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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 (meaning you haven’t had your period in at least one year). 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 experiencing abnormal bleeding after menopause, and should you be concerned?

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.” You may be used to having an abnormal period around the time of menopause. However, after menopause, no vaginal bleeding is considered to be normal — even spotting. If you’re bleeding after menopause, you should contact your healthcare physician to schedule a consultation.

What causes postmenopausal bleeding?

Approximately 4-11% of women experience abnormal bleeding after menopause, or postmenopausal bleeding. Bleeding after menopause can result from a number of causes, such as hormone therapy, infection or use of certain medications. It can also be caused by several different conditions, with some being easier to treat than others. Here are a few of the most common causes of abnormal bleeding after menopause includes:

  • Polyps: Polyps are small, abnormal growths that are usually noncancerous. Polyps can develop in the uterus, on the cervix (the tissue that connects the vagina and the uterus) or inside the cervical canal. Most women who develop polyps do not have symptoms or need treatment. However, when symptoms do occur, they 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). Thinning of the endometrial lining may result in abnormal bleeding. 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. According to the Mayo Clinic, the cause of endometrial cancer is not known, but there are a number of factors that may increase your risk of developing it, such as endometrial hyperplasia, obesity and never having been pregnant. The risk of developing this type of cancer also increases with age, with more than half of those diagnosed being over the age of 55. Fortunately, endometrial cancer is usually detected early, as it produces symptoms such as abnormal bleeding. Endometrial cancer is often treated with a total hysterectomy (surgical removal of the uterus and cervix). Advanced cases of endometrial cancer, cervical cancer and other gynecologic cancers may require hormone therapy, radiation or chemotherapy.

Please keep in mind, most postmenopausal bleeding is not caused by cancer but is it is important to investigate, as 90% of women with endometrial cancer experience vaginal bleeding.

How to Determine the Cause of Abnormal Bleeding

To determine the cause of bleeding, your healthcare provider will likely ask your medical history, including:

  • 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
  • Your previous pregnancies and their outcomes
  • Your recent sexual activity
  • Your past use 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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About the practice

Dr. John Garofalo, M.D., is a CT OBGYN based in Fairfield County, providing care for Norwalk, Darien, New Canaan, Weston, Rowayton and the surrounding areas. 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. Women undergoing signs and symptoms of menopause can make an appointment with Laury for Hormone Replacement Therapy. 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.