What Is Postmenopausal Bleeding?
is bleeding from the vagina after a woman has stopped having menstrual cycles
due to menopause. Because perimenopause can last several years, periods may be
irregular for months. Once a woman has gone 12 months without a period, she is
considered to be in menopause. Vaginal bleeding that occurs after that 12-month
timeframe is considered postmenopausal bleeding.
Women with postmenopausal
bleeding should always see a doctor, in order to rule out serious medical
What Causes Postmenopausal Bleeding?
Bleeding can occur in postmenopausal women for several reasons.
For example, women who take hormone replacement therapy may have vaginal
bleeding for a few months after starting the hormones. It is also possible a
woman who was believed to be in menopause may ovulate. If this occurs, bleeding
may also occur.
Additional causes of bleeding after menopause include uterine
polyps, which are non-cancerous growths in the lining of the endometrium. Another
possible cause is endometrium hyperplasia, which is the thickening of the
Bleeding may also develop due to thinning of the vaginal tissues. This
is common in women who are postmenopausal. Thinning often develops due to a
decrease in estrogen.
Although bleeding after menopause is often harmless,
postmenopausal bleeding can be a sign of cancer. According to Harvard Health
Publications, about 10 percent of women who have postmenopausal bleeding have endometrial
cancer. (Harvard Health Publications)
What Are the Symptoms of Postmenopausal Bleeding?
Many women who
experience postmenopausal bleeding may not have other symptoms. But symptoms
may be present and depend on the cause of bleeding. Women that have postmenopausal
bleeding due to thinning of the vaginal tissues may experience pain with
How Is Postmenopausal Bleeding Diagnosed?
The first step in
diagnosing the cause is an exam and a medical history. A doctor may conduct a pap
smear as part of a pelvic exam. This can also screen for cervical cancer.
Doctors may use other
procedures to view the inside of the vagina and the uterus.
ultrasound is one option. This procedure allows doctors to view the ovaries,
uterus, and cervix. In this procedure, a technician inserts a probe into the
vagina or asks the patient to insert it herself. The probe emits sound waves
that bounce off of inner structures. A computer then creates pictures of the inner
Another diagnostic procedure
is a hysteroscopy. This procedure shows endometrial tissue. In a hysteroscopy,
a doctor inserts a fiber optic scope into the vagina and cervix. The doctor
then pumps carbon dioxide gas through the scope. This helps to expand the
uterus and makes the uterus easier to see. During this procedure, a doctor may
also remove polyps or take a biopsy of endometrial tissue in order to rule out
How Is Postmenopausal Bleeding Treated?
In some cases, bleeding
may require no treatment. Treatment depends on the cause of the bleeding, on whether
bleeding is heavy, or if additional symptoms are present. In situations where
cancer has been ruled out, treatment may include the following:
- Estrogen creams: Your doctor may prescribe estrogen cream if your
bleeding is due to thinning and atrophy of your vaginal tissues.
- Polyp removal: Polyp removal is a surgical procedure.
- Progestin: Progestin is a hormone replacement. Your doctor may recommend it
if your endometrial tissue is overgrown. Progestin can decrease the overgrowth
of tissue and reduce bleeding.
- Hysterectomy: Bleeding that cannot be treated in less invasive ways may
require a hysterectomy. During a hysterectomy, your doctor will remove the patient’s
uterus. The procedure may be done laparoscopically or through conventional abdominal
If bleeding is due to
cancer, treatment will depend on the type of cancer and how advanced it is.
Common treatment for endometrial or cervical cancer includes surgery,
chemotherapy, and radiation therapy.
What Is the
Outlook for Postmenopausal Bleeding?
Postmenopausal bleeding is successfully treated in many cases. If your bleeding
is due to cancer, the prognosis depends on the type of cancer and stage at
which it was diagnosed. The five-year survival rate is about 95 percent when
endometrial cancer is detected early and has not spread (Medline