Women are subject to many types of bleeding both normal, regular and unusual throughout their hormonal lives.
However if you’ve gone through menopause, whether natural or surgical as in a hysterectomy, you shouldn’t have any menstrual bleeding as menopause means you haven’t had a period in at least one year.
So if you notice any any bleeding – even if it’s only spotting -you should always see a doctor about this so they can rule out any potentially serious conditions.
What causes it?
A number of conditions may lead to postmenopausal bleeding, and these are the most usual:
Polyps: These tissue growths show up inside your uterus or cervical canal, or on your cervix.
They’re usually not cancerous, but they can cause spotting, heavy bleeding, or bleeding after sex.
Endometrial atrophy which is the thinning of the uterine lining: The endometrium is the tissue that lines your uterus. It responds to hormones like oestrogen and progesterone.
Low hormone levels after menopause can cause it to get too thin and this may trigger bleeding.
Vaginal atrophy or thinning of vaginal tissue: Oestrogen helps to keep this tissue healthy. After menopause, low oestrogen levels can cause your vaginal walls to become thin, dry, and inflamed.
This causes both discomfort and can often leads to bleeding after sex, so again report this as soon as you notice it.
Endometrial hyperplasia which is thickening of the uterine lining: After menopause, you may have too much oestrogen and too little progesterone.
As a result, the endometrium gets thicker and can bleed. Sometimes cells in the endometrium can become abnormal. This could lead to cancer, so get it diagnosed and treated as soon as possible.
Cancer: Bleeding is the most common symptom of endometrial or uterine cancer after menopause.
It can also signal vaginal or cervical cancer so always report any bleeding from this area.
Sexually transmitted diseases: Some, like chlamydia and gonorrhoea, may cause spotting and bleeding after sex and herpes sores can also bleed.
Medication: Bleeding is often a side effect of certain drugs, like HRT, tamoxifen, and blood thinners.
Never ignore any bleeding post menopause and discuss it as soon as possible with your doctor.
Good hormone balance is essential post menopause as the levels of both oestrogen and progesterone drop, but progesterone drops further and faster.
You need both hormones for helping reduce the risk of o osteoporosis and to help with vaginal dryness, but it is progesterone that reduces the risk of hormonal cancers.