Vaginal Bleeding After Menopause: The Most Common Causes of Post-Menopausal Bleeding

Menopause is a period in a woman’s life that is associated with a number of symptoms that may be uncomfortable for some. Hot flashes, mood swings, night sweats and insomnia are among the consequences of hormonal changes caused by menopause. As the ovary stops to produce estrogen and progesterone, a fluctuation of the hormones occurs, and this has an effect on a woman’s moods. Menstruation also stops once there is an end in the production of the two female hormones.

There are several means to alleviate the discomfort caused by menopausal symptoms. Some women may resort to natural remedies such as saw palmetto, dong quai, and black cohosh to treat low levels of estrogen hormones, thus improving moodiness. Hormone replacement therapy and use of oral contraceptives also help women deal with certain physical and emotional changes as they approach menopause.

It is expected that during menopause, menstruation completely stops. Some women, however, may experience vaginal bleeding after menopause, a condition where bleeding resumes six months after their last menstrual period. There are several causes of this condition such as hormone replacement therapy, polyps and fibroids, and hyperplasia.

Causes of Post-Menopausal Bleeding

Hormone Replacement Therapy

Hormone replacement therapy (HRT) is an approach where synthetic or natural female hormones are supplied to the body once the production of estrgoen and progesterone stops. This approach is used as preventive treatment against osteoporosis and heart disease, and it also alleviates physical symptoms associated with menopause.

Mood swings, hot flashes, heart palpitations and sleep disturbances are conditions that are caused by a lowered level of estrogen. HRT works by maintaining the normal levels of estrogen, thus eliminating these symptoms. It can also treat vaginal dryness and urinary tract problems. A decreased level of estrogen in the blood also causes the bones to weaken, and this condition can lead to osteoporosis. By providing a balanced supply of estrogen through HRT, this bone disorder may be prevented.

Women who are taking hormone replacement therapy may experience bleeding even during menopause. The supplemental estrogen stimulates the uterine lining to grow, and bleeding occurs when the lining is shed. Most women on HRT who take progesterone with estrogen may also experience monthly withdrawal bleeding, and this is one of its side effects.

Polyps and Fibroids

These are benign growths that develop in the uterine cavity. The presence of polyps can cause irregular spotting to light bleeding, while fibroids are associated with heavier bleeding. Vaginal bleeding caused by these growths are usually harmless.

Hyperplasia

An increased production of cells in a normal tissue or organ can be of two types can also cause vaginal bleeding. Pathologic hyperplasia is an overgrowth of cells that may be precancerous, while physiologic hyperplasia is an increase in the number of normal cells that may not be malignant.

Endometrial Atrophy

Lack of estrogen can cause the uterine lining to become thin, causing the blood vessels in this area to break down easily. This break down causes spontaneous bleeding.

Although it is normal for women to lose their menstruation during menopause, there are still instances where vaginal bleeding may be experienced irregularly. This bleeding is caused by a number of factors such as hormone replacement therapy, overgrowths in the uterine cavity, and thinning of the endometrium. Although usually harmless, regular visits to a health care provider should be done to ensure that the kind of bleeding experienced is normal and nothing to be concerned about.

Resources

Bradley, J.Glenn, MD, “The Significance of Bleeding After Menopause,” https://www.obgyn.net/displayarticle.asp?page=/women/articles/bradley/banter_0803

National Women’s Health Information Center, “Menopause Basics”, https://womenshealth.gov/menopause/basics/