Vaginal Bleeding after Menopause

From the time of that first period, women must learn to adjust to the fact that vaginal bleeding is just a normal part of life. But then, one day it all ends, and after a year of no menstrual periods, the woman is officially in menopause!

But then suddenly, at this point in her life, vaginal bleeding becomes a cause for concern. In fact, little else will cause your health care provider's eyebrows to rise higher than if you report an episode of vaginal bleeding after you have officially entered menopause.

So what’s the big worry? Well, once a woman has entered menopause, the hormonal stimulation to the uterine lining that results in menses is no longer present. This means that it's very important to identify the source of any vaginal bleeding and to treat it appropriately.

Non-Serious Causes of Vaginal Bleeding

Let’s review some of the more common causes of bleeding after menopause, ones that are not particularly worrisome and are easy to treat:

  • Vaginal wall atrophy (dryness) can result in the vaginal walls becoming dry and then bleeding easily. This condition can be treated with topical estrogens or lubricants.
  • Cervical polyps are growths on the cervix that resemble skin tags (small, usually harmless growths on the skin's surface) that bleed easily. They are almost always benign, and can be removed in your health provider's office by means of a simple twist.
  • Uterine polyps are growths inside the uterus that resemble the ones on the cervix. They too are easily removed, either in the office or in the operating room, using a procedure called a hysteroscopy, dilatation, and curettage (often known as a D&C).
  • Extreme stress can occasionally result in a single episode of vaginal bleeding, one for which some other cause is not found.
  • Urinary tract bleeding and rectal bleeding can sometimes look as though they are originating from the vagina; in this case, the source of the bleeding should always be determined and evaluated.

Some Causes are More Worrisome

These must be identified and treated as soon as possible.

  • Cervical cancer will often present with vaginal bleeding. Treatment by a GYN oncologist is imperative.
  • Uterine cancer always bleeds, and abnormal vaginal bleeding is one of the hallmarks of uterine cancer. Again, treatment by a GYN oncologist is a must.

What if you are having vaginal bleeding after menopause?

Get a checkup ASAP. If you are menopausal and are having any vaginal bleeding, you must get in to see your health care provider immediately. If you are 35 or older, you should also report any abnormal bleeding (heavier than usual, periods closer together than usual, etc.).

Have routine Pap smears. You should always see that your Pap smear is up to date and be sure to have any cervical lesions evaluated through colposcopy (magnification of the cervix) and biopsy (sampling of the tissue of the cervix).

Have the inside of your uterus examined. Your health care provider may also perform a procedure called an endometrial biopsy, in which a small straw-like object is passed into the uterus and then used to remove a small sample of the uterine lining for inspection. For most women, this procedure can be done easily in their provider's office. You may also be sent for a pelvic ultrasound to evaluate the interior of your uterus.

The decision to perform any or all of these procedures will depend on the findings during your visit. Some of these causes are easily treated and require little intervention, while others may require a visit to the operating room or a referral to a GYN oncologist.

The Most Important Point

If you experience any bleeding after menopause, the important thing to remember is that you must get in to see your health care provider promptly!

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