According to studies, vaginal bleeding is seen in 4-11% of postmenopausal women. Any kind of bleeding after menopause needs to be investigated by a gynecologist.
“Menopause is considered to have begun if a woman has not had her periods for at least twelve months. This is why any bleeding after menopause is not considered normal,“ says Dr. Rinku Sen Gupta Dhar, Senior Obstetrician – Gynecologist, Madhukar Rainbow Children’s Hospital, South Delhi.
Any bleeding even after 10 years of menopause should be evaluated.
What is postmenopausal bleeding?
Postmenopausal bleeding is said to occur if:
- you’ve bled even once after menopause
- You notice spotting, heavy flow or any pink, brown or red discharge
“There may be many causes of postmenopausal bleeding, and an early assessment helps us detect the cause and treat the condition better, which is why we advise women to take action early,” says Dr. Rinku.
Usually there is no pain associated with postmenopausal bleeding, though women may consider the bleeding to be similar to that experienced during their menstrual cycles.
What colour is postmenopausal bleeding?
Any amount of blood, be it pink, brown or red discharge may indicate postmenopausal bleeding.
What causes an older woman to bleed after menopause?
Postmenopausal bleeding can be caused by:
- Thinning of the endometrium/ womb lining (endometrial atrophy)
- Thickening of the endometrium (endometrial hyperplasia) lining due to hormone replacement therapy (HRT)
- Endometrial polyps or growths in the uterus
Should I worry about postmenopausal bleeding?
Postmenopausal bleeding is not common and hence requires examination by a gynecologist. Do not wait more than 2 weeks to see a doctor.
Many times women shy away from a consultation because they do not know what to expect. Dr. Rinku clarifies what such a check up would include.
What can I expect in a consultation with a gynecologist?
Your gynecologist will ask about your symptoms, do an internal examination and may also suggest a transvaginal ultrasound. A hysteroscopy may also be suggested through which the doctor will view the inside of the uterus. Your doctor may suggest a biopsy of the womb lining as well.
What is the treatment for postmenopausal bleeding?
The treatment for postmenopausal bleeding depends on the cause.
If endometrial polyps are found to be causing postmenopausal bleeding then these will need to be removed.
If the lining of the uterus is found to be very thin, then your doctor may suggest medication.
In a few cases, depending on the severity of the condition, a hysterectomy may be advised.
If the bleeding is found to be associated with hormone replacement therapy, then your doctor may suggest modifications or discontinuation.
According to the Royal College of Obstetrician-Gynecologists (RCOG), 9 out of 10 women with postmenopausal bleeding do not have cancer.
If, however, uterine or ovarian cancer is detected, surgery may be needed to remove the uterus and ovaries.
Precautions to Take with Postmenopausal Bleeding
Dr. Rinku suggests being in touch with your doctor, depending on the cause identified in your first visit.
If your tests and biopsy come clear, you should still get a check up once every 3 months.
FAQs around Postmenopausal Bleeding
Does postmenopausal bleeding stop on its own?
Any bleeding will stop on its own, but this should not deter you from getting it checked.
Is bleeding after menopause always cancer?
No, in most cases, it may not be cancer. This will have to be ruled out after tests suggested by your doctor.
Can periods restart after menopause?
No. Any heavy bleeding or light spotting after menopause, whether it is bright red or pale, may have various causes, and should be evaluated by a gynecologist.
Swarnlekha’s Experience with Postmenopausal Bleeding
Swarnlekha Kumar, 63, was shocked when she noticed she was bleeding. She had reached menopause several years earlier, so this was definitely unexpected. Worried, she scheduled the earliest appointment with her gynecologist, Dr. Rinku Sen Gupta Dhar.
“Swarnlekha visited us in a state of panic. We asked her about her symptoms, family history and any medication she was taking. Based on her responses and ultrasound examination, we found that her bleeding was caused by an endometrial polyp,” says Dr. Rinku.
“A hysteroscopic polypectomy was suggested to remove the polyp.”
The doctor explained the procedure in which a thin telescope-like instrument (called hysteroscope) with a light and camera is inserted into the uterus through the vagina. The images captured by the instrument are transmitted to the doctor’s monitors, allowing them to get a clear view of the uterus.
When the polyp is detected, an electrosurgical wire loop is passed through the hysteroscope and swung around the polyp and gently pulled out.
Swarnlekha understood that the procedure would be painless as it would be done under general anesthesia in about 30 minutes. Relieved that it wouldn’t cause much discomfort post surgery, she consented to the procedure.
She was discharged on the same day and after resting for a few days, felt better.
“My doctor was quick to diagnose and treat the problem. I was anxious when the polyp was sent for a biopsy but was immensely grateful that it turned out to be non-malignant,” says Swarnlekha.
As instructed by her doctor, Swarnlekha remains alert about any such incident and also cautions her friends and family to watch out should they experience the same.
Medically Reviewed by Dr. Rinku Sen Gupta Dhar
Senior Consultant, Obstetrician-Gynecologist
MBBS (Lady Hardinge Medical College)
MD (University College of Medical Sciences)
25+ years of experience
Dr. Rinku Sen Gupta Dhar practices in Madhukar Rainbow Children’s Hospital in Malviya Nagar and Rosewalk Hospital, Panchsheel Park in South Delhi.
For appointments/ details about OPD timings or consultation fees, please whatsapp +919810404057