Women having Bleeding after menopause is at high risk of endometrial cancer. If bleeding is light or just spotting, then there is nothing to worry but you must consult with your doctor. What is menopause? Menopause is the cessation of the menstrual cycle after the age of 45 or 50. Age may vary from women to women. Therefore, bleeding after menopause is a serious issue which you should never ignore.
There are many reasons for this postmenopausal bleeding, but the most common cause of Endometrial Cancer. Now, this gynecological issue is becoming common in women due to irregular menstrual cycle, poor dietary habits, high-stress levels, hormonal issues, and environmental factors. But it is curable if diagnosed early.
Signs & Symptoms Of Postmenopausal Bleeding
Many women don’t have any symptoms while having postmenopausal bleeding. But some may have symptoms like hot flashes, mood swings, and irritable behavior. These symptoms go out after menopause.
But some Symptoms come in postmenopausal women, that may include:
- Decrease libido
- vaginal dryness
- stress incontinence
- increased chances of urinary tract infections
- weight gain
- Pallor due to tremendous loss of blood
Not all symptoms are present in women of postmenopausal bleeding. However, their frequency and intensity vary from individual to individual.
What Are The Causes Of Bleeding After Menopause?
Many conditions are responsible for postmenopausal bleeding. Few are discussed below
1- Sexually Transmitted Diseases
Infections like Chlamydia and Gonorrhea can be bleeding or spotting after menopause. The herpes virus causes sores that can bleed.
Endometrial cancer or uterine cancer is the most common cause of postmenopausal bleeding. Vaginal cancer is also the cause of bleeding after menopause.
3- Atrophic Vaginitis
It is the thinning and inflammation of the uterine wall or endometrial wall due to decrease estrogen level, therefore, it is known as vaginal atrophy or atrophy vaginitis. After 40 or 50, this atrophy may be a cause of postmenopausal bleeding.
4- Hormonal Replacement Therapy
Endometrial hyperplasia or thickened endometrial lining also may be responsible for bleeding after menopause. This hyperplasia can be caused by hormonal replacement therapy (HRT), overweight or high level of estrogen.
Postmenopausal bleeding may also be a side effect of other medications like tamoxifen, hormone replacements, or diuretics.
Other potential causes of bleeding after the menopause may include:
- Pelvic Trauma
- Clotting disorders
- Endometritis (an infection of the endometrial lining of the uterine wall)
- Thyroid disorders
- Bleeding from uterine tract
These potential causes are less likely. Therefore, your doctor must know the cause of your bleeding before starting the treatment.
How It Can Be Diagnosed?
What is the actually cause of your bleeding after menopause can be clinically diagnosed by taking a proper history, physical examination, and some specific investigations? These one or more investigations, which you may need are
A transvaginal ultrasound scan is the most commonly used test to diagnose the source of bleeding. A small probe is inserted into the vagina through which sound waves are send-off. These waves create a clear picture of the inside part which helps your doctor check and examine the case properly.
This is a light, thin rod instrument that had a camera on one end. Your physician can use it when he needs to see inside your uterus. This hysteroscope is helpful in checking the uterus and it’s lining and it is a safe instrument.
Endometrial Biopsy (EMB)
The most common and most authentic investigation is to take a sample of the endometrial wall or the small tissues that line the uterine walls by a thin rod. This sample is sent off to laboratories to check the cell’s morphology, physiology, and replication.
Dilation and curettage is also a common test for the investigation of bleeding after menopause. In this procedure, your health care provider opens your cervix with an instrument. Then a thin tool is inserted to scrape or suck a sample of the tissues that lining the uterine walls. This sample is then sent for further evaluation whether there is polyp, cancer, or hyperplasia.
Treatment Options Available For Postmenopausal Bleeding
There are many options to treat or control the bleeding after menopause, depending on the cause and source of bleeding.
1- Estrogen Replacement Therapy
Estrogen creams or tablets may be given to you by your doctor if the cause of bleeding in a woman is thinning of the uterine wall or Vaginal atrophy. This estrogen hormone replacement therapy is proven very effective in controlling the bleeding.
2- Polyp Removal
Polyps can be removed surgically if the source of bleeding is endometrial polyps after menopause.
3- Progestin therapy
If there is an outgrowth in uterine wall and blood is coming out from that source, your health care provider prescribed you progesterone hormone which reduces the at outgrowth and prevents the bleeding.
When all the above mentioned less invasive treatments fail to control the bleeding, then hysterectomy is done. During this procedure, your whole uterus is removed out. But this procedure is recommended only to those women who have completed their pregnancy or those who haven’t responded to other treatments.
5- Dilation and curettage
In this procedure, a thin rod is inserted into the uterus after opening the cervix by your physician to remove out the polyp or any abnormal thickened area of the endometrial wall.
6- Radiation and chemotherapy
Your doctor may recommend radiotherapy or chemotherapy after surgery. This treatment is also used nowadays to control the bleeding that comes after menopause.
In short, postmenopausal bleeding is the bleeding after 1 year of menopause due to multiple causes such as endometrial polyps, hyperplasia, or Vaginal atrophy. The most common cause is endometrial cancer. Through vaginal ultrasound, endometrial biopsy, or hysteroscopy, your doctor finds out the actual cause of your bleeding then treats the underlying cause to control the bleeding. Some patients recovery with only medication, but some have to treat by surgery, chemotherapy, or radiotherapy.