Bleeding after menopause

When a woman has had no periods for 12 consecutive months she is considered to be “Postmenopausal”. The average age of onset of menopause is around 50 years.

Bleeding after menopause, also known as post menopausal bleeding (PMB), is a condition characterised by vaginal bleeding in women after 12 months of menopause.

In most cases, PMB is harmless, but sometimes it may be secondary to an underlying medical disorder. Therefore,  bleeding after menopause should be carefully investigated.

Causes

Common causes of post menopausal bleeding include:

  • Thinning of the tissues lining the uterus or vagina (atrophy)
  • Medications such as hormone replacement therapy (HRT)
  • Uterine fibroids
  • Cervical and endometrial polyps
  • Infection and inflammation of the uterine lining (endometritis)
  • Endometrial hyperplasia – this occurs when the endometrium, the lining of the uterus, becomes too thick. It is not cancer, but in some cases, it can lead to cancer of the uterus.
  • Cancer of the uterus, including endometrial cancer and uterine sarcoma
  • Cancer of the cervix or vagina
  • Non-gynaecological causes such as pelvic trauma or bleeding disorder
  • Bleeding from the urinary tract or rectum

Investigations

The cause of PMB can be determined by

  • Medical history and physical examination.
  • Transvaginal ultrasound
  • Endometrial biopsy: This involves the insertion of a fine tube inside the uterus for withdrawing a sample of uterine lining for laboratory analysis
  • Hysteroscopy

Treatment Options

Treatment of the PMB depends on the underlying cause of bleeding. Management of some of the common causes of PMB is as follow:

  • Polyps: They are surgically removed – hysteroscopy
  • Endometrial atrophy: Treated with medications
  • Endometrial hyperplasia: Treated with medications or hysterectomy.
  • Endometrial cancer: Treatment involves total hysterectomy i.e. surgical removal of uterus and cervix. In some cases, other organs such as ovaries, fallopian tubes, nearby lymph nodes, and part of vagina may also be removed.

The treatment of advanced endometrial cancer may include additional hormone therapy, chemotherapy, and radiation therapy. Early detection and treatment of the cancer can result in full recovery.