Postmenopausal bleeding is bleeding from the reproductive system that occurs six months or more after menstrual periods have stopped due to menopause.
Menopause, the end of ovulation and menstrual periods, naturally occurs for most women at age 40–55 years. The process of ending ovulation and menstruation is gradual, spanning one to two years.
Postmenopausal bleeding is bleeding that occurs after menopause has been established for at least six months. It is different from infrequent, irregular periods (oligomenorrhea) that occur around the time of menopause.
Many women experience some postmenopausal bleeding. However, postmenopausal bleeding is not normal. Because it can be a symptom of a serious medical condition, any episodes of postmenopausal bleeding should be brought to the attention of a woman's doctor.
Women taking estrogen (called hormone replacement therapy or HRT) are more likely to experience postmenopausal bleeding. So are obese women, because fat cells transform male hormones (androgens) secreted by the adrenal gland into estrogen.
Causes and symptoms
Postmenopausal bleeding can originate in different parts of the reproductive system. Bleeding from the vagina may occur because when estrogen secretion stops, the vagina dries out and can diminish (atrophy). This is the most common cause of bleeding from the lower reproductive tract.
Lesions and cracks on the vulva may also bleed. Sometimes bleeding occurs after intercourse. Bleeding can occur with or without an associated infection.
Bleeding from the upper reproductive system can be caused by:
estrogen-secreting tumors in other parts of the body
The most common cause of postmenopausal bleeding is HRT. The estrogen in the replacement therapy eases the symptoms of menopause (like hot flashes), and decreases the risk of osteoporosis. Sometimes this supplemental estrogen stimulates the uterine lining to grow. When the lining is shed, postmenopausal bleeding occurs. Most women on HRT usually take the hormone progesterone with the estrogen, and may have monthly withdrawal bleeding. This is a normal side effect.
About 5–10% of postmenopausal bleeding is due to endometrial cancer or its precursors. Uterine hyperplasia, the abnormal growth of uterine cells, can be a precursor to cancer.
Tish Davidson, The Gale Group Inc., Gale, Detroit,