Bleeding After Menopause

Perimenopause-The Beginning of The End

Menstruation marks a major transition for young girl and when it ends, it again marks a major transition for a woman.

Perimenopause, that period in time prior to menopause (usually when a woman is in her 40s and 50s), brings changes to a woman’s menstrual cycle. The periods become erratic and gradually taper off over a period of years until she becomes menopausal. Menopause is marked by the cessation of the menstrual cycle for a period of 12 months. After a year, a woman is considered fully menopausal. Between perimenopause and menopause, it is common for a woman to have bleeding.

PMB-What’s Normal And What’s Not

Bleeding during the process of menopause is normal, but bleeding after menopause is not normal. It should be taken very seriously. Post-menopausal bleeding (PMB) may be due to a reduction in the production of estrogen. The lining of the vagina becomes dry and thin and it loses its elasticity. Typically, when this happens, vaginal tissue becomes inflamed, broken, or irritated and causes bleeding after menopause. One of the common problems with this condition is that sexual intercourse becomes very painful and can cause further damage to the tissue of the vagina.

There are other causes of post-menopausal bleeding, most commonly HRT, hormone replacement therapy. PMB often occurs in women who are taking HRT because the uterus is very sensitive to estrogen, the hormone that causes growth of the lining of the uterus. Since HRT acts as estrogen in the body, there is growth of the endometrium (uterine lining) just as when the woman was having her normal reproductive cycle. When estrogen is lacking, the lining of the uterus dries out (atrophies) and the blood vessels become very fragile. In this condition, they can easily break and bleed.

Have Bleeding Checked-It May Be More Than You Think

Polyps and fibroids, most often benign, can develop easily in the uterine cavity. Polyps may cause light spotting or irregular light bleeding. Fibroid tumors can also present with light bleeding, but more often they are associated with much heavier bleeding. Hyperplasia, overgrowth of the uterine lining, has the potential to cause abnormal PMB and is associated with malignancies (cancers). About 20 percent of women who bleed after menopause have endometrial cancer.

In many cases, post-menopausal bleeding stops without problems. However, if a woman is experiencing PMB it is important that she talk with her physician. A careful check of her history and a thorough pelvic exam will help determine the need for further treatment. If cancer is detected it can usually be controlled very effectively with early treatment. Annual pap smears are as important for women who are peri and post menopausal as they are for women who have their regular monthly cycles.

As with all aspects of health, education about menopause, its symptoms, and treatments, can be very effective in removing the sense of fear that may accompany post-menopausal bleeding.

Learn more about menopause in our menopause forum and ask the questions you need to ask.