Vaginal bleeding after menopause is not an uncommon occurrence and there may be the odd instance of abnormal vaginal bleeding which should not be a cause for concern. This post-menopausal bleeding is usually mild spotting or a light flow that lasts for a day or two. If it is a heavy flow, persisting for a long period of time or resembles a period (menses), then it warrants further investigation.
Before diagnosing a post-menopausal bleed, it is important to first confirm that you have entered menopause. Cessation of periods after the age of 40 years is not necessarily menopause unless your periods have stopped for 6 consecutive months. Prior to this, you may be in perimenopause and experiencing the odd month or two with no period. Perimenopause is the transitory phase from your fertile years to menopause and you may experience many of the signs and symptoms of menopause during this time.
Causes of Abnormal Bleeding in Menopause
Some of the common causes of abnormal vaginal bleeding during menopause include :
- Hormone replacement therapy (HRT). This is the most common cause of a post-menopausal bleed and is due to the estrogen in HRT. However stopping your HRT may also lead to vaginal bleeding after a period of time.
- Cancer. Any malignancy of the associated organs may lead to bleeding after menopause. This includes cases of ovarian, endometrial, cervical or vulval cancer.
- Uterine polyps are growths that protrude from the wall of the uterus. It tends to cause a light bleed or mild spotting which may occur at irregular intervals.
- Uterine fibroids are benign tumors that originate from the muscle layer of the uterus (myometrium). In this case, the bleeding is not as light as in a uterine polyp but is usually not as heavy as a period.
- Uterine prolapse occurs when the uterus collapses from its normal position into the vaginal canal. The risk is usually higher in women who have had one or more vaginal births and it is one of the reasons women opt for an elective cesarean section in the earlier years of life.
- Hyperplasia of the endometrium is an overgrowth of the uterine lining. This may not be associated with cancer but in a significant number of cases, this overgrowth may be precancerous.
- Vaginal atrophy is the thinning of the walls of the vagina as a result of low estrogen levels with inflammation of the inner lining of the vaginal wall. Bleeding does not often occur spontaneously and tends to appear after sexual intercourse.
- Diagnostic procedures. Vaginal bleeding may occur after certain diagnostic procedures like an endometrial biopsy, pap smear or even a gynecological examination, although the latter is less likely unless there is vaginal atrophy.
- Infections like a urinary tract infection (UTI) causes bleeding from the urethra. In cases of thrush, vaginal bleeding is more like spotting or streaking in the accompanying discharge. An infection due to chlamydia may also account for mild spotting or light bleeding particularly after sex.
- Lichen sclerosus is a rare skin condition that tends to affect the skin of the vulva. There may be cracking or ulcerating of the skin with bleeding especially after sex.