Can you still bleed after menopause?

Postmenopausal bleeding

Vaginal bleeding or spotting that occurs after a woman has gone through 12 consecutive months without menstrual periods is known as postmenopausal bleeding (PMB).

About 10% of women report experiencing vaginal bleeding a year or more after their final menstrual period. While most postmenopausal bleeding is not life-threatening, it is key to seek medical advice right away to rule out other potentially serious underlying causes.

Vaginal bleeding after menopause is commonly observed 5 to 10 years after attainment of menopause and the common age of presentation is 50 to 60 years in India. 14% of women with postmenopausal bleeding are in the age group 45 to 50 years, while most women (56%) are between 50 to 60 years, while 30% of the women are above the age of 60 years.

Six reasons for vaginal bleeding after menopause:

1. Hormone Replacement Therapy (HRT)

Women who take HRT to reduce the symptoms of menopause may experience vaginal bleeding as a side effect. This bleeding or spotting is usually light and unpredictable but can sometimes become excessive. It can significantly affect a woman's confidence and quality of life.

2. Vaginal Atrophy

Vaginal atrophy (atrophic vaginitis) is characterized by inflammation and thinning of the vaginal walls, which often occurs due to decreased estrogen levels during post-menopause. This condition can cause various uncomfortable symptoms such as vaginal dryness, itching, pain during sex, and urinary problems.

3. Cervical Polyps

Benign cervical polyps are growths of tissue that are relatively common in postmenopausal women. These growths are found on the lower part of the uterus that connects to the cervix, or the cervical canal. While they are typically not dangerous, they can cause bleeding after menopause. On the other hand, precancerous or malignant polyps are very rare.

4. Endometrial Atrophy

A decrease in estrogen levels not only results in a thinning of the vaginal lining but also causes the lining of the uterus to become thinner and leads to the breakdown of vessels in the lining. As a result, postmenopausal women may experience spontaneous bleeding or spotting.

5. Endometrial Hyperplasia

Endometrial hyperplasia is a condition in which the uterine lining thickens due to an excess amount of estrogen in the body, along with a lack of progesterone to counteract its effects because of HRT. It is considered a risk factor for endometrial cancer.

6. Endometrial Cancer

Around 10% of postmenopausal women who experience vaginal bleeding will have endometrial cancer. In almost all of these cases, bleeding is the first indication of the cancer. If the cancer is detected early and treated promptly, it is usually curable. This is why postmenopausal women need to undergo regular check-ups and report any vaginal bleeding right away.

Recommendations

Postmenopausal bleeding is not normal and should be evaluated by your doctor to rule out potentially life-threatening underlying causes. Along with medical evaluation, your doctor may recommend that you adopt a healthy lifestyle to alleviate any further postmenopausal symptoms experienced. This includes following an optimized diet, developing wholesome habits, and making use of alternative medicine. It is important to learn more about the various treatments available to manage postmenopausal symptoms, so you can enjoy an improved quality of life as you age gracefully.