What’s Postmenopausal Bleeding? Causes, Symptoms And Treatment For Patients

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What’s postmenopausal bleeding?

Postmenopausal bleeding occurs in a woman’s vagina after she has undergone menopause. Once a woman has gone 12 months without a period, she’s considered to be in menopause.In order to rule out serious medical problems, women with postmenopausal bleeding should always see a doctor.

What is vaginal bleeding?

Vaginal bleeding can have a variety of causes. These include normal menstrual cycles and postmenopausal bleeding. Other causes of vaginal bleeding include:

  • trauma or assault
  • cervical cancer
  • infections, including urinary tract infections

If you’re experiencing vaginal bleeding and are postmenopausal, your doctor will ask about the duration of the bleed, the amount of blood, any additional pain, or other symptoms that may be relevant.Because abnormal vaginal bleeding can be a symptom of cervical, uterine, or endometrial cancer, you should get any abnormal bleeding evaluated by a doctor.

 

What causes postmenopausal bleeding?

Bleeding can occur in postmenopausal women for several reasons. For example, women who take hormone replacement therapy may have vaginal bleeding for a few months after starting the hormones. It’s also possible for a woman who thought she was in menopause to begin ovulating. If this occurs, bleeding may also occur. There are a variety of other conditions that can cause postmenopausal bleeding.

Some common causes include: polyps, endometrial hyperplasia, and endometrial atrophy.

Uterine polyps

Uterine polyps are noncancerous growths. Though benign, some polyps may eventually become cancerous. The only symptom most patients with polyps will experience is irregular bleeding. Uterine polyps are particularly common in women who have gone through menopause. However, younger women can also get them.

 

Endometrial hyperplasia

Endometrial hyperplasia is the thickening of the endometrium. It is a potential cause for postmenopausal bleeding. It is often caused when there is an excess of estrogen without enough progesterone. It occurs frequently in women after menopause. Long-term use of estrogen can lead to increased risk of endometrial hyperplasia. It can ultimately lead to cancer of the uterus if not treated.

Endometrial cancer

Endometrial cancer begins in the uterus. The endometrium is a layer of the uterus. In addition to abnormal bleeding, patients may experience pelvic pain. This condition is often detected early. It causes abnormal bleeding, which is easily noticed. The uterus can be removed to treat the cancer in many cases. About 10 percent of women who have postmenopausal bleeding have endometrial cancer.

 

Endometrial atrophy

This condition results in the endometrial lining becoming too thin. It can occur in postmenopausal women. As the lining thins, bleeding may occur.

Cervical cancer

Bleeding after menopause is often harmless. However, it can also be a rare sign of cervical cancer. Cervical cancer tends to progress slowly. Doctors can sometimes identify these cells during a regular exam. Annual visits to the gynecologist can help with early detection and even prevention of cervical cancer. This can be done by monitoring for abnormal Pap smears. Other symptoms of cervical cancer can include pain during physical relationship or abnormal vaginal discharge, including in women who are postmenopausal bleeding.

Symptoms of postmenopausal bleeding

Many women who experience postmenopausal bleeding may not have other symptoms. But symptoms may be present. This can depend on the cause of postmenopausal  bleeding. Many symptoms that occur during menopause, like hot flashes, often begin to decrease during the postmenopausal time period. There are, however, other symptoms that postmenopausal women may experience.

 

Symptoms postmenopausal women may experience include:

  • vaginal dryness
  • decreased libido
  • insomnia
  • stress incontinence
  • increased urinary tract infections
  • weight gain

How is postmenopausal bleeding treated?

Treatment depends on the cause of the postmenopausal bleeding, on whether bleeding is heavy, and if additional symptoms are present. In some cases, bleeding may require no treatment. In other situations where cancer has been ruled out, treatment may include the following:

  • Estrogen creams: Your doctor may prescribe estrogen cream if your bleeding is due to thinning and atrophy of your vaginal tissues.
  • Polyp removal: Polyp removal is a surgical procedure.
  • Progestin: Progestin is a hormone replacement therapy. Your doctor may recommend it if your endometrial tissue is overgrown. Progestin can decrease the overgrowth of tissue and reduce bleeding.
  • Hysterectomy: Bleeding that cannot be treated in less invasive ways may require a hysterectomy. During a hysterectomy, your doctor will remove the patient’s uterus. The procedure may be done laparoscopically or through conventional abdominal surgery.

If bleeding is due to cancer, treatment will depend on the type of cancer and its stage. Common treatment for endometrial or cervical cancer includes surgery, chemotherapy, and radiation therapy.