After 12 consecutive months without a menstrual period, menopause can be confirmed, according to the Mayo Clinic. Once menopause has occurred, any vaginal bleeding is abnormal and should be examined by a medical professional. The majority of causes for postmenopausal bleeding are not serious and can be treated and managed, but it may also be a sign of endometrial cancer, which is why accurate diagnosis is important.
Uterine Polyps/Fibroids
One cause for postmenopausal bleeding is uterine polyps or fibroids, according to the Mayo Clinic. If polyps are present, removal is necessary, since they can be potentially cancerous. Fibroids are benign growths that many women have, and generally do not need to be removed unless they are causing postmenopausal bleeding, which may be a sign of precancerous changes, says the Mayo Clinic.
Endometrial Hyperplasia and Endometrial Cancer
The Mayo Clinic describes endometrial hyperplasia as a condition where the endometrium, or lining of the uterus, grows too much and too fast. Women who are menopausal are at a higher risk for this condition, especially if they have been exposed to estrogen for extended amounts of time, like women who have never given birth, or if they are obese. The Mayo Clinic goes on to cite that one in 10 women experiencing postmenopausal bleeding has endometrial hyperplasia, and one in 10 has endometrial cancer. Endometrial hyperplasia increases a woman's risk for endometrial cancer, so accurate diagnosis is crucial. Surgery is sometimes used to treat this, but it may also be managed with medication.
Weight Loss
According to certified menopause clinician Marcy Holmes, bleeding after menopause can sometimes occur after large amounts of weight loss, such as with gastric bypass surgery. This happens because, as the weight is lost, the estrogen that is in the fatty tissue goes into the bloodstream, causing hormonal shifts and bleeding. The balance between estrogen and progesterone needs to rebalance itself after sudden and drastic weight loss, which is why the bleeding occurs.
Nutrition
Hormones depend on nutrients, and any nutritional deficiencies will become apparent in menopause through physical symptoms, according to Holmes on WomenToWomen.com. She recommends eating a well-balanced diet and taking a multivitamin to help protect against any further deficiencies. If women are insulin-resistant, progesterone is converted to estrogen, throwing off hormone balances and causing various symptoms, including postmenopausal bleeding. Daily exercise, limiting fats, sugars and simple carbohydrates, and better nutrition can all help ameliorate this occurrence.
Thinning of the Endometrium
The most common cause of postmenopausal bleeding, according to the Mayo Clinic, is the thinning of the endometrium. As estrogen levels fall during menopause, the lining starts to thin, which is a common occurrence and does not usually cause problems. If it becomes very thin, it may cause vaginal spotting or bleeding; this can be treated with vaginal estrogen.
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