Bleeding After Menopause

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You’ve had no periods for a year so BOOM! You’re officially in menopause. Now you can throw out all those supplies that you had once needed monthly from under the bathroom sink and not have to worry about them again.

But then you experience some bleeding. What? Are your periods back? Likely not, but if you’re having a recurrence of bleeding after you’re officially in menopause, it could be a sign of another health condition that’s worth a visit to your doctor to investigate.

Common causes of bleeding after menopause include:

  • Polyps – Polyps are growths that are usually non-cancerous that form from tissue similar to the lining of the uterus, which is the endometrium. These growths may develop on the wall of the uterus, on the endometrium itself, on the cervix, or inside the cervical canal. They can cause bleeding and, in the case of those in the area of the cervix, bleeding after sex.
  • Endometrial atrophy – After you’re in menopause, the low levels of estrogen in your body can cause the endometrium to become too thin. This condition can cause bleeding as the lining thins.
  • Endometrial hyperplasia – The reverse of endometrial atrophy, this condition is the result of a thickened endometrium. Too much estrogen in your body without enough progesterone hormone causes it. Sometimes the cells of the endometrium can become abnormal (atypical hyperplasia) and develop into endometrial cancer. However, if endometrial hyperplasia is diagnosed and treated early on, endometrial cancer can often be prevented.

Diagnosing the Cause

When you see your doctor about bleeding after menopause, he or she will talk to you about your family history and likely do a physical exam. Then you may need to have one or more of these tests to confirm your diagnosis:

  • Endometrial biopsy – A small amount of tissue is taken from the lining of your uterus using a thin tube. The sample is sent to a lab where it will be examined under a microscope.
  • Sonohysterography – Fluid is injected into your uterus through a catheter while ultrasound images are made of your uterus.
  • Hysteroscopy – A hysteroscope, a thin tube with a light and a camera on the end, is inserted through the vagina and the opening of the cervix to allow the inside of your uterus to be seen.
  • Dilation and curettage (D&C) – The opening of the cervix is enlarged to allow tissue to be removed from your uterus. The sample is sent to a lab where it will be examined under a microscope.

Treatment

Treatment for bleeding after menopause depends on the cause.

  • Polyps may be removed with surgery.
  • Endometrial atrophy can be treated with medications.
  • Endometrial hyperplasia can be treated with progestin (synthetic progesterone) therapy, which causes the endometrium to shed like it would when you were having periods. Thickened parts of the endometrium may be removed using hysteroscopy and D&C. If you are diagnosed with endometrial hyperplasia, you are at risk of developing endometrial cancer. You will need to have regular biopsies to ensure the hyperplasia has been eliminated and doesn’t return.
  • Endometrial cancer is usually treated with a hysterectomy and lymph node removal. If you receive this diagnosis, your doctor will talk with you about your treatment options.

Call Your Doctor When…

Make an appointment to see your doctor if you have any bleeding after menopause. He or she will determine the cause and discuss the best treatment options with you.

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