Post Menopausal Bleeding is abnormal and you should arrange to see your healthcare professional as soon as possible for medical assessment. Of course, not all bleeding after menopause means cancer, but for obvious reasons, no matter how slight, spotting or brief it may be, cancer needs to be ruled out as soon as possible.
Post menopause bleeding is defined as: after 12 months without menstruating you experience an unscheduled bleed (ie not due to hormone replacement therapy).
So you’ve had a full 12 months without a period and are now in the post menopause phase of your life, only for bleeding to occur again. This can be an extremely frightening experience, however, it occurs more often than you may think and can be due to harmless causes.
What Can Cause Post Menopausal Bleeding?
Polyps and Fibroids – Growths which are usually benign. Polyps can develop in the uterus, inside the cervical canal, on the cervix and may cause bleeding. Fibroids originate in the uterus and can be situated either inside or outside of the organ.
Surgery may be needed to remove them.
Endometrial Atrophy (thinning of the endometrium) – The tissue that lines the uterus (womb) is called the endometrium. This tissue can become very thin after menopause due to diminished estrogen levels and may cause unexpected post menopausal bleeding.
This condition can usually be treated with medication.
Endometrial Hyperplasia – The lining of the uterus becomes thick, normally as a result of too much estrogen and too little progesterone -postmenopausal bleeding may occur as a result of this condition.
This condition can usually be treated with medication and/or surgery.
Endometrial Cancer (uterine cancer) – Post menopausal bleeding can be a sign of endometrial cancer.
This can be treated with surgery by a total hysterectomy being performed (removal of the uterus and cervix). In some cases, part of the vagina will be removed; the fallopian tubes and ovaries may also be removed along with nearby lymph nodes. Women with more advanced endometrial cancer may need to undergo radiation, hormone therapy or chemotherapy along with surgery.
Cervical Cancer – Symptoms in a post menopausal woman may be pelvic pain, increased vaginal discharge and bleeding following intercourse. On the other hand, symptoms can be non-existent, therefore, screening is essential.
There are many treatment options depending on the stage of the cancer including surgery and radiotherapy.
Atrophic Vaginitis – Also known as vaginal atrophy (thinning and inflammation of vaginal tissue) which is caused by a decline in estrogen post menopause. This can cause light bleeding after intercourse.
This condition can be treated with lubricants, forms of estrogen and HRT.
Other Causes Include:
- Hormone Therapy – If you are starting, changing, adding to or weaning off HRT you may experience unexpected episodes of bleeding.
- Nutrition and Insulin Resistance – Nutrients maintain the cycle of hormone balance, so if you have had a deficiency in certain nutrients, it may show at menopause in the form of bleeding. it is worth adding a high quality multivitamin to your daily diet.
- Weight loss – dramatic weight loss can lead to estrogen which is normally stored in fatty tissue being released into the bloodstream which can cause bleeding.
- Emotional stress – is believed to be associated with menopausal bleeding. Women have reported unexpected bleeding at times of anxiety.
- Infection of the uterus or cervix.
- Infections such as thrush.
- Certain medications i.e. blood thinners.
- Other types of cancer.
Your healthcare professional can establish the cause of your bleeding by listening to your symptoms, taking a medical history, performing a physical examination and by carrying out various tests.
Tests may Include the following:
Transvaginal Ultrasound: An imaging device is inserted into the vagina to enable the doctor to view the pelvic organs and look for any abnormalities.
Endometrial Biopsy: A thin tube is inserted into your uterus and a small sample of the uterine lining is removed and sent for analysis.
Hysteroscopy: An instrument with a light and a small camera is used to examine the inside of the uterus.
D & C (Dilation and Curettage): Tissue from the uterus lining is removed and sent for analysis.
Although the exact cause of endometrial (womb) cancer is unknown, there are factors that appear to increase the risk and factors that appear to reduce the risk:
- Being overweight
- Diet and alcohol
- Having had children or not
- Menstrual history
- Endometrial Hyperplasia
- Polycystic Ovary Syndrome
- Family history & other cancers
- Tamoxifen and Reloxifene
- Hormone Replacement Therapy
- Contraceptive pills
- Talcum powder
- Diabetes and high blood pressure
- Physical activity
- EthnicityUseful links:
Post-menopausal bleeding. Retrieved from http://www.nhs.uk/Conditions/postmenopausal-bleeding-or-spotting/Pages/Introduction.aspx
Shannon, K. Bleeding after menopause. Retrieved from http://www.mayoclinic.org/diseases-conditions/menopause/expert-answers/bleeding-after-menopause/faq-20058396
Womb Cancer Symptoms. Retrieved from http://www.cancerresearchuk.org/about-cancer/type/womb-cancer/about/womb-cancer-symptoms
Newell, ., Overton, C. (2012) Post menopausal bleeding should be referred immediately. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22662514
Womb cancer risks and causes. Retrieved from http://www.cancerresearchuk.org/about-cancer/type/womb-cancer/about/womb-cancer-risks-and-causes