It is common for women to experience spotting between menstrual cycles during childbearing years. However, when women go through menopause, meaning they have had no menstrual cycle for at least a year, abnormal spotting might be cause for concern.
Causes
A woman can experience spotting after menopause because of non-cancerous growths that develop on the uterine wall, known as polyps. This tissue consists of the same tissue that lines the uterus and might cause bleeding, especially after sex. These polyps also might line the cervix or cervical canal, according to the American Congress of Obstetricians and Gynecologists. After menopause, the uterine lining becomes thin from a lack of estrogen, known as endometrial atrophy. As the lining thins, a woman might experience abnormal spotting. Other causes of postmenopausal spotting include hormone replacement therapy, infections of the cervix or uterus and certain medications.
Warnings
Endometrial cancer is the most common type of cancer of the reproductive system, and bleeding after menopause is the most common sign of this cancer, according to the American Congress of Obstetricians and Gynecologists. The Mayo Clinic explains that other symptoms include abnormal vaginal discharge, pelvic pain, pain during intercourse and unintended weight loss.
Diagnosis
Physicians will run tests to help determine the cause of postmenopausal bleeding. After performing a thorough medical history to assess risk factors, a physician will perform a physical examination and can include other tests. An endometrial biopsy involves removing a small amount of tissue from the uterine lining and sending it to a lab for examination. A patient might undergo a transvaginal ultrasound to view the pelvic organs, or a sonohysterography in which fluid is injected into the uterus while ultrasound images are taken. Physicians also might view the inside of the uterus with a camera device inserted through the vagina. In some instances, a woman might undergo a procedure known as a dilation and curettage, in which the cervix's opening is enlarged, and tissue is scraped from the uterine lining and examined under a microscope.
Treatments
This often depends on the underlying cause. A physician often can treat endometrial atrophy with progestin therapy, according to the American Congress of Obstetricians and Gynecologists. Endometrial cancer is often treated with surgical removal of the reproductive organs, called a hysterectomy, as well as removal of the nearby lymph nodes.
Considerations
Any bleeding after menopause is a cause for concern, and a woman should discuss the issue with her physician, according to the Mayo Clinic. Women who have endometrial hyperplasia are at an increased risk for cancer of the endometrium and should receive regular endometrial biopsies to ensure that the hyperplasia has been treated.
