Most women will become postmenopausal at some point in middle age. Women who have had a hysterectomy may enter this stage immediately after their surgery, since they can no longer menstruate. Bleeding in postmenopausal women is not due to menstruation. All instances of bleeding postmenopause are considered abnormal.
What is Postmenopause?
Postmenopause is the third stage of menopause, following perimenopause and menopause. The first stage, perimenopause, occurs two to eight years before menopause begins. It is the only stage in which a woman still has a menstrual cycle. The second stage, menopause, marks the ending of a woman's reproductive years and is counted from day one of the first missed cycle. Postmenopause occurs after a woman has missed 12 consecutive cycles. During this time a woman may experience mood swings, hot flashes, weight gain and fatigue.
Vaginal Causes
During postmenopause the vagina shrinks and becomes drier in a process called vaginal atrophy. This dryness can cause pain during sexual intercourse and a small amount of bleeding. This bleeding is caused by the thinning of the vaginal walls and a lack of lubrication. The bleeding is caused when there is trauma to the vaginal walls. Additional symptoms of vaginal atrophy are vaginal dryness, vaginal burning, burning during urination and watery vaginal discharge. Vaginal bleeding in postmenopause can also be caused by vaginal infections. Symptoms of vaginal infections include heavier than normal discharge or discolored discharge, foul-smelling discharge, itching and frequent urination.
Uterine Causes
Uterine fibroids or uterine atrophy can cause uterine bleeding in postmenopausal women. Uterine fibroids are small, benign growths in the muscle, on the lining, on the perimeter or in the cavity of the uterus. These uterine growths are estrogen sensitive. Although uterine fibroids begin to shrink around the start of menopause and throughout menopause, uterine fibroids may cause slight bleeding as they shrink. Uterine atrophy is another cause of abnormal uterine bleeding during postmenopause. This light bleeding happens as the uterus becomes smaller. There may be slight cramping associated with the shrinkage and light blood spotting.
Ovarian Causes
Ovarian cysts also can cause postmenopausal bleeding. These benign cysts normally collapse after the egg that was housed within them is released. Symptoms of ovarian cysts include slight abdominal cramping, spotting or light bleeding, and abdominal bloating.
Warning
Although abnormal bleeding may happen at any time during menopause, heavy bleeding or extreme cramping are emergency signs. If heavy bleeding, bleeding with blood clots, extreme pain, unexplained weight gain in the abdomen, or shortness of breath occur see a physician immediately.
