Bleeding after the menopause

Sunanda has just received a call from her 60 year old mother. Her mother sounded frightened. She has noticed bleeding from the vagina. It has been 10 years since she had her menopause. Sunanda has assured her that she will get her an appointment with the gynaecologist immediately but is at the same time very concerned. Does her mother have a serious problem?

Menopause is the time in a woman's life when she stops having menstrual periods. When a woman has not had a period for 1 year, she is considered postmenopausal. After menopause, there should not be any bleeding. Any vaginal bleeding after menopause should be investigated by a gynaecologist. Though 90% of the time the bleeding is due to benign causes, in 10% of women, the bleeding may be due to cancer. Postmenopausal bleeding has a number of causes, including cancer. The earlier the cause of postmenopausal bleeding is found, the better it can be treated. If the bleeding recurs after treatment, your gynaecologist needs to know right away.

Bleeding around and after menopause

The 4-5 years prior to the actual menopause is called the perimenopause. During this time periods can be irregular. Approaching menopause, the bleeding pattern for most women will change. The cycles can become shorter initially, and then with time, the menstrual interval begins to lengthen. Soon, many cycles will be skipped and then finally the periods stop entirely.  Menopause in most women occurs around the age of 50- 52 years. If bleeding occurs after menopause, it should be investigated. A woman older than 55 years and still having menstrual periods also needs to be tested.

Causes of abnormal bleeding

In postmenopausal women, bleeding can be due to many reasons.

• Extreme thinning of the uterine lining (endometrial atrophy) because of the total lack of estrogen, can result in the spontaneous breaking down of small blood vessels in the uterine lining.
• Polyps (noncancerous growths that develop from the lining of the uterus) can cause bleeding.
• Endometrial hyperplasia is a condition in which the lining of the uterus grows too much. This can be potentially pre-cancerous.
• Endometrial cancer (cancer of the lining of the uterus), cancer of the cervix (mouth of the uterus) and cancer of the vagina can present as bleeding from the vagina.
• Some women may choose to take the hormones estrogen and progesterone (hormone replacement therapy) after menopause to relieve hot flushes and vaginal dryness and to protect against osteoporosis. More than half of these women will have bleeding or spotting.