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Postmenopausal bleeding: causes, diagnosis, and best treatment alternatives

 

After menopause, many women experience vaginal bleeding, which acts as a clear health warning. Seeking professional medical advice is essential if you notice postmenopausal bleeding, regardless of whether you believe it to be minor or insignificant. 

This article highlights the significance of addressing this type of bleeding, examines its primary causes, outlines how healthcare professionals diagnose it, and discusses available treatment options. Continue reading for vital health information that could make a difference. 

 

What is postmenopausal bleeding and why is it important? 

 

Imagine this: You have already gone through menopause, meaning you haven’t had a period for at least 12 months. Then, suddenly, you notice vaginal bleeding. This is known as postmenopausal bleeding. While this may feel alarming, understanding its causes and treatment options can help you take the right steps (1,2). 

Menopause marks the end of a woman’s reproductive years. At this stage, the body stops producing the hormones necessary for ovulation and menstruation (1,2). During perimenopause, the years leading up to menopause, it is normal for periods to become irregular, heavier, or appear as spotting (1). 

Once menopause occurs, any vaginal bleeding becomes abnormal and requires medical attention. This applies even if the bleeding is light spotting, a one-off event, or a pink or brown discharge. Whether or not you experience additional symptoms or feel unsure if the discharge contains blood, you should consult your doctor (1,2). 

 

 

Possible causes  

 

Here are the most common causes (1-4): 

 

  1. Endometrial hyperplasia. A non-cancerous thickening of the uterine lining that requires treatment to prevent complications. 

  1. Atrophic vaginitis. Low oestrogen levels after menopause can cause the vaginal walls to become thinner, drier, and inflamed. This leads to discomfort during intercourse and increases the risk of vaginal infections due to higher tissue vulnerability. 

  1. Uterine polyps or fibroids. These are benign (non-cancerous) lumps that grow in the uterus. Although they are not dangerous, they can cause irregular bleeding. 

  1. Endometrial, cervical, or ovarian cancer. Although rare, postmenopausal bleeding can indicate cancer. Early detection is crucial, so doctors must investigate any unexplained bleeding as soon as possible. 

  1. Additional causes Several factors, including douching, recent vaginoplasty, pelvic floor disorders, or vaginismus, can also lead to bleeding. 

 

Evaluation and diagnosis  

 

If you experience postmenopausal bleeding, you should schedule an appointment with a specialist. During the consultation, your doctor will review your medical history, discuss any medications you are taking, and examine other symptoms such as pelvic pain or the frequency of bleeding episodes. He will also conduct a comprehensive evaluation to identify the underlying cause(s) of your bleeding (1,4). 

 

Relevant diagnostic tests and examinations 

Doctors typically follow a multi-step process to diagnose postmenopausal bleeding, although the specific tests depend on the individual case. Below are the most common diagnostic procedures (1-4): 

 

  1. Physical exam. Your doctor will first examine your reproductive system. He will therefore use a speculum to inspect the inside of your vagina and cervix. He will also perform a pap test (pap smear) to check for any abnormal cervical cells. Generally, these procedures are quick and painless, but they may cause some discomfort. 

  1. Transvaginal Ultrasound (TU) or Trans Vaginal Sonogram (TVS). A small ultrasound probe is inserted into the vagina to produce detailed images of the uterus and endometrium. This painless procedure helps detect abnormalities. If the results are inconclusive, the doctor may proceed with an endometrial biopsy. 

  1. Endometrial biopsy. This test involves collecting a small sample of the uterine lining for further analysis. There are two common methods for obtaining the sample: 

 

    • Hysteroscopy. A tiny camera is inserted into the uterus to examine the lining and collect a sample.

    • Uterine curettage. A more invasive procedure used to remove and examine uterine tissue. 

 

Management and treatment options for postmenopausal bleeding 

 

The suitable treatment for postmenopausal bleeding relies on its underlying cause. Your doctor will evaluate your condition and suggest the most appropriate solution for you. There are treatment alternatives such as hormone therapy or hysterectomy. If the cause of postmenopausal bleeding is cancer, the treatment will be provided by an oncologist (1,4)). 

In conclusion, you should pay attention. It can be inoffensive, but it may relate to conditions such as cancer that require immediate treatment. You must visit your doctor as soon as possible, so you can determine if your bleeding is risky, and you need to begin appropriate treatment before it is too late. Finally, many women experience poor circulation during menopause. If you're dealing with this issue, you can find valuable information on the topic through this link. We encourage you to read quality articles to enhance your health. 

 

Bibliographic References 

  1. NHS. Postmenopausal bleeding. [Online]. 2023 [cited 2025 Mar 1]. Available from: https://www.nhs.uk/conditions/post-menopausal-bleeding/. 

  1. Cleveland Clinic. Postmenopausal Bleeding. [Online]. 2024 [cited 2025 Mar 1]. Available from: https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding. 

  1. Liao S. Postmenopausal Bleeding. [Online]. 2024 [cited 2025 Mar 1]. Available from: https://www.webmd.com/menopause/postmenopausal-bleeding. 

  1. Casper K. Should you be concerned about postmenopausal bleeding [Online]. 2023 [cited 2025 Mar 1]. Available from: https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/postmenopausal-bleeding-should-you-be-concerned. 

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