Menopause is defined as no menstrual periods for at least 12 months continuously. It is a natural decline in reproductive hormones when a woman reaches 50 years of age. This period marks the stop of menstruation and the woman is unable to reproduce further. Menopausal women usually do not experience vaginal bleeding after menopause under normal conditions.
Bleeding after Menopause
Bleeding after menopause is mostly referred as “postmenopausal bleeding” or PMB. It can have natural, normal causes or it may be an indication of certain diseases. Although, sometimes it may be due to the therapies taken during menopause, some may be symptoms of other significant health conditions and should be noted and an immediate medical attention is to be taken.
What Can Cause Bleeding After Menopause?
The causes of bleeding after menopause can be varied and are as follows:
The non-cancerous tissues or cells that grow on the surfaces of the vagina, cervix or inside the cervical canal are called polyps. This might be one of the causes of bleeding after menopause.
Endometrial Atrophy as a Cause of Bleeding after Menopause
Endometrial tissue lines the uterus. The thinning of the endometrium is called as the endometrial atrophy. This is usually due to the low levels of estrogen. It causes slight bleeding.
Endometrial Hyperplasia Can Cause Bleeding after Menopause
The abnormal thickening of endometrial tissue lining the uterus is called as endometrial hyperplasia. This is mostly due to obesity and may sometimes lead to endometrial cancer.
Hormonal Replacement Therapy
This therapy is given to regain normal hormonal levels which can reduce the menopausal symptoms. The constant changes in the level of hormones can also lead to bleeding after menopause.
Trauma as a Reason for Bleeding after Menopause
External trauma from a foreign body or while intercourse can also cause bleeding.
Blood Clotting Problems
Usage of certain medications like steroids and diseases of the kidney, thyroids and liver can cause problems in the clotting mechanism of the blood. This may also lead to possible bleeding after menopause.
Vaginal infections and diseases transmitted sexually can also cause bleeding after menopause. Infections of the uterus and the cervix can also lead to bleeding after menopause.
Certain treatments and cancer medications can also cause postmenopausal bleeding. Medications of breast cancer mainly cause bleeding after menopause due to the varied hormonal levels.
Vaginal Dryness Causing Bleeding after Menopause
Dryness in the vagina can lead to a painful sexual intercourse and may also result in bleeding after menopause. Normal vaginal pH of 3.8 to 4.5 should be maintained.
Characteristics of Bleeding after Menopause
The main characteristics points of postmenopausal bleeding include:-
- Menstrual bleeding stops more than a year before the first bleeding after menopause
- Constant hormonal shifts
- Bleeding after menopause is at least experienced by 30% of the women
- The blood flow depends on the cause of bleeding; it may be light or heavy
- Rare cases are concerned with serious problems in the uterus.
Symptoms of Bleeding after Menopause
- Mood swings due to hormonal imbalance
- Pain in the pelvic region
- Pain during intercourse
- Sudden weight loss or weight gain
- Sudden changes in the bowel movements from constipation to diarrhea or vice versa.
How to Diagnose the Causes of Bleeding After Menopause?
The first step is to determine where the blood is coming from. The blood seen while using toilets can be from vagina, uterus, bladder or rectum. If blood cannot be seen in pads or tampons, then perhaps the blood is coming from the bladder or rectum and should be treated immediately. If blood is seen in the pads or tampons then the chances are high that it is coming from the vagina or the uterus.
A medical history and examination of cervix is primarily done followed by:
- Ultrasound: A small vaginal probe is gently placed in the vagina which helps in the visualization of the uterus. For menopausal women, the lining of the womb should be thin. If the lining is thick then a hysteroscopy is done.
- Hysteroscopy: In this method a small camera with lighting is inserted gently inside the cervix under a general anesthesia. A biopsy might be taken or a fibroid or polyp may be removed which may undergo further testing.
Treatment for Bleeding after Menopause
The treatment primarily focuses on stopping the blood flow. It may also provide relief from the symptoms. The treatment depends on the cause of bleeding. Treatment methods for bleeding after menopause include:
- Surgery: The most used form of treatment is the surgical removal of the excessive lining in the uterus under general anesthesia.
- Medications: Bleeding after menopause due to endometrial atrophy can be treated by medications, fibrin clots can also be treated via medications. However, the treatment of fibrin clots is not done by medications for patients with history of thromboembolism as it may cause stroke or heart attack.
- Other Remedies: Other remedies include –
- Using pads instead of tampons to avoid irritation
- Changing pads frequently to avoid infections
- Avoiding anti-inflammatory medications or aspirin which can prevent the thinning of blood.
Nutritional Practices to Treat Bleeding of Menopause
Postmenopausal bleeding can cause excess loss of blood which may cause anemia, dizziness and tiredness. Hence, in order to overcome these, healthy and nutritious food intake is necessary. A diet high in iron and high in antioxidants such as vitamin A, C, E, and selenium as well as zinc, vitamin D, and omega 3 can help for the treatment of bleeding after menopause and also helps in the prevention of cancer.
Risks Associated with Bleeding after Menopause
Bleeding after menopause can lead to various complications and risk factors which include:-
- Hypovolemia: This is caused due to the low blood volume after excessive bleeding.
- Shock: The excessive blood loss can also lead to cardiovascular diseases and hypertension.
- Sepsis: The infection in the vagina can harbor pathogens which may spread in the bloodstream and cause sepsis.
- Endometrial Cancer: Endometrium is a layer of the uterus; hence this type of cancer occurs in the uterus. This causes abnormal bleeding and is easily detected. Patients experience severe pain in the abdominal region and in most cases the uterus is removed completely.
- Cervical Cancer: Bleeding after menopause is a rare sign of the cancer of the cervix. This cancer develops slowly. This causes pain during sexual intercourse and abnormal vaginal discharge. Annual visits to the gynecologists can help in the prevention and in the treatment of cervical cancer.
Although, the cause for bleeding after menopause could be something very minor; however, the reason could also be cancer. Hence, one must not ignore this problem. If it is cancer, the sooner it is treated, the more likely it is to have a full recovery.
Prevention of Bleeding after Menopause
In order to prevent bleeding after menopause, the best way is to reduce the risk factors that lead to it. The other preventive methods are:
- Use of pads and regular change of pads during menstruation which reduce the chances of infection.
- Safe and hygienic sexual intercourse and use of condoms to avoid sexually transmitted diseases that can cause bleeding after menopause
- Constantly watching over vaginal dryness and maintaining accurate pH levels
- Maintaining a healthy body to avoid obesity by exercise and healthy diet
- Regular checkups with gynecologists to ensure a healthy uterus
- Treatment for Postmenopausal bleeding should be done early to prevent cancer.
Despite the fact that gynecological issues are hard to discuss, it is very important to recognize the problem and find a solution to it. Only then it will help to lead a healthy and happy life. Hence, bleeding after menopause should be noted and treated cautiously in order to avoid serious problems like cancer. Healthy and hygienic practices should be followed to avoid the symptoms. Bleeding after menopause should not be neglected and should be treated immediately as prescribed by a gynecologist.
- Mayo Clinic. (2021). Menopause. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
- WebMD. (2021). Postmenopausal Bleeding. https://www.webmd.com/menopause/guide/postmenopausal-bleeding
- Cleveland Clinic. (2021). Postmenopausal Bleeding (PMB). https://my.clevelandclinic.org/health/diseases/14663-postmenopausal-bleeding