Menopause is that time in a woman’s life when she is transitioning from being reproductive to being non-reproductive. Menopause explained by doctors is generally one full year without period bleeding, spotting, or staining. Scroll down to understand if it is normal or not, its symptoms and what can you do about it.

Is Bleeding After Menopause Normal?

Dr Asha Hiremath, Consultant Obstetrician and Gynaecologist, Motherhood Hospital, Bengaluru, told HerZindagi that "bleeding after one has reached the menopausal stage is not normal. Abnormal bleeding after menopause must be checked by your gynecologist as soon as possible as there may be some underlying medical conditions that need immediate attention and need to be treated. This needs a workup and evaluation by one’s doctor."

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Causes

  • Atrophied estrogen to the lining of the uterus
  • Polyps inside the uterus (which are mostly benign): There is a tissue-like growth inside the cervical cavity or uterus which causes bleeding, staining or spotting.
  • Sexually Transmitted Diseases: Few STDs like chlamydia may cause bleeding after sexual intercourse.
  • The most concerning cause of bleeding after reaching menopause is cancer of the uterus or endometrial cancer.
  • Vaginal tissue atrophy: After a woman reaches menopause the levels of estrogen in her body also reduce. The estrogen would normally help keep the vaginal tissue healthy. However, when the tissue reduces it gets inflamed, thin, and dry and causes the vagina to bleed after sex.
  • Hyperplasia: More unusually women can have a thickening of the lining of the uterus called hyperplasia, which can in some instances be the beginning of cancer

How Is It Diagnosed?

The reasons behind bleeding after menopause can be diagnosed or tested through these methods as stated by Dr Hiremath:

Cervical Biopsy

This may have a certain level of discomfort attached with it, but it may help if the tissue is tested to find out whether one has cancer of the cervix or not.

Ultrasound

If a biopsy cannot be obtained or a woman seems to be too uncomfortable with it, an ultrasound of the pelvic region can be done. It is imperative that this ultrasound be done with a transvaginal probe (this also has a bit of discomfort attached to it).

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Treatment

The treatment of postmenopausal bleeding depends on the reason for the bleeding. 

  • If a woman is bleeding due to thinning of the lining of the uterus, she is recommended to take medication or hormone medication to thicken the lining of the uterus. This treatment can be either oral hormone replacement or vaginal hormone replacement therapy.
  • If the patient has polyps or endometrial polyps or thickened endometrium, is removed with a minor surgical procedure known as Dilation Curating or DNC and send for biopsy. This is usually done with a hysteroscopy where you look in the uterus. The treatment for endometrial hyperplasia usually depends on biopsy reports, hormone therapy, it is usually through oral tablets or surgical procedures.
  • Cancers are generally treated with surgery but if there are other medical conditions that may put the patient in danger due to surgery and if the patient is very old the doctor may try hormone therapy. This hormone therapy is in extremely high doses of progesterone to convince cancer to not grow or spread anymore. If not surgery or medication – radiation therapy can also be used to remove the cancer cells.

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  • Progestin: This is also a hormone replacement therapy, but what this medication does is- reduces the thick lining or the overgrown endometrial tissue.
  • Hysterectomy: Hysterectomy is a surgery where the uterus of a woman is removed. If the bleeding cannot be stopped through any other procedure this is the last resort that doctors come to.

If you are a woman who has experienced postmenopausal bleeding please go and get it checked by your gynecologist right now!

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