Post-Menopausal Bleeding

Perimenopause

The timeframe beginning in your later 40s and leading up to menopause is called perimenopause. This is the transition time from regular menstrual periods to stopping your periods. On average, menopause happens at the age of 51 and is marked by not having a menstrual cycle for over a year.

In perimenopause, menstrual cycles can become irregular and vary in timing and duration. This can be concerning if the cycle is occurring too frequently. Cycles that are more often than 23 days and lasting longer than a week, especially if they are heavy, will need to be evaluated by your doctor.

Bleeding After Menopause

In menopause, no further uterine bleeding is expected. When bleeding does occur, it needs to be carefully evaluated. This could be a sign of health problems. The bleeding may be very light to heavy. Bleeding that occurs after menopause can be caused by hormone imbalances or abnormal tissue. The abnormal tissue is the greatest concern. This could mean polyps, excessive growth of the inner lining of the uterus, or precancerous and even cancerous tissue.

• Polyps are typically benign inflammatory growths on the cervix or inner uterine lining.
• Excessive tissue, called endometrial hyperplasia, can be from too much estrogen and not enough progesterone.
• Bleeding is the most common sign of endometrial cancer in menopausal women. This is the most worrisome cause of postmenopausal bleeding, but when diagnosed early, most cases can be treated successfully.
• Women who are older, started their cycle earlier, entered menopause later, are obese, have diabetes, high blood pressure, gallbladder disease or thyroid disease have a higher risk of endometrial (uterine) cancer. Certain medications and histories of ovarian and colon cancer also increase their risk of uterine cancer.

What Should You Do?

When bleeding occurs in menopause it is very important to contact your doctor for an examination. This visit would include a review of your history, medications, and a pelvic examination. A pelvic ultrasound can help evaluate the uterus further, which helps your doctor decide on the next steps.

Often a sampling of the inner lining of the uterus is helpful − this called an endometrial biopsy (EMB). An EMB is done using a thin tube passed through the cervix and into the uterus, which takes a sample that is looked at under a microscope.

If further evaluation and care is needed for post-menopausal bleeding, a camera can be inserted through a dilated cervix to direct further sampling or remove polyps. This is a hysteroscopy, and it is typically done in a surgery center with you asleep. It is often combined with a dilation and curettage which involves using an instrument, a curette, to rub the inner lining and remove excessive tissue from the inner uterine lining. All tissue removed is carefully and assessed for signs of excessive and abnormal growth or cancer.

Treatment for Bleeding After Menopause

Treatment of post-menopausal bleeding is determined by the cause and could vary from hormone adjustment, to surgical removal of polyps, or even removing the uterus with a hysterectomy.

If the bleeding is caused by endometrial cancer, it is treated with surgery. The degree of spread (called staging) is determined by performing a surgical procedure and sampling tissue. Staging is graded 1 through 4, with the most advanced stage being 4. The staging of the cancer determines if chemotherapy or radiation therapies are needed. Detecting endometrial cancer early may mean that no further treatments are needed beyond the hysterectomy.

Bleeding after menopause is always concerning and you will want to let your doctor know as soon as possible. Further evaluation is needed. You and your doctor can discuss and plan the necessary steps to reach your best outcome.