Once menopause occurs, vaginal bleeding normally ceases. Any type of vaginal bleeding that occurs in the postmenopausal period is abnormal and fits into a category sometimes known as dysfunctional uterine bleeding, or DUB. Postmenopausal bleeding can be benign or serious; only a medical practitioner can determine the reasons for the bleeding.
Definition
The definition of abnormal bleeding in postmenopausal women is any vaginal bleeding that occurs 12 months after the complete cessation of menstrual periods, according to the Mayo Clinic. Any bleeding that occurs after this time frame merits medical investigation.
Causes
Uterine cancer is the main concern of medical practitioners when they encounter postmenopausal bleeding, since one out of three menopausal women with abnormal bleeding has uterine cancer, Cedars-Sinai reports. Other possible causes include benign uterine growths such as fibroids and polyps, thinning of the vaginal and uterine tissues, thickening of the uterine lining, known as endometrial hyperplasia and infection.
Radiation treatment and blood thinning medications can also cause uterine bleeding in menopause, Dr. Annekathryn Goodman, associate professor at Harvard Medical Center reports on UpToDate.
Symptoms
Postmenopausal bleeding is usually painless. If large fibroids are the cause of abnormal bleeding, they may put pressure on different structures and cause discomfort, increased urination or constipation in addition to bleeding. Bleeding can be scant or heavy, and may occur just once or last for days. Any type of bleeding should be evaluated, regardless of the duration.
Diagnosis
Abnormal uterine bleeding can be diagnosed by vaginal ultrasound, hysteroscopy, the examination of the inside of the uterus with the help of a lighted telescope, endometrial biopsy, removal of a piece of the uterine lining or in some cases, dilatation and curettage, scraping of the uterine lining, according to Dr. Paul Indman.
Treatment
Treatment depends on the cause. A dilatation and curettage (D&C) may be done to remove uterine tissue for examination of the cells for possible cancer. Ultrasound can diagnose fibroids and polyps, fleshy benign growths in the uterus. These can be surgically removed if bleeding is abnormally heavy. Hysterectomy, removal of the uterus, treats uterine cancer and large fibroids that are causing abnormal bleeding or pain. Hormone replacement therapy may be used to shed a uterine lining that becomes too thick over time.
Complications
Uterine cancer can metastasize, or spread, if not treated promptly. Abnormal bleeding that continues in menopause can cause anemia, a low red blood count. Fatigue and shortness of breath may accompany severe anemia. Endometrial hyperplasia can increase the risk of uterine cancer and should be shed regularly with the use of hormone replacement therapy. Continued abnormal bleeding can be annoying and frustrating, and also provides a constant source of concern, even if the cause is deemed to be benign.
