You’ve taken a big sigh of relief...it’s officially been 12 months since your last period, and you’ve made it to menopause. Woohoo! But then 18 months later, you have some bleeding. What is going on?!?! Are you now back in perimenopause?
The short answer is probably not. Most likely, it’s a thing known as postmenopausal bleeding. While we don’t want to give you another thing to worry about, it’s good to know what you’re getting into as you go through the menopausal transition. Let’s dive into what that is and what you can do about it.
What is postmenopausal bleeding?
Postmenopausal bleeding (PMB) refers to any vaginal bleeding that occurs after you’ve gone into menopause (defined as having no period for 12 straight months). PMB can range from light spotting to a heavier flow like a regular period. While bleeding after you’re sure you’ve reached menopause is confusing, it has been reported that up to 10% of postmenopausal females will experience PMB. This can affect your quality of life, is often a sign of another issue, and should be taken seriously.
So, while you may have some bleeding after menopause, it doesn’t mean that you’ve gone back to being in perimenopause. There’s likely another cause. While it may not be something serious, it’s best to check with a doctor to help you figure out what’s going on.
What are the common causes of postmenopausal bleeding?
The most common causes of postmenopausal bleeding include:
- Thinning and inflammation of the vaginal tissues (vaginal atrophy) or the uterine lining (endometrial atrophy).
- Non-cancerous growths in the uterus (endometrial polyps or uterine fibroids).
- Abnormally thick uterine lining (endometrial hyperplasia) — this can be pre-cancerous.
- Endometrial cancer — a cancer that develops in the lining of the uterus. This is the most serious cause of PMB but is only responsible for less than 10% of cases.
Are some people more likely to get postmenopausal bleeding?
Certain factors can increase the likelihood of experiencing postmenopausal bleeding. These include:
- Being overweight or obese can contribute to hormonal imbalances and an increased risk of PMB.
- Having diabetes.
- Having a family history of endometrial cancer or a genetic predisposition to endometrial cancer.
- Using menopause hormone therapy (MHT).
- Abnormal bleeding can occur when taking certain medications, such as tamoxifen or anticoagulants.
What tests are available to identify the underlying causes of postmenopausal bleeding?
To determine the cause of postmenopausal bleeding, healthcare providers may conduct a thorough history, a physical exam, and diagnostic tests. These tests may include:
- Pelvic or transvaginal ultrasound. An imaging test that uses sound waves to create images of the uterus and ovaries. It can help identify any abnormalities, such as endometrial polyps or fibroids.
- Endometrial biopsy. A procedure that removes a small sample of tissue from the lining of the uterus. They examine it under a microscope for any abnormal cells or changes. This is the best test for diagnosing endometrial cancer and hyperplasia.
- Hysteroscopy. A procedure where a thin, lighted instrument is inserted into the uterus to examine the uterine cavity.
- Dilation and curettage (D&C). This procedure involves dilating the cervix and scraping the lining of the uterus to collect a tissue sample for examination.
- Cancer screenings. This could include a pap smear (cervical cancer), HPV testing (linked to cervical cancer), and CA-125 (a protein that can be elevated in types of cancer, including ovarian cancer).
If you experience postmenopausal bleeding, you’ll want to reach out to your doctor as soon as possible.
What are the treatment options for postmenopausal bleeding?
Treatment options for postmenopausal bleeding depend on the underlying cause. They may include:
- Hormonal therapy. This involves using hormones, such as estrogen or progesterone, to help reduce bleeding or treat atrophy (the thinning and inflammation of the vaginal tissues).
- Surgical procedures. These may include removing endometrial polyps or fibroids or performing a hysterectomy (removal of the uterus) in severe cases.
The effectiveness of these treatments varies depending on the person and the details of their situation. It's important to consult with a healthcare provider to determine the most appropriate treatment option based on your individual circumstances.
What can I do to reduce the risk of postmenopausal bleeding?
To reduce the risk of postmenopausal bleeding, you should consider:
- Maintaining a healthy weight. Obesity can increase the risk of PMB.
- Engaging in regular physical activity. This can help regulate hormone levels and reduce the risk of PMB.
- Undergoing regular gynecological check-ups and screenings. Thee are recommended postmenopause to help detect and manage PMB and endometrial cancer.
Postmenopausal bleeding (PMB) can be a confusing and concerning experience for those who have already gone through menopause. However, it’s important to remember that having PMB is not likely a sign of returning to perimenopause. If you experience postmenopausal bleeding, are concerned, or have questions, reach out to your healthcare provider as soon as possible.
