Many women experience bleeding abundant at some point, often in the years before menopause and usually due to the effects of estrogen dominance. And most women have been told that any bleeding after menopause is abnormal.
However, did you know that postmenopausal bleeding is often not caused by cancer or any other abnormality? In fact, there can be any number of causes for this, such as taking a new supplement, starting a new exercise routine, and even falling in love!
But what is really going on when you have bleeding after menopause, and when should you seek medical advice?
Conditions that can cause bleeding after menopause
Women in our culture have been conditioned to believe that bleeding after menopause it is a sign of cancer. That’s why the bleeding after menopause it is a common reason for women to seek medical advice.
If you’re postmenopausal and have bleeding that’s not normal for you, make sure you get checked out by your doctor. While bleeding can be a symptom of cancer of the uterus, vagina, or cervix, the vast majority of cases are not cancer.
Here are 7 common conditions that can cause bleeding after menopause:
uterine polyps
Polyps are growths that can occur inside your uterus. They can also grow on the cervix and sometimes in the vagina.
Polyps usually range in size from a few millimeters to several centimeters. Polyps are usually not cancerous, but they can cause bleeding that can range from light spotting to a heavy flow like a period.
They are also a common cause of bleeding after sex. Uterine polyps can increase in size and number due to high levels of estrogen. Other risk factors for developing uterine polyps include high blood pressure, obesity, and taking tamoxifen.
fibroids
Uterine fibroids are more common during perimenopause, but you may experience fibroid-related symptoms during menopause. Fibromas are the most common benign tumors.
Even small fibroids, if located submucosally, just below the endometrial lining of the uterus, can cause abnormal bleeding. Some risk factors that increased your chance of having fibroids that cause bleeding include high blood pressure, inadequate vitamin D levels, obesity, chronic stress, being African-American, and having a family history of fibroids.
Like uterine polyps, fibroids are sensitive to estrogen and are also associated with low levels of progesterone, too much prostaglandin F2-alpha, and often too much insulin.
If you experience bleedingperiod-like cramps, fullness in the lower abdomen, lower back pain, frequent urination or incontinence, or painful intercourse due to fibroids, you may want to look into treatment options.
endometrial hyperplasia
Endometrial hyperplasia is when the lining of the uterus becomes thicker. Again, after menopause, this can be caused by having too much estrogen and too little progesterone.
As a result, the endometrium becomes thicker and may bleed. Risk factors may include obesity, diabetes, polycystic ovary syndrome (PCOS), a history of anovulation, and certain medications that mimic estrogen.
In many cases, endometrial hyperplasia can be treated with natural progesterone, which would help the thickened lining slough off. Other common treatments include synthetic progesterone (progestins), birth control pills, dilatation and curettage (D&C), or endometrial ablation.
vaginal atrophy
Vaginal atrophy is when the tissues of the vagina become thin, dry, and swollen. It can be the result of too low levels of estrogen, usually caused by menopause.
However, vaginal atrophy can also occur due to estrogen-blocking medications such as tamoxifen and aromatase inhibitors, luteinizing hormone-releasing hormone (LHRH) agonists such as Lupron, and gonadotropin-releasing hormone (GnRH) agonists such as Synarel.
A sign that the bleeding may be due to vaginal atrophy It usually happens after sexual intercourse. Vaginal atrophy is easily treated with vaginal moisturizers and lubricants and low-dose vaginal estrogens.
Herbal products, such as Pueraria mirifica, can be game changers for symptoms of vaginal atrophy.
hormone replacement therapy
One of the most common side effects of hormone replacement therapy is breakthrough bleeding.
If you are taking hormones and experience breakthrough bleeding, you may want to see your doctor. You can also take a DUTCH test (Dry Urine Test for Comprehensive Hormones) to see where things are with your hormones.
Medicines
In addition to hormones, estrogen-blocking drugs, and LHRH and GnRH agonists, other drugs can cause bleeding in postmenopausal women, including blood thinners. Be sure to discuss your medications with your doctor.
Other causes of bleeding
Other causes of postmenopausal bleeding include sexually transmitted diseases, bleeding that originates in the rectum or urinary tract, bleeding disorders such as Von Willebrand disease, infections of the uterus, thyroid disorders, and pelvic trauma.
Again, be sure to check with your health care provider to rule out any abnormalities.
Tests you may need to get a diagnosis
If you have bleeding after menopauseyour specialist doctor will probably recommend that you carry out some tests to look for the cause.
The tests your health care provider recommends to identify physical causes of bleeding may depend on several factors, including your age, medical history, and the symptoms you’re experiencing. Some of these tests may include:
Transvaginal ultrasound: With an ultrasound probe inserted into the vagina, your doctor will look at your uterus, vagina, cervix, fallopian tubes, ovaries, and bladder to identify anything that may be causing bleeding. It is a safe and painless test.
Sonohysterography: A sonohysterography uses fluid that is injected through the vagina into the uterus so your doctor can see the lining of your uterus. Once the fluid is injected, an ultrasound will be used. The liquid can help get a better image than when you use ultrasound alone.
Hysteroscopy: During a hysteroscopy, a thin, lighted tube with a camera on the end is inserted into your vagina and allows your cervix and uterus to be examined for any abnormal growths, such as polyps.
Endometrial biopsy: Your doctor will insert a small, thin tube into your vagina and through your cervix to take a sample of the tissue lining your uterus. The tissue is then analyzed for the presence of abnormal cells.
Dilation and curettage: This procedure involves dilating or widening the cervix to obtain a larger tissue sample by scraping the lining of the uterus. Your doctor may also use a hysteroscope to see inside your uterus and identify any possible growths.
While most of these tests can be done in a doctor’s office, others, such as a D&C, are often done in a hospital or surgical center.