Postmenopausal bleeding : Common Symptoms & How to Detect Them

Vaginal bleeding that starts a year or more after your last menstrual cycle is known as postmenopausal bleeding. It may be a sign of polyps (noncancerous growths), vaginal dryness, or other abnormalities in your reproductive system. Bleeding after menopause is a symptom of uterine cancer in 10% of women.

After menopause, bleeding is referred to as postmenopausal bleeding. When a woman enters menopause, her monthly menstrual cycles end and her reproductive hormones start to decline (this usually happens at about age 51). It is not usual for a woman to experience vaginal bleeding more than a year after her last menstruation. There may be minor (spotting) or severe bleeding.

Endometrial polyps are one example of a benign (noncancerous) gynaecological disorder that frequently causes postmenopausal bleeding. However, bleeding after menopause is a symptom of uterine cancer in roughly 10% of women (endometrial cancer). Speaking with your healthcare practitioner if you suffer any bleeding after menopause. It is advised since uterine cancer is the most frequent kind of reproductive cancer (more common than ovarian or cervical cancers).

Causes

Postmenopausal bleeding has a variety of potential causes

The most common of which include:

Endometrial atrophy or atrophic vaginitis are estrogen-related conditions that cause inflammation and weakening of the vagina or womb's lining. This can be a potential cause of postmenopausal bleeding.

Cervical or uterine polyps are growths in the uterus that are often non-cancerous. This is another potential cause of postmenopausal bleeding.

Another potential cause is endometrial hyperplasia, a thicker uterine lining that can be brought on by hormone replacement treatment (HRT) as certain medications that contain estrogen and progesterone lessen some menopausal symptoms, nevertheless excessive estrogen, or being overweight, can result in womb cancer.

Although less frequent, cancer, such as ovarian cancer and womb cancer, can also be the cause of postmenopausal bleeding. 

Risk Factors

Although no significant risk factors can be found with postmenopausal bleeding, the following might be useful to be aware of: 

Bleeding after menopause is frequently effectively solved. If your bleeding is cancer-related the treatment depends on the kind of cancer and the stage at which it was discovered.

A person may have postmenopausal bleeding if:

• There was only a small quantity of blood, spotting, or pink or brown discharge, and they had no additional symptoms. 
• A person is unsure whether its blood.
• Although postmenopausal bleeding is usually not dangerous, it could indicate cancer. Early cancer detection makes treatment easier and safer.

Symptoms

Postmenopausal bleeding may be the only symptom for many women. But there could be signs. The reason for the bleeding may affect this.

During the postmenopausal period, many menopause symptoms, including hot flashes, frequently start to subside. However, postmenopausal women may also suffer other symptoms.

Postmenopausal women may suffer the following symptoms:

• vaginal dryness 
• reduced libido
• stress incontinence and sleeplessness
• weight gain and more urinary tract infections

Prevention

Bleeding after menopause may be indicative of a more serious illness, such as malignancy. Even though you might not be able to stop abnormal vaginal bleeding, you can seek assistance right at once to establish a diagnosis and treatment strategy, regardless of the cause. 

Early cancer diagnosis increases the likelihood of survival. The best course of action is to lower your risk factors for the disorders that could result in irregular postmenopausal bleeding.

Early treatment of endometrial atrophy can stop it from developing into cancer.

For routine exams, see your gynaecologist. This can aid in the early detection of problems that could worsen or cause postmenopausal bleeding.

Keeping a healthy weight, eating a balanced diet and consistent exercise. This alone can stop a wide range of issues and ailments throughout the body.

Take into consideration hormone replacement therapy if your doctor advises it. This could lower the risk of endometrial cancer. However, there are drawbacks that you should talk to your doctor about.

Treatments

Depending on the cause, postmenopausal bleeding may require different treatments.

If, for example, someone has the following causes, the treatment stated alongside it may help with postmenopausal bleeding. 

Polyps in the cervix: A professional physician who is specialised in their field may be required to remove the polyps.

Endometrial or vaginal atrophy: A person may not require therapy, however, they might be given pessaries or estrogen cream instead.

Endometrial hyperplasia:  You can be given the option of no treatment, hormone therapy which can consist of taking oral medication or an intrauterine system or an IUS, or a total hysterectomy depending on the type of hyperplasia you have. This is a surgery that removes the whole of the uterus, cervix and ovaries. You can learn more about the various methods of uterine removal from your doctor. Some operations only require tiny incisions and are therefore minimally invasive (incisions).

HRT side effect: Changing or discontinuing HRT therapy

Womb and ovarian cancer: Frequently, a total hysterectomy will be advised.

Some other surgical procedures that might be useful in the treatment of postmenopausal bleeding include: 

A procedure called hysteroscopy uses a camera to look at the cervix and uterus. In order to remove polyps or other abnormal growths that might be causing bleeding, a healthcare professional inserts a hysteroscope (a thin, lighted tube) into the vagina. Under general anaesthesia, hysteroscopy is frequently performed in the operating room to remove any growths.

Another procedure called dilation and curettage (D&C) is used to sample the uterus' lining and contents. A doctor might combine a D&C with a hysteroscopy. Some forms of endometrial hyperplasia can be treated with a D&C.

Medications that might also be useful in the treatment of postmenopausal bleeding include: 

The majority of the cervix and uterine infections may be treated with antibiotics.

Estrogen may reduce bleeding brought on by dry vaginal tissue. This can be done via a variety of different ways such as a cream, a ring or an insertable tablet to deliver estrogen straight to your vagina. 

A pill or a patch may be used for systemic estrogen therapy. Systemic estrogen therapy refers to the hormone's distribution throughout the body.

A synthetic version of the hormone progesterone is known as progestin. It causes the uterus to shed its lining, which can be used to treat endometrial hyperplasia. Progestin can be given to you as a pill, injection, cream, or as an intrauterine device (IUD).

Complications of Postmenopausal Bleeding 

If someone develops vaginal bleeding, it is important for them to get in touch with their doctor right away especially if it has been: 

• More than a year following your final period.
• Several months after beginning hormone replacement therapy (HRT).

For further information please access the following resources: