Postmenopausal bleeding refers to any vaginal bleeding that occurs in a woman after she has gone through menopause. Menopause is defined as occurring 12 months after a woman's last menstrual period. So any bleeding after that 12-month mark is considered abnormal.
Some potential causes of postmenopausal bleeding include:
- Uterine cancer - Cancer of the uterus can cause vaginal bleeding even years after menopause. Uterine cancer is one of the most common causes of bleeding after menopause.
- Endometrial atrophy - The lining of the uterus (endometrium) becomes very thin after menopause. If the lining becomes too thin, it can lead to bleeding.
- Endometrial polyps - These noncancerous growths on the lining of the uterus can sometimes cause bleeding.
- Hormone replacement therapy - Taking estrogen alone as a hormone replacement can cause the buildup and eventual shedding of the uterine lining, leading to spotting or bleeding.
Other less common causes include:
- Cervical polyps or cancer
- Vaginal atrophy
- Pelvic inflammatory disease
- Use of blood thinners
When to see a doctor
Any postmenopausal bleeding warrants further evaluation by a doctor. While the bleeding may ultimately be due to a benign cause, the only way to rule out cancer is through an endometrial biopsy.
Here is a typical workflow to evaluate postmenopausal bleeding:
- Physical exam - This includes a pelvic exam to visually inspect the vulva, vagina, and cervix.
- Endometrial biopsy - A small sample of the uterine lining is taken to analyze under a microscope. This can determine if cancer is present.
- Imaging tests - Ultrasounds or MRIs may be done to look for uterine or cervical tumors.
Treatment depends on the underlying cause:
- Cancer is treated with some combination of surgery, radiation, chemotherapy, and hormone therapy.
- Noncancerous causes like atrophy or polyps generally only require treatment if they are causing significant symptoms.
- Hormone replacement therapy may need to be adjusted.
The keys with postmenopausal bleeding are to
never ignore it and to make sure cancer is ruled out as the source. Reach out to your doctor whenever you experience any abnormal vaginal bleeding after menopause. Getting checked out quickly leads to the best health outcomes.
If you are experiencing abnormal bleeding after menopause, the hormone specialists at
Balance Hormone Clinic can help. Our compassionate team of physicians and nurse practitioners specialize in the delicate hormonal changes that occur during
perimenopause and
postmenopause. We provide cutting-edge testing and personalized treatment plans to help alleviate uncomfortable symptoms and address any underlying causes.