Vaginal spotting can be at best socially awkward and at worse an omen of serious disease. According to "William’s Gynecology," ovulation and your period typically stop, via the menopause process, at an average 51 1/2 years. The termination of your cycle can start in the late 40s to early 50s and it usually presents with occasional missed periods and a longer interval between periods. It can last four to seven years and you may still become pregnant during this time. Vaginal spotting beyond menopause is most commonly from minor conditions, easily managed by your physician, but can be a warning sign of life-threatening conditions.
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The anatomy of the female genital tract includes the vagina, uterus, fallopian tubes and ovaries. The uterus is a muscular hollow organ that is an average of 8 centimeters long, 5 centimeters wide and 2, and 5 centimeters thick. The uterus is anteverted, tilted forward, in most women but can be vertical or retroflexed, tilted backwards, in 25 percent of women. The innermost layer of the uterus is the endometrium and it contains the area involved in the menstrual cycle. The next layer is the myometrium and it is the muscle layer followed by the visceral peritoneum which surrounds the organ. The tissues of the genital tract react to the circulating female hormones estrogen and progesterone which help to maintain the integrity of the genital tract.
Vaginal spotting is seen in about 20 percent of women over age 65 and the most common finding is atrophy and thinning of the inner layer of the uterus. This layer of muscle is maintained throughout their reproductive life by the actions of estrogen and progesterone, which provide the signals needed for the maintenance of the uterus lining and the sloughing of the same tissue during menstruation.
Once they enter menopause those hormones are largely diminished and the tissues of the uterus, vagina, and vulva become thin and may easily bleed. Bleeding can also be due to blood retention, trauma and may sometimes be related to hemorrhoids.
Women should discuss vaginal spotting with a physician who will determine if he needs any diagnostic tests .Typically the source of the bleeding needs to be identified because 22 percent of women with bleeding can have abnormal growths, tumors, or cancer of the structures. Any examination will include a physical exam and a thorough review of family history. The doctor will then determine if it is appropriate to perform an imaging test and may need a biopsy of the uterus.
Exercise and Vaginal Spotting
Exercise is recommended by the American Congress of Obstetrics and Gynecology for pre- and post-menopausal women along with calcium and vitamin D supplementation. When athletes reach a low body fat mass they can experience a cessation of ovulation and irregular bleeding due to the interruption of normal hormonal patterns. Since menopausal women do not have the same hormonal control mechanisms it is not likely that exercise will have any effect on bleeding and other causes should be sought.
- "Williams Gynecology"; JO Schaffer et. al; 2010
- ACOG Menopause Education Booklet
- “Atlas of Human Anatomy”; Frank H. Netter; 2004
- "Hazzard's Geriatric Medicine and Gerontology"; Karen Miller et al.; 2003