at your cervix and uterus. To treat bleeding caused by polyps or other abnormal growths, your doctor will introduce a hysteroscope (a thin, lighted tube) into your vagina. In-office diagnostic is possible. Hysteroscopy, which is used to examine the uterus and remove tumors, is often performed under general anesthesia in a hospital operating room.

2. Dilation and curettage (D&C)

The uterine lining and its contents can be sampled with this method. A hysteroscopy may be used in conjunction with a D&C by your doctor. Some cases of endometrial hyperplasia respond well to a dilation and curettage procedure.

3. Hysterectomy

The cervix and uterus will be surgically removed. If you've been diagnosed with uterine cancer, your doctor may recommend a hysterectomy. Learn about the many surgical options for removing your uterus from your doctor. During minimally invasive operations, just tiny incisions are made (incisions).

Conclusion

In the years before menopause, it is common for women to have irregular vaginal bleeding or postmenopausal bleeding. You should contact a doctor if you're still bleeding a year after your previous period.

References

1. Munro MG (2014). Southern California Permanente Medical Group’s Abnormal Uterine Bleeding Working Group. Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations.

2. Sung S, Abramovitz A. (2022). Postmenopausal Bleeding.

3. Gale A, Dey P. (2009). Postmenopausal bleeding. Menopause Int.