Doctors warn that, "any postmenopausal bleeding is abnormal."
While there are many uncomfortable side effects of menopause —hot flashes, mood swings, and weight gain, to name a few — the one upside is that you no longer have to deal with that pesky monthly bleed. So, if you find that you’re bleeding after menopause — and we’re not talking spotting but menstrual-like flow — then you need to do more than simply brush it off as an annoyance: You need to see a doctor.
As you begin menopause, you might find yourself spotting or bleeding on and off. “We know that menopause occurs over a period of time that is different for each woman,” Elissa Gretz Friedman, MD, Director of Menopause in the Department of OB-GYN at the Mount Sinai Health System, tells Woman’s Day. “The initial changes can begin five years before the final menstrual period; it is a transition.”
During this transitory time, your bleeding pattern may start to change due to some wild fluctuations in your hormone levels, Jessica Chan, MD, an assistant professor of OB-GYN at Cedars-Sinai Hospital in Los Angeles, tells Woman’s Day. “At first, you usually have a shortening of the cycle. Then you may have a change in bleeding pattern. It can be lighter. Then there’s a lengthening of the cycle. You may skip some periods, before you stop altogether.” You are officially menopausal when there is no menstrual period for one year, says Friedman. “This occurs when the number of eggs in the ovary have decreased to almost no functional eggs, which in turn stops the normal monthly cycling of hormones,” she explains. Friedman notes the average age women enter menopause is 51 and a half years. But again, this age is unique to you, and can range from 40 to 58.
If you are bleeding after you’re in menopause, Friedman says you need to see your doctor “100 percent of the time,” adding that “any postmenopausal bleeding is abnormal.”
“Any bleeding will be evaluated to make sure it is not cancer,” Friedman says. “But the most common reason for post-menopausal bleeding is atrophic changes to the tissues of the uterine lining or vagina.” This means they might be thinning, drying or inflamed. “The tissues can become thin from the lack of estrogen, and become more prone to tearing or bleeding.” Vaginal atrophy like this can be diagnosed with a pelvic exam, urinalysis, and a test for the acid balance in your vagina. Fortunately, there are plenty of treatments to try. These include vaginal moisturizers and lubricants, topical estrogen, medication targeting the pain and discomfort, estrogen therapy, and vaginal dilators.
Other reasons for bleeding also exist. “Sometimes, the cause of bleeding can be a fibroid or a uterine polyp, which can be removed,” says Chan. “There can also be bleeding if you’re having hormone therapy. But the one you don’t want to miss is endometrial cancer” [also known as uterine cancer].
Since “the most common symptom of uterine cancer is bleeding,” Friedman says you’ll want to get that ruled out as soon as possible. Around 10 percent of postmenopausal bleeding experience it due to cancer. “It can usually be diagnosed early, when it is curable, since it presents itself early with bleeding,” Friedman says.
But the bottom line is: If you’re bleeding at all after menopause, call your doc and get an appointment.