Vaginal Bleeding After Menopause

Vaginal bleeding or spotting after menopause should never be ignored, nor should you wait to bring it up with your doctor. Because you have no period after menopause, vaginal bleeding after menopause can signify a serious health issue that sometimes may be serious, like cancer. Here is what postmenopausal women need to know about vaginal bleeding after menopause and when to seek Gynecological care. 

What is Menopause?

Menopause signifies the time in a woman’s life when her reproductive hormones drop and her monthly periods end for over one year or more. During menopause, women encounter many symptoms as a result of this change in hormones, including hot flashes, metabolism slowing, difficulties sleeping, and mood swings. Many of these symptoms subside during postmenopause, but this stage can lead to other symptoms, like vaginal dryness, stress incontinence, and more. 

Patient in the Doctor’s Office, Receiving Prescription Medicine.

What Causes Vaginal Bleeding After Menopause?

Spotting after menopause and bleeding that mirrors a period after menopause is not normal. Four of the main causes of vaginal bleeding after menopause include uterine polyps, endometrial hyperplasia, endometrial atrophy, and cancer, but they are not the only related health conditions. Even if you are simply spotting after menopause, University Park OBGYN recommends consulting your physician or gynecologist to rule out any serious health issues and determine the cause of your spotting or bleeding. 

Causes of vaginal bleeding after menopause:

  1. Pelvic Trauma or injury to the pelvis may cause vaginal bleeding or spotting. 
  2. Uterine polyps or fibroids are (typically) benign growths that may appear in your cervical or uterine canal or on the cervix itself. Polyps and fibroids may cause spotting after menopause or heavy bleeding after intercourse.
  3. Endometrial atrophy occurs when the uterine lining begins to thin. This happens because the endometrium is affected by our estrogen and progesterone hormones, and the decline in these hormones during menopause can make the endometrium thin and cause vaginal bleeding after menopause. 
  4. Endometritis is an infection of the uterine lining.
  5. Bleeding stemming from the urinary tract or rectum 
  6. Cancer of the vagina, uterus, endometrium, or cervix is signified by irregular spotting or vaginal bleeding after menopause.
  7. Vaginal Atrophy – Low estrogen levels after menopause can make the vaginal walls thinner, inflamed, and dry. These effects can lead to vaginal bleeding, especially after sex.
  8. Endometrial Hyperplasia is the thickening of the endometrium triggered by the shift in hormones after menopause (too much estrogen and too little progesterone) that can cause irregular vaginal bleeding after menopause. These abnormal cells in the endometrium may lead to cancer, so it is best to treat endometrial hyperplasia early. 
  9. Sexually Transmitted Diseases such as chlamydia and gonorrhea, or sores from herpes, may cause spotting after menopause or vaginal bleeding after menopause bright red in color after sex. We recommend regular STI and STD testing to reduce the risk of complications. 
  10. Medications such as hormone therapy, blood thinners, and more can trigger vaginal bleeding after menopause. 

Perimenopausal Bleeding

The years leading up to menopause, known as perimenopause, is the time in a woman’s life in which your hormones shift and your menstruation changes. Spotting and changes to your menstrual cycle, such as heaviness or lightness, is normal. If vaginal bleeding lasts longer than usual or is particularly heavy or if you keep bleeding after intercourse, consult your doctor. It is better to take precautions when it comes to irregular bleeding because although many causes of perimenopausal bleeding are usually not serious, they can be. Things like cancer are better treated when detected early, so regular, preventative Gynecological care is recommended. 

Diagnosing the Cause of Postmenopausal Bleeding

Suppose you are bleeding at 60+ years old, bleeding after menopause bright red in color, or are experiencing any irregular vaginal bleeding or spotting after menopause. In that case, the first step is to reach out to your doctor. Next, you will be asked to visit the office to go over medical history, have a physical exam, and have any tests your doctor may find helpful in ruling out serious medical conditions.

Some of the tests may include:

  • A Physical Exam of the pelvis will be conducted first to check for any abnormalities or tenderness in the area. A pap smear may be performed to check for abnormalities. 
  • A Transvaginal Ultrasound may be ordered to internally view the ovaries, uterus, and cervix via an ultrasound transducer or wand inserted into the vagina.
  • During an Endometrial Biopsy, a  thin tube takes a small sample of your endometrium or the tissue lining your uterus, and it is sent to a lab to rule out things like infections or cancer. 
  • Sonohysterography is used to create a clear ultrasound image and measure a polyp after saltwater is put into the uterus. 
  • A Hysteroscopy helps your doctor to look inside your uterus through a thin tube with a camera. 
  • D&C or dilation and curettage is a procedure that opens the cervix by using a thin tool to collect a sample of the uterine lining, which is then sent to a lab to screen for cancer, polyps, and endometrial hyperplasia. Hysteroscopy and D&C require anesthesia, so these procedures will take place in a hospital or outpatient surgery center.

How to Treat Postmenopausal Bleeding

Woman Suffering From Postmenopausal Bleeding

It is important to remember that bleeding at 60+ years old, bleeding after menopause bright red in color, having a period after menopause, and irregular spotting or vaginal bleeding after menopause are not normal occurrences and should be evaluated by your doctor. Depending on the cause of your spotting or bleeding, your doctor can assist in finding the right treatment or therapy for you or refer you to a gynecological oncologist. 

Treatments may include:

  • Medications such as antibiotics can clear up cervical or uterine infections, STDs, and STIs, which may help in resolving irregular vaginal bleeding after menopause.
  • Estrogen therapy may be utilized to help treat vaginal and endometrial atrophy and comes in many forms, including oral pills, vaginal cream, the vaginal ring, or vaginal tablets. 
  • Progestin therapy is used to assist with treating endometrial hyperplasia and is available in various forms as well, including a pill, shot, a vaginal cream, or an intrauterine device. 
  • Surgery including D&C, or dilation and curettage, and hysteroscopy are performed to remove polyps and thickened sections of the uterine lining caused by endometrial hyperplasia. 
  • Hysterectomy is a major surgery utilized for the treatment of endometrial or cervical cancer. This procedure removes part or the entirety of your uterus. Sometimes, the ovaries, fallopian tubes, or affected lymph nodes may also need to be removed. 
  • Systemic Therapy such as chemotherapy, radiation, and hormone therapy are used in cancer treatment after surgery is performed and is dependent on the kind of cancer and what stage it is in. 

The key to treating postmenopausal bleeding is preventative care and reducing your risk factors for the conditions that may cause it. For example, by treating endometrial atrophy early, you can prevent it from progressing into cancer, or you can have your doctor screen for conditions early before postmenopausal bleeding may even begin. University Park OBGYN recommends maintaining a healthy diet, regular exercise routine, and yearly visits to the doctor (or more if any irregularities are noted) to prevent various health conditions and complications. 

Can My Doctor Help?

At University Park OBGYN, our care team is comprised of highly skilled, trained, and compassionate professionals who are here to support guide you through your perimenopausal, menopausal, and postmenopausal journey. Early detection and treatment are crucial in preventing serious conditions, especially cancer, and it is necessary to receive annual examinations and necessary screenings. Visit our website or give us a call today to schedule your well-visit and take control of your healthcare!