Medically Reviewed by W. Brad Campbell, MD

“I’m glad you called right away,” Mary’s OB/GYN assured her. Mary was surprised when she started bleeding because she thought when her menopause ended 5 years ago, her bleeding was over, too. Recently, Mary started spotting or light bleeding. Then, the bleeding grew heavier and she again needed to wear pads.

“The formal name for Mary’s situation is Postmenopausal Bleeding,” says McLeod OB/GYN Brad Campbell, M.D. “About 10% of women over age 55 will experience the problem. Most causes are benign. However, 1 out of 10 women who start to bleed more than a year after their menopause had ended, will face endometrial cancer. It’s important to see your OB/GYN right away to find out the actual cause and possible treatments.”

CAUSES

With menopause, levels of the hormone estrogen drops, causing the blood vessels in the uterus to become fragile, break and bleed. This weakening or atrophy accounts for the bleeding in about 60% of the women who suffer bleeding after menopause. Other common causes include:

• Polyps, which are non-cancerous growths in the lining of the uterus or vagina, which cause light spotting.
• Fibroids can cause heavier bleeding.
• Hormone Therapy can cause a thickening of the uterus lining, which can bleed.
• Thickening of the uterus lining (hyperplasia) has some potential for leading to cancer.
• Cervical Cancer is the cause of bleeding in a very small number of women.

DIAGNOSING

Physicians may use a vaginal ultrasound, directly view the tissue with a camera on a thin tube (hysteroscopy), or take a tissue sample (biopsy) with the hysteroscope or using a D&C (a common GYN procedure).

TREATMENTS

For polyps and fibroids, surgery may be needed. Both can be removed through the vagina or with small incisions. Patients usually go home the same or next day.

Adjusting the medication can usually control bleeding caused by hormone therapy.

Hyperplasia can be treated with progestin hormone therapy. Thickened areas can be removed with a hysteroscopy or D&C.

If the diagnosis is cancer, a hysterectomy is the treatment of choice. The surgeon may also remove lymph nodes to prevent the cancer from spreading further.

FINAL THOUGHT

Although postmenopausal bleeding can be serious, most causes are benign and can be treated easily. It’s best to follow Mary’s example and see your OB/GYN if you see evidence of bleeding a year or more after you believe your menopause has ended.

Find an OB/GYN near you.

Sources include: McLeod Health, National Institutes of Health, American Journal of Obstetrics & Gynecology, National Health Service (UK), American Association of Family Physicians, American College of Obstetricians & Gynecologists