Commonly called postmenopausal bleeding, this symptom is important as it may indicate that there is an underlying disorder.
The menopause occurs when the ovaries cease to function and stop their production of hormones. It is these hormones that drive the womb to thicken the lining and then shed it resulting in the periods that a woman gets. By the time women reach the ages of 50 – 60, the ovaries diminish their activities and eventually will cease to function altogether. At that time, periods will cease altogether. It is therefore unusual for women to experience bleeding after the menopause.
There are a number of possible causes for bleeding in this circumstance. Some are as follows:
• Excessive thinning of the skin of the vagina called atrophic vaginitis
• Estrogen hormones taken for relief of menopausal symptoms
• Herbal therapies that may contain estrogen hormones
• Vaginal infection.
• Polyps in the womb
• Abnormal changes that may indicate the possibility of cancer in the vagina, neck of the womb or lining of the womb itself
Obviously the last is of most concern. Whilst most women with this symptom, do not have cancer, it is important to exclude it. In some cases, there may be changes occurring that, if left untreated, may lead to a higher risk of cancer developing.
Investigation may include:
• Vaginal swabs to exclude infection
• Cervical screening for HPV
• Ultrasound
• D and C, hysteroscopy. This is a surgical procedure that allows the introduction of a telescope into the cavity of the womb under anaesthetic. Then a curette is performed and a scraping of the lining of the womb is obtained and sent for pathology.
Subsequent management will depend on the findings.
These notes reflect my personal opinion and are intended for general advice only. It should not be used for any one individual case. You should consult your own doctor to determine the appropriate management of your own individual situation.