Post menopause bleeding is when a woman starts bleeding vaginally after a
full year without a period or other bleeding. It can be a very frightening and
confusing experience, but few people realise how common post menopausal bleeding
actually is; it affects as many as 30% of post menopausal women.
Post menopausal bleeding can occur for a number of reasons, the most common of
which is hormone replacement therapy. The supplemental hormones used in this
kind of treatment stimulate the uterine lining in the same manner as would the
natural hormones found in a healthy pre-menopausal female. The frequency and
amount of bleeding will vary from woman to woman, but adjusting the dosage of
the hormone replacement treatment is usually all that is required to alleviate
There are many other reasons why a woman would experience post menopausal
bleeding when not undergoing hormone replacement therapy. Around 90% of these
cases will have no obvious cause, or prove to be caused by a minor problem,
often not requiring treatment.
The most common cause for post menopausal bleeding is atrophic vaginitis, which
is an inflammation of the lining of the vagina, caused by lower levels of
The second most common causes of bleeding post menopause are polyps and
fibroids. Polyps and fibroids can occur in the uterus, and may cause irregular
post menopausal bleeding, and are usually harmless
Endometrial atrophy is when the lack of oestrogen causes thinning of the lining
of the uterus. It also causes the small blood vessels in the uterine lining to
break down, and is similar to when a severe cold causes the lining of the nasal
passages to break down, resulting in spontaneous bleeding.
Endometrial Hyperplasia is a condition where overgrowths of the uterine lining
develop. This can cause post menopausal bleeding, and can sometimes turn
cancerous. If caught early, it is treatable with progesterone, but if left,
severe cases can result in a hysterectomy being required.
Bleeding post menopause can also be caused by abnormalities in the cervix or
vagina itself, and rarely in the fallopian tube or ovary.
Not all cases of post menopausal bleeding are caused by a medical problem.
Sometimes lifestyle and stress levels can have an effect on the body, causing
bleeding to occur.
Dramatic weight loss can lead to oestrogen, normally stored in fatty tissues,
being released into the bloodstream, leading to bleeding in the same way that
hormone replacement treatment does. To avoid this, post menopausal women are
recommended to lose weight gradually.
Emotional stress seems to have ties to post menopausal bleeding. Many women have
reported spontaneous bleeding at times of extreme anxiety or excitement.
The only way to determine the cause of most cases of post menopausal bleeding is
by a thorough gynaecological examination. This usually involves a range of
Ultrasound is commonly used to detect problems in the pelvic organs, such as
ovarian cysts and problems in the uterine lining. Ultrasound is done by applying
a transducer wand to the abdomen, but some in some cases of post menopausal
bleeding a transvaginal ultrasound may be required. This is where a specially
shaped transducer is inserted directly into the vagina. This gives a superior
image, and is sometimes necessary for accurate diagnosis.
Sometimes a further test – a hysteroscopy – is required. This involves the
insertion of a thin telescope through the cervix into the uterus. This usually
causes little discomfort, and provides a more detailed image of the uterus.
Another possible procedure that may be carried out is a biopsy. This is where a
small sample of the womb lining is taken for pathological analysis.
Although post menopausal bleeding is often little more than an annoyance and
inconvenience, it should always be checked out by a health professional, due to
the possibility of further complications caused by some of the conditions
Any post menopausal women experiencing post menopausal bleeding are therefore
recommended to seek medical advice, no matter how light or insignificant the
bleeding may seem at the time.
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