Post-Menopausal Bleeding

Menopause — gone without a period for more than one year —there should be no menstrual bleeding. Even a little spotting is not normal after menopause. In case of postmenopausal bleeding, evaluation by the doctor is necessary as it may be due to health problems, some of which are serious and need urgent treatment.

Causes of Postmenopausal Bleeding

Several health conditions can cause postmenopausal bleeding, including:

Polyps: These are growths, usually noncancerous but may be cancerous.  Polyp can develop in the uterus, on the cervix, or inside the cervical canal, and may cause bleeding or abnormal vaginal discharge.

Endometrial atrophy (thinning of the endometrium): The endometrium, the tissue that lines the uterus, can become very thin after menopause because of diminished estrogen levels, and may cause unexpected bleeding.

Endometrial hyperplasia: In this condition, the lining of the uterus becomes thick, usually as a result of too much estrogen and too little progesterone, and bleeding may occur as a result. Obesity may be the cause of the problem. Some patients with endometrial hyperplasia may have abnormal cells that can lead to endometrial cancer (cancer of the uterine lining).

Endometrial cancer (uterine cancer): Bleeding after menopause can be a sign of endometrial cancer.

Other causes: Hormone therapy, infection of the uterus or cervix, use of certain medications such blood thinners, and other types of cancer can cause postmenopausal bleeding.

Determining the Cause of Postmenopausal Bleeding

The cause of post menopausal bleeding can be determined by taking medical history, performing a physical exam, and conducting a few tests. It includes

Transvaginal ultrasound:

Endometrial biopsy: A thin tube is inserted into your uterus and a tiny sample of the uterine lining is removed so that it can be sent to a lab to look for abnormalities.

Hysteroscopy: During this test, an instrument with a light and small camera is used to examine the inside of the uterus and look for problems.

D&C (dilation and curettage): This test allows to remove tissue from the uterus lining so that it can be sent to a lab for analysis.

How Is Postmenopausal Bleeding Treated?

Treatment depends on what is causing the bleeding. If polyps are cause, surgery may be needed to remove them. Endometrial atrophy can be treated with medication alone; endometrial hyperplasia may be treated with medication, such as progestin or progesterone therapy, and/or surgery to remove thickened areas of the endometrium or hysterectomy can be planned. In conditions with potential of malignancy or malignancy, hysterectomy is advised.