Definition Overview

Post-menopausal bleeding refers to any vaginal bleeding that occurs after menopause, which a point in a woman’s life, typically at 45 to 50 years old, when she stops having menstruation.

Post-menopausal bleeding is a relatively common complaint among patients, but it is not normal as it could be a symptom of a more serious, life-threatening condition. Research shows that around ten percent of post-menopausal women experience bleeding or spotting, and around ten percent of them suffer from endometrial cancer, or the development of cancerous cells in the uterine lining. It is for this reason that post-menopausal bleeding is treated as an urgent matter.

Causes of Condition

There are a number of conditions that can cause post-menopausal bleeding, including the following:

  • Atrophic vaginitis - This refers to the inflammation and subsequent thinning of the tissues lining the vaginal canal. This condition occurs when the patient suffers from lower estrogen levels.

  • Endometrial atrophy - The lining of the uterus is inflamed or thinning, also caused by lower estrogen levels.

  • Polyps in the uterus or cervix - These are benign growths that develop in the uterus or the cervix.

  • Endometrial hyperplasia - Research shows that this condition, which involves the thickening of the uterine lining, can be caused by obesity, hormone replacement therapy, or unusually high levels of the hormone estrogen.

Key Symptoms

The main symptom of post-menopausal bleeding is the expulsion of blood from the vagina. In some cases, the blood comes from the patient’s rectum. Most patients who have experienced post-menopausal bleeding do not suffer from other symptoms.

Who to See and Types of Treatment Available

There are many ways to identify the exact cause of post-menopausal bleedings. The patient should consult a gynecologist, who will first ask about the patient’s medical history and assess her risk factors for uterine cancer and other conditions. The gynecologist will order diagnostic procedures to determine the presence of malignant or benign masses that might be causing the abnormal bleeding or spotting, including the following:

  • Endometrial biopsy - In this procedure, the technician or gynecologist will insert a thin tube into the uterus to obtain a small chunk of tissues from the uterine lining. The samples will then be sent to a laboratory for further testing.

  • Transvaginal ultrasound - The technician or gynecologist will insert a device into the patient’s vagina, which will then transmit images of the interior structures to a computer screen.

  • Dilation and curettage - Like in an endometrial biopsy, the doctor will take tissue samples from the uterine lining, which will be sent to a laboratory for further analysis.

  • Hysteroscopy - In this procedure, the technician or gynecologist will use a small camera, like the one used in an endoscopy, to look inside the patient’s uterus.

  • Blood tests

  • Pap test

The treatment plan for post-menopausal bleeding depends on the causes of the condition. A thinning endometrium can be addressed by medication, which elevates the level of estrogen hormones in the body. The medication for this condition can come in topical gel or cream (to be applied to the patient’s vagina), tablet or pill, or patch form. Some gynecologists can also recommend a ring-like device inserted into the vagina that releases medication over a certain period of time.

In the case of polyps in the uterus, cervix, or vaginal canal, they can be removed in a minimally invasive procedure performed under local anesthetic.

In case of thickened endometrial lining, the patient can be prescribed with a medication containing progesterone or undergo surgery.

If endometrial cancer is causing the condition, treatment will depend on the stage of the condition. Options include:

  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Hormonal therapy
    References:

  • American College of Obstetricians and Gynecologists: "Perimenopausal Bleeding and Bleeding After Menopause."

  • National Cancer Institute: "Endometrial Cancer Treatment."

  • UK National Health Services: “Postmenopausal Bleeding or Spotting.”

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