Meno Health. Clinical Evidence.

TWC #030: Bleeding after the menopause – what you need to know!

Bleeding after the menopause – what you need to know!

If you’re going through the menopause, you may be worried about bleeding. But don’t panic! We’ve got everything you need to know about it here. Let’s find out together how you can tackle this issue!

When exactly is the menopause?

The menopause is a natural process that occurs in women between the ages of 45 and 55. During this time, there is a hormonal change in the body that causes the ovaries to stop functioning and menstruation to stop. Many women experience symptoms such as hot flushes, sleep disorders and mood swings during the menopause.

The hormonal changes during the menopause can lead to months-long gaps between menstrual cycles. The menopause is officially reached when at least 12 months have passed after the last menstrual period without any further bleeding.

Even if the ovaries gradually cease to function, their activity can sometimes flare up again temporarily. This leads to a renewed rise in oestrogen levels, which triggers a new cycle with bleeding. Occasionally this is just a one-off bleed, while in other cases periods can return for several months.

With each new menstrual cycle, the countdown to the menopause starts all over again. Only when a full year has passed without a period can we assume that the last period marked the start of the menopause. Until then, irregular bleeding with longer breaks is completely normal. The term «post-menopausal bleeding» is only used when bleeding occurs more than a year after the last menstrual episode.

What triggers bleeding after the menopause?


If you’re going through the menopause, it’s important to pay attention to your body and notice any changes. There are a number of causes that can lead to postmenopausal bleeding:

a) Endometrial atrophy (thinning of the uterine lining):the endometrium is the tissue that lines your uterus. It reacts to hormones such as oestrogen and progesterone. Low hormone levels after the menopause can cause it to become too thin.
b) Endometrial hyperplasia (thickening of the uterine lining): after the menopause, you may have too much oestrogen and too little progesterone. As a result, the lining of the uterus becomes thicker and can bleed. Sometimes cells in the lining of the womb can become abnormal. This can lead to cancer, so get it treated as soon as possible.
c) Cancer: bleeding is the most common symptom of endometrial or uterine cancer after the menopause. It can also indicate vaginal or cervical cancer.
d) Medication: bleeding is often a side effect of certain medications, such as hormone therapy, tamoxifen and blood thinners.
e) Polyps: these tissue growths appear in the uterus, cervical canal or cervix. They are not usually cancerous, but they can cause spotting, heavy bleeding or bleeding after sex.
f) Sexually transmitted diseases: some, such as chlamydia and gonorrhoea, can cause spotting and bleeding after sex. Herpes blisters can also bleed.
g)Vaginal atrophy (thinning of the vaginal tissue): oestrogen helps to keep this tissue healthy. After the menopause, low oestrogen levels can cause your vaginal walls to become thin, dry and inflamed. This often leads to bleeding after sex.

With the right care and attention, you can feel comfortable and healthy even during this time.

When should you see a doctor?

It is important that you see a doctor if you experience bleeding after the menopause. Although most bleeding at this age is harmless, it can also be a sign of more serious conditions. A doctor can carry out an examination to determine whether it is a hormonal change or a sign of illness. The earlier a condition is recognised, the better the treatment options. You should also consult a doctor if you are worried or unsure.

What will your doctor do?

To find out the cause of the bleeding, your doctor will perform a physical examination and review your medical history. One or more of the following tests may be necessary:

1) Endometrial biopsy: your doctor will take a small tissue sample from the uterus using a thin tube. It is sent to a laboratory where scientists look for unusual findings such as infections or cancer cells.
2) D&C (dilation and curettage): in this procedure, your doctor dilates your cervix. Using a thin instrument, she scrapes or sucks a sample of the uterine lining. This sample is sent to a laboratory where it is analysed for polyps, cancer or a thickening of the uterine lining (endometrial hyperplasia).
3) Hysteroscopy: if your doctor needs to take a look inside your uterus, she will use a hysteroscope. This is a thin, illuminated tube with a camera.
4) Sonohysterography: during this examination, your doctor can measure the size of a polyp. For this, saline solution is placed in your uterus to obtain a sharper ultrasound image.
5) Transvaginal ultrasound: with this image, your doctor can look for growths and examine the thickness of your uterine lining. To do this, she inserts a small probe into your vagina. This emits sound waves that create an image of the inside of your body.

Ultrasounds and biopsies are usually carried out in your doctor’s surgery. Hysteroscopy and D&C require a partial or full body anaesthetic. You will either be admitted to a hospital or an outpatient surgery centre.

What are the treatment options?


There are several treatment options for post-menopausal bleeding. The first step is to see a doctor to clarify the cause of the bleeding. Depending on whether it is due to hormonal changes or other illnesses, a personalised treatment may be recommended.

Hormonal changes can be treated with hormone replacement therapy. If the bleeding is due to ovarian disease, surgery may be necessary.

It is important that menopausal women have regular contact with their doctor in order to recognise and treat changes in the body at an early stage. Our symptom checker will help you with this. With the right treatment options, post-menopausal women don’t have to worry about bleeding.

Well, dear readers, if you have bleeding after the menopause, you don’t have to worry! Modern treatment methods can help you quickly and effectively. So if you have bleeding after the menopause, don’t hesitate to see your doctor.

If you need personalised advice or support on your journey through the menopause, contact The Women Circle here.

In our next edition, again on Saturday 9am, we will cover more aspects of menopause and women’s health. Stay informed and feel comfortable in this special phase of life.

If you would like to get in touch with us, please get in touch.

We are here for you.

Joëlle & Adrian

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