The presence of blood in the urine is known as haematuria, but why does it happen? It can have different causes and presentations. During menopause, it is quite common due to the hormonal changes that occur in the body. If you suspect you are experiencing haematuria or have been diagnosed with this condition, this article may be of use to you. 

What does it mean to have blood in the urine?

Although the presence of haematuria can be a cause for concern, it is not always a sign of a serious problem. However, it is important to investigate to determine the cause. Depending on its presentation, is classified as follows (1):  

• Gross haematuria: visible in the urine, where you will notice streaks of blood or a reddish tinge in the toilet bowl. 

• Microscopic haematuria: although not visible to the naked eye, it can be detected by a urine test.  

For this reason, it is important to see a specialist whenever you have urination-related discomfort, as it is not possible to detect blood with the naked eye in all cases (1). 

What causes haematuria? 

The causes of haematuria vary, and some may require medical treatment. The main ones include the following (1,2,3):  

• Vaginal atrophy: during menopause, hormonal changes can cause increased fragility of the vaginal tissue, making it thin, dry, less elastic, and resistant. Very different from what it used to be. This can lead to blood in the urine, especially after intercourse or with extreme exertion. 

• Bleeding from the vagina: there are often small amounts of blood in the urine, either from the onset of the menstrual cycle, bleeding after intercourse, vaginitis, or after a procedure such as vaginal tightening. 

• Urinary tract infection: urinary tract infections can cause haematuria. They may also be accompanied by dysuria, nocturia, urinary urgency, among other manifestations. 

• Kidney stones: movement of stones in the urinary tract can cause severe pain and haematuria. 

• Kidney failure: chronic kidney disease can cause progressive wasting and, in some cases, bleeding that mixes with urine. 

• Cancer: although not the most common cause, cancer should not be ruled out if there is haematuria without an apparent cause. 

• Medications: some medications such as penicillin, aspirin, anticoagulants (heparin or warfarin, for example) and cyclophosphamide can cause haematuria.  

• Endometriosis: it is a condition in which uterine lining-like tissue (endometrium) grows outside the uterus. It may be associated with vaginal bleeding, which mixes with urine. It is also often accompanied by pelvic pain. 

How is blood in the urine diagnosed? 

Diagnosis usually begins with a physical examination and review of the medical history. Then, the specialist may order one or more of the following tests (2,3): 

• Urinalysis: it detects infections and measures the amount of blood in the urine. 

• Imaging tests: renal ultrasound, CT scan or MRI are some of them. They detect possible structural problems. 

• Cystoscopy: it is a procedure in which the specialist inserts a camera through the urethra to examine the bladder. 

Not all tests are necessary for every case. Your doctor will select the most appropriate ones for your particular situation (2). 

When to see a doctor? 

If you notice blood in your urine, even in small amounts, it is important to seek medical attention. It is not necessary to wait for other symptoms to appear before seeing a specialist. You should also consult a doctor if you experience pelvic, abdominal, or lower back pain, fever, chills, nausea, vomiting or difficulty urinating (1,4). 

If you have haematuria, avoid self-medication or home treatments. It is best to have a specialist assess your situation and determine the cause of the blood in the urine.  

Finally, if you suspect that menopause may be a causative factor, inform your gynaecologist. Menopause is a normal stage in every woman's life. It is therefore important to take care of yourself and address any concerns with the right support. 

Referencias Bibliográficas 

1. Ellis M. Why is there blood in my urine? [Internet]. New York: Healthline Media; 2023 [cited 2024 May 8]. Available from: https://www.healthline.com/health/urine-bloody#diagnosis 
2. Cleveland Clinic. Vaginal atrophy: causes, symptoms, diagnosis & treatment [Internet]. Cleveland: Cleveland Clinic; 2023 [cited 2024 May 8]. Available from: https://my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy 
3. Eske J. What to know about blood in urine (hematuria) in females [Internet]. EE.UU.: Medical News Today; 2023 [cited 2024 May 8]. Available from: https://www.medicalnewstoday.com/articles/325324#causes 
4. ‌NHS. Blood in urine [Internet]. UK: NHS; 2023 [cited 2024 May 9]. Available from: https://www.nhs.uk/conditions/blood-in-urine/