Postmenopausal Bleeding

Menopause is a biological phenomenon which occurs right after the woman stop having her periods for a year. Women in their 40’s or 50’s are more likely to experience menopause due to an evident fall in the levels of hormones.

After menopause, normally bleeding does not occur anymore but at times many women experience vaginal bleeding. It is important to highlight the root cause of such bleeding as it is not considered normal. Postmenopausal bleeding may appear in following ways:

• There may be bleeding after sex
• The bleeding may be rather heavy to be placed under ‘spotting’

Causes Of Postmenopausal Bleeding

Given below are the contributing factors of postmenopausal bleeding:

• Endometrial atrophy, a condition in which the endometrial lining begins thinning and becomes prone to bleeding. This may be due to insufficient or no production of estrogen hormone.
• Endometrial hyperplasia, a condition in which the uterine lining becomes thicker causing irregular or heavy bleeding. This results due to skyrocketed levels of estrogen with no progesterone for its offset.
• Endometrial cancer is the cancer of endometrial lining and is responsible for 10% of the postmenopausal bleeding in women.
• Polyps, outgrowths that develop on uterus lining. They may be non-cancerous but are capable of causing excess bleeding. Polyps inside a cervical canal can cause bleeding during sex.

Other causes may be:

• Thyroid disorder
• Urinary tract bleeding
• Pelvic trauma
• Issues related to clotting
• A hormone medicine: tamoxifen

• Hormone replacement therapy

Diagnosis

After the assessment of symptoms and physical exam, the doctor may recommend the following tests for the diagnosis of what’s causing the postmenopausal bleeding:

• Dilation and Curettage (D&C): This procedure is used to examine the inside of uterus and any potential growths.
• Endometrial biopsy: This procedure may assist in the identification of cancerous cells.
• Hysteroscopy: This procedure may help in the detection of abnormal growths or polyps.
• Sonohysterography: This test enables the doctor in assessing the uterine lining, whether it is thin or thick.

Treatment Protocol

In order to treat postmenopausal bleeding, it is crucial to address the underlying cause. Given below is the treatment approach based on the root cause:

• Polyps: Polyps can be treated by being surgically removed so they may no longer cause unwanted bleeding.
• Endometrial cancer: Usually endometrial cancer is treated by removing the uterus and the lymph nodes nearby where cancer could most likely metastasize. Surgical removal of uterus is referred to as hysterectomy. Chemotherapy and radiation therapy may as well be required depending on the stage of cancer.
• Endometrial hyperplasia: This condition can be addressed by a medicine called progestin that prevents the lining of endometrium from thickening.
• Thinning of endometrial tissues may also result in vaginal bleeding however it can be prevented by vaginal estrogen that minimizes the effects of endometrial thinning.

Outlook

It is alright for women to experience vaginal bleeding during perimenopause, the time before the occurrence of menopause however after menopause, vaginal bleeding is not considered normal on any level. There may not always be a concerning reason behind postmenopausal bleeding nevertheless consulting a doctor is always thought as playing safe as the diagnosis and various tests a doctor recommends may rule out any concerning underlying factors.

References

• Loiacono, R. M. R., Trojano, G., Del Gaudio, N., Kardhashi, A., Deliso, M. A., Falco, G., ... & Trojano, V. (2015). Hysteroscopy as a valid tool for endometrial pathology in patients with postmenopausal bleeding or asymptomatic patients with a thickened endometrium: hysteroscopic and histological results. Gynecologic and obstetric investigation, 79(3), 210-216.