Once you have gone through menopause (and it has been a year since you’ve had a period), you should not be bleeding. More conservative doctors consider bleeding after six months of not bleeding to be a potentially worrisome sign. Not even spotting is considered normal after menopause, and should be evaluated by your doctor as soon as possible. Some of the conditions that can be responsible for postmenopausal bleeding include:
Polyps: These typically benign growths can develop on the cervix or in the uterus and can cause bleeding.
Endometrial atrophy: This is the thinning of the tissue lining the uterus, the endometrium. After menopause, lower estrogen levels are responsible for this condition, which can be a cause of unexpected bleeding.
Endometrial hyperplasia: Sometimes, when too much estrogen and too little progesterone are present, the endometrium can thicken, and this can cause bleeding.
Endometrial cancer: Endometrial or uterine cancer can cause bleeding. This is most common between the ages of 65 and 75.
Other potential causes for postmenopausal bleeding include infection, hormone therapy, certain medications (blood thinners, for example), and other types of cancer besides endometrial.
In order to find the reason for your bleeding, your doctor will want to take your medical history, perform a physical examination, and perform some tests. These tests may include a transvaginal ultrasound, a biopsy, a hysteroscopy (in which the inside of your uterus is examined with a small camera), a sonohysterogram (which is a transvaginal sonogram with saline solution instilled into the uterine cavity) or a D&C (dilation and curettage; during this test, uterine tissue is removed and sent to a lab to be analyzed).
Which treatment your doctor recommends will depend on the cause of the bleeding. If you have polyps, surgery may be necessary to remove them. Medication is typically used for endometrial atrophy; endometrial hyperplasia may call for both medication and surgery aimed at the removal of the thickened endometrial tissue.
What If It’s Cancer?
If it is determined that you have endometrial cancer, your doctor will probably want to perform a total hysterectomy, a surgical procedure in which your uterus and cervix are removed. Other parts that might need to be removed include the ovaries, fallopian tubes, part of the vagina, or nearby lymph nodes. You may also need radiation, chemotherapy, or hormone therapy.
Just keep in mind that while irregular bleeding during perimenopause can be normal, bleeding after menopause isn’t. Even if it’s very light, postmenopausal bleeding warrants an immediate call to your doctor to have it checked out. Chances are good that the bleeding is being caused by a minor problem, but there is always the chance that it could be something more serious. And if it is cancer, the earlier it is treated, the better, so don’t ignore even very light postmenopausal bleeding.
Read more about the menopause and other natural changes in your body in my health book, “Inside information for Women”.
– Yvonne S. Thornton, M. D., M. P. H