Post-menopausal bleeding is defined as any vaginal bleeding that occurs once a woman's menstrual cycle has completely stopped for at least one full year. Most bleeding that occurs after menopause is harmless but there are a several conditions that can be dangerous to your health and even life-threatening. If you have any post-menopausal bleeding, make an appointment with your doctor immediately to rule out a serious condition.
Causes
The natural thinning of the lining of the uterus that occurs after menopause is a common cause of post-menopausal bleeding. In addition, non-cancerous growths in the uterus, such as polyps and fibroids that normally shrink after menopause, may continue to thrive and cause bleeding.
When women start hormone replacement therapy, they often experience light bleeding. This generally occurs only for the first few months when progesterone and estrogen are taken together on a daily basis. When hormone therapy is cyclic and progesterone is only taken on certain days, it is common to have spot bleeding on the days when only estrogen is taken.
The most serious causes of bleeding after menopause are endometrial hyperplasia and endometrial cancer. Endometrial hyperplasia is an overgrowth of cells in the uterine lining. Endometrial cancer, which affects the lining of the uterus, can occur separately from or as a result of endometrial hyperplasia, and will also cause abnormal bleeding. Endometrial cancer strikes post-menopausal women more often than women of any other age.
Significance
One in 10 women with post-menopausal bleeding will be diagnosed with endometrial hyperplasia and 1 in 10 will also be diagnosed with endometrial cancer, according to Dr. Rosalina Abboud from the Mayo Clinic in Rochester, Minnesota. Your risk of developing endometrial cancer is higher if you are obese, have a late menopause, have endometrial hyperplasia that has not been treated, have had ovarian, breast or colon cancer, or have a close family member with uterine cancer.
Diagnosis
Initially, after reviewing your medical history and symptoms, your doctor may take blood tests to check your hormone levels and order more tests, such as an ultrasound, MRI or CT scan to determine the cause of bleeding. A vaginal, cervical or uterine biopsy may be necessary.
If further testing is required, your doctor may refer you for a hysteroscopy, which uses a lighted instrument to explore the uterus, a laparoscopy, which requires an incision in the abdomen or a dilation and curettage (D&C), which allows a doctor to get a scraping of uterine tissue for laboratory testing.
Treatment
Endometrial hyperplasia should be treated as soon as possible to reduce the risk of developing uterine cancer. Ablative surgery or removal of the uterus may be necessary but post-menopausal bleeding can often be controlled by hormones, hormone adjustment and other medications, depending on the condition that is causing the bleeding.
Considerations
All post-menopausal bleeding must be checked by a doctor and treated or monitored in an appropriate manner. In particular, early detection and treatment of endometrial hyperplasia and cancer are key to a successful outcome. While most tests can be performed in a doctor's or radiologist's office, some may require a brief stay in a hospital.
