Notes on Women's Health
Notes on Women's Health

Abnormal Bleeding After Menopause: When to be Concerned

Woman on bed complaining of menopause bleeding & cramping You’ve made it through menopause. You’re done with the mood swings and the hot flushes, the fatigue and the cramping. And now, after decades of dealing with regular and irregular uterine bleeding, you’re settling into the latest phase of your body’s development, hopefully with a minimum of fuss. So what does it mean if you start bleeding again?

As we described in our previous blog (“Abnormal Bleeding Around Menopause: Navigating the Changes”), menopause can be a time of irregular bleeding as the production of estrogen (the main female sex hormone) shifts on its way to your body’s new “normal.” After going through this phase of your life, it might not seem surprising that you’re spotting or bleeding again.

Three important things to remember

If you’re bleeding after menopause, there are three important things to remember. The first is that, if you’ve gone through 12 months in a row without a menstrual period, you’ve reached menopause. The second is that, after menopause, no uterine bleeding is normal — even spotting. The third thing to remember is that, if you’re bleeding after menopause, you should contact your healthcare physician.

What causes postmenopausal bleeding?

Bleeding after menopause (or “postmenopausal bleeding,” to use the medical term) can result from hormone therapy, infection or use of certain medications. It can also be caused by several different conditions. Here are a few:

Polyps. Polyps are small, abnormal growths, usually noncancerous, that can develop in the uterus, on the cervix (the tissue that connects the vagina and the uterus) or inside the cervical canal. Polyps are often treated with surgery.

Thinning of the endometrium. After menopause, lower estrogen levels can result in a thinner endometrium (the tissue that lines the uterus). Also called endometrial atrophy, this condition can be treated with medication.

Thickening of the endometrium. When your body is still producing estrogen but you have lower levels of progesterone (another female hormone), the endometrium may become abnormally thick. Also called endometrial hyperplasia, this condition can be treated with medication, hormone therapy or surgery.

Endometrial cancer. Sometimes called uterine cancer, endometrial cancer occurs when endometrial cells grow and multiply at a faster rate than normal. The cause of endometrial cancer is not known, but women with endometrial hyperplasia are at higher risk for this type of cancer. Endometrial cancer is often treated with a total hysterectomy (surgical removal of the uterus and cervix) along with removal of the ovaries and fallopian tubes. Advanced cases of endometrial cancer, cervical cancer and other gynecologic cancers may require hormone therapy, radiation or chemotherapy.

What’s causing your bleeding?

To determine the cause of bleeding, your healthcare professional will likely ask you about the following:

  • Details about your most recent episode of vaginal bleeding
  • Your most recent normal menstrual cycle
  • Any previous episodes of abnormal uterine bleeding, including a calendar record or an assessment chart, if you have one
  • Your previous pregnancies and their outcomes
  • Your recent sexual activity
  • Your past use of any form of birth control
  • Any medications, supplements or drugs you’re taking
  • Any personal or family history of bleeding disorders
  • Any recent surgeries or gynecological procedures

After asking these questions, your doctor will probably perform a complete physical examination, including a thorough pelvic exam to look and feel for any abnormalities. This may involve an endometrial biopsy (tissue sample) or an ultrasound imaging test. Your doctor may also take fluid or tissue samples to test for bleeding disorders, thyroid problems, sexually transmitted diseases, cancer or other possible conditions.

Although it’s possible or even likely that something minor is causing the bleeding, there’s also a chance that cancer could be to blame. In any case, it’s best to diagnose the cause of bleeding as soon as possible. Even when the bleeding is related to cancer, if it’s diagnosed early there is a good chance that the disease can be cured.

If you have any questions about abnormal uterine bleeding or bleeding after menopause, feel free to schedule a consultation by clicking below to discuss your particular situation.

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Additional information

American Congress of Obstetricians and Gynecologists: Perimenopausal Bleeding and Bleeding After Menopause

American Congress of Obstetricians and Gynecologists: Frequently Asked Questions on Abnormal Uterine Bleeding

About the practice

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

For more information, go to www.garofaloobgyn.com. John Garofalo, MD, and Laury Berkwitt, APRN, can be reached for personal consultations by calling 203.803.1098.