Menopause is the stage in life in which a woman no longer ovulates and doesn’t have a monthly menstrual period. Most women assume that this is the end of uterine bleeding of all kinds and no longer need to stock feminine supplies. For some, this is accurate, but others may experience uterine bleeding after menopause from time to time. The causes for PMB, or post-menopausal bleeding, vary and may range in seriousness. Treatment for uterine bleeding after menopause may be as minor as adjusting hormones or can result in surgery.
Hormone Replacement Therapy
Participating in hormone replacement therapy and the normal fluctuation of hormones in post-menopausal women are the most common reasons for uterine bleeding after menopause. Bleeding of this kind is considered “abnormal” if it occurs between 6 months and a year after periods have completely stopped. Women who have been taking hormones for less than a year are usually observed for a period of time (a few months up to a year, depending on each doctor’s practice) to see if the bleeding stops as the body’s hormone levels adjust.
Overabundance of Endometrium
The lining of the uterus, called the endometrium, continues to develop even after menopause. Women who use hormone replacement therapy in their post-menopausal years are more likely to develop an endometrium that is overgrown and has thickened in areas. When such a thickening occurs, bleeding is possible. Sometimes an overgrown endometrium is associated with uterine cancer, but this is not always the case.
Abnormal Uterine Growths
Post-menopausal uterine bleeding can be the result of growths that lie within the uterus, such as fibroids and polyps. When women experience intermittent spotting or “staining” that doesn’t require heavy feminine protection, it can sometimes indicate that polyps are present. Larger fibroids that may be either benign or malignant can cause bleeding that can be described as a “flow,” rather than just spotting. Doctors may use ultrasound technology to diagnose polyps or fibroids that are contributing to PMB.
Uterine Cancer
Post-menopausal uterine bleeding can be a sign that cancer is present in the uterus. This type of cancer, called uterine or endometrial cancer, occurs in the cells of the uterine lining. Women who experience bleeding after menopause and increased vaginal discharge and pain in the pelvic region should consult their doctors for further testing. Endometrial biopsies can detect cancer cells, while ultrasounds will reveal if there are any unusual tumors or other growths in the uterus.
Treatment
The most common form of treatment for uterine bleeding is an adjustment of a woman’s hormone supplements. Trying a new brand of hormones or increasing or decreasing dosage levels may be all that’s needed to stop PMB. Women who are not taking hormones may require further diagnostic testing to determine the cause of the bleeding. Sonohysterography is a type of ultrasound that looks at the endometrial lining and will show abnormalities. Dilation and curettage may be an option for some women who experience heavy bleeding.