Meno Health. Clinical Evidence.

EN TWC #054: Wann sind Blutungen nach der Menopause gut- oder bösartig?

Dear MHI reader

In our newsletter #30 I’m worried because I have bleeding after the menopause, we described what generally triggers the bleeding and what your doctor will do to find out the causes of the bleeding.

Today we want to take a closer look at when bleeding after the menopause is benign and when it is malignant.

Benign causes of bleeding after the menopause

In most cases, the causes of postmenopausal bleeding are harmless.

Decrease in the uterine lining (endometrial atrophy)
The reason for the reduction in the uterine lining is the drop in hormone levels, particularly oestrogen, after the menopause. The lining of the uterus is then no longer sufficiently built up, thins and can bleed easily.

Benign growths such as polyps or fibroids
Both polyps (benign growths in the lining of the uterus) and fibroids (benign muscular nodules in the uterine wall) can be common benign causes of bleeding after the menopause.

Hormone replacement therapy
Cessation of bleeding due to the cyclical intake of hormones as part of hormone replacement therapy is a common cause. The use of oestrogen preparations with added progestogen regularly sheds the lining of the uterus during breaks in the intake. This can lead to abortive bleeding (menstrual-like bleeding). If an increased oestrogen level is the cause of postmenopausal bleeding, the amount of oestrogen can be reduced as part of hormone therapy in order to alleviate the symptoms.

Inflammation or injury to the vagina/uterus
Infections, erosions or minor injuries in the vaginal or cervical area can also be sources of bleeding.

Thinned, dry vaginal mucosa (vaginal atrophy)

A thinned, dry vaginal mucosa very often develops after the menopause due to a lack of hormones. This development is medically known as «urogenital menopause syndrome«. Small tears in the vaginal mucosa can lead to weaker bleeding, for example after sex. So-called colpitis senilis, a typical inflammation of postmenopausal women that occurs as a result of the thin mucous membrane, can be treated and prevented by applying oestrogen preparations locally to the vaginal mucous membrane.

Stressful situations, illnesses, sport
Severe stress, illness or extreme physical exertion such as competitive sport can lead to fluctuations and imbalances in hormones such as oestrogen and progesterone. These hormonal changes can in turn trigger bleeding from the uterus.

Malignant causes of bleeding after the menopause

The risk of malignant causes of bleeding after the menopause increases with age. This affects the female reproductive organs such as the ovaries and fallopian tubes, uterus, cervix and vagina.

Types of uterine cancer (endometrial carcinoma) 
Endometrial carcinoma, i.e. cancer of the uterine lining, is one of the most common malignant causes of postmenopausal bleeding. Endometrial carcinoma is present in approx. 5-10% of cases.

Ovarian cancer (ovarian carcinoma)
Although rare, ovarian cancer can also be a cause of bleeding after the menopause. Ovarian cancer is often diagnosed late, after the menopause, due to the frequent lack of early symptoms. Unusual bleeding can be one of the first signs. The average age of onset is 69 years.

Cervical cancer (cervical carcinoma)
Cervical cancer can lead to bleeding and discharge after the menopause, especially between the ages of 40 and 59. Initially there are often no symptoms, but at an advanced stage there may be «unusual bleeding» and «foul-smelling or flesh-water-colored discharge».

Vaginal carcinoma
In rare cases, malignant changes in the vaginal mucosa (vaginal carcinoma) can make themselves felt through bleeding, discharge and abdominal pain.

Most bleeding after the menopause is harmless. However, to be on the safe side, you should visit your gynecologist early on.

We hope this information will help you to better understand the menopause and take practical steps to deal with it. If you need personal advice or support on your journey through the menopause, contact The Women Circle here.

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

Book recommendation

The little menopause coach by Susanne Vogel is now available in bookshops!

You can order the book here: The little menopause coach

Actively combating symptoms during the menopause

Many women are plagued by symptoms such as joint pain, weight problems and hot flushes during the menopause. The risk of osteoporosis also increases. Muscle building through targeted strength training helps to combat this. Muscles not only support our skeleton, but also burn fat and are the driving force behind a healthy, active metabolism. The little coach will show you lots of varied exercises and give you valuable tips that will effectively alleviate your symptoms.
 – Self-test: How fit are you and where should you start?  – Targeted training programs for at home: Efficient exercises for more strength and stability, endurance and performance, flexibility, coordination and balance for both beginners and advanced users.  – Plus pelvic floor training: Strengthen your core to combat bladder weakness, prolapse problems and for a strong pelvic floor.

 Small coach, big effect!

Order the book here: The little menopause coach

We wish you a great week.

Kind regards

Joëlle & Adrian

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