The menopause is diagnosed when a woman has not experienced a menstrual bleed for 12 consecutive months, marking the end of her reproductive years. In the UK, most women reach menopause by 51 (1).
Postmenopausal bleeding is not an uncommon phenomenon and occurs in approximately 4 to 11 per cent of postmenopausal women. Nevertheless, it is still important to get this symptom assessed by a medical professional to rule out anything serious (2).
Here, we take a look at what might cause postmenopausal bleeding and how best to approach it.
What is postmenopausal bleeding?
Postmenopausal bleeding is any vaginal bleeding that occurs after you have stopped menstruating for 12 consecutive months or more. Unscheduled bleeding can range from spotting — a pink or brownish discharge — to heavier, period-like bleeding (3).
While there is often a simple explanation for bleeding in postmenopause, you should still see your GP if you experience the following: (4)
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Bleeding that only happened once
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A small amount of blood, spotting, or pink or brown discharge
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You do not have any other symptoms
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You are unsure if it’s blood
Your GP will enquire about the amount of blood, the duration of the bleed, any additional discomfort, and other symptoms that may be relevant.
What percentage of postmenopausal bleeding is cancer?
Most cases of postmenopausal bleeding can be attributed to conditions that are not usually serious and can be treated easily.
Bleeding, for instance, might be the result of polyps (growths in the uterus or cervix) or genitourinary syndrome of menopause (GSM) (thinning and inflammation of the vaginal lining), both of which are non-cancerous.
However, 10 per cent of postmenopausal bleeding cases may be symptomatic of endometrial or cervical cancer, so it is vitally important to get it checked by a doctor.5 Research suggests that around 90 per cent of women with endometrial cancer experience vaginal bleeding (6).
By assessing bleeding, medical professionals have a greater window to catch cancer early, when it is most treatable.
What causes postmenopausal bleeding?
It is always important to consult your doctor if you notice any unscheduled bleeding in postmenopause.
Below, we have outlined some of the conditions that may cause this symptom:
Genitourinary syndrome of menopause (GSM)
After the menopause, oestrogen levels fluctuate in a downward trajectory decline, which can lead to changes in the vagina. The vaginal lining may become drier, thinner, more fragile, and less elastic, often resulting in genitourinary syndrome of menopause (GSM), or vaginal dryness (7). GSM is the most common cause of postmenopausal bleeding.
GSM is exceptionally prevalent amongst postmenopausal women. In most cases, it can be effectively treated with lubricants and moisturisers.
Polyps
Endometrial polyps are small, soft growths that develop on the inside of a woman’s womb or uterus (8). Irregular bleeding is a common symptom of polyps.
Though benign, some polyps may become cancerous over time but polyps can be removed in a simple surgical procedure.
Endometrial hyperplasia
Endometrial hyperplasia is the thickening of the endometrium – the mucous membrane that lines the uterus (9). Postmenopausal bleeding may occur when there is an excess of oestrogen without sufficient progesterone. Long-term use of HRT carries an increased risk of endometrial hyperplasia.
Without the correct management, there is a small chance this condition may lead to endometrial cancer (10). Progesterone treatment is usually given to fix the imbalance (11).
Endometrial cancer
While rare, postmenopausal bleeding may signal endometrial cancer (12). Endometrial cancer typically begins in the uterus. Besides abnormal bleeding, women may also experience discomfort in the pelvic region.
If caught early, the prognosis is far better for endometrial cancer. The majority of women are diagnosed with early-stage cancer and treated with surgery (13).
Cervical cancer
Similarly to endometrial cancer, postmenopausal bleeding could be a sign of cervical cancer. Cervical cancer is known to progress slowly, and accounts for 1 in 10 cancers diagnosed amongst women globally (14).
Alongside monitoring any changes to your body, regular cervical cancer screenings can help with early detection. Other symptoms may include abnormal vaginal discharge and pain during sex. Depending on the stage, treatment may comprise surgery, radiotherapy, or a combination of chemotherapy and radiotherapy.
Although postmenopausal bleeding can be disconcerting, in most cases, you do not need to worry about having a serious condition. However, this type of bleeding is still deemed ‘abnormal’, so you should always consult a medical professional if you notice this symptom.
Enjoyed reading this article? Please visit the rest of our Menopause hubto learn about supporting your health and happiness at this stage.
References:
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nhs.uk. 2020. Menopause. Available online: https://www.nhs.uk/conditions/menopause/
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Astrup. K., Olivarius N., Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstetricia et Gynecologica Scandinavica. 2004;83(2):203-207.
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Kch.nhs.uk. 2020. Postmenopausal Bleeding. Available online: https://www.kch.nhs.uk/Doc/pl%20-%20830.2%20-%20postmenopausal%20bleeding.pdf
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nidirect. 2020. Postmenopausal Bleeding. Nidirect. Available online: https://www.nidirect.gov.uk/conditions/postmenopausal-bleeding
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Hospital, T., 2020. Bleeding After Menopause. Available online: https://www.thewomens.org.au/health-information/periods/periods-overview/bleeding-after-menopause
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Newson D. Endometrial Cancer. Uterine Cancer; Symptoms And Diagnosis. Patient.info. 2020. Available online: https://patient.info/doctor/endometrial-cancer#ref-1
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Willacy D. Atrophic Vaginitis, Information About Vaginal Dryness. Patient.info. 2020. Available online: https://patient.info/doctor/atrophic-vaginitis
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Payne D. Uterine Cervix And Common Cervical Abnormalities. Patient.info. 2020. Available online: https://patient.info/doctor/uterine-cervix-and-common-cervical-abnormalities
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Harding D. Endometrial Hyperplasia. Read About Endometrial Hyperplasia. Patient.info. 2020. Available online: https://patient.info/doctor/endometrial-hyperplasia-pro
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nhs.uk. 2020. Womb (Uterus) Cancer – Causes. Available online: https://www.nhs.uk/conditions/womb-cancer/causes/
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Chandra V. et al., Therapeutic options for management of endometrial hyperplasia. Journal of gynecologic oncology. 2016;27(1):e8.
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Newson D. Endometrial Cancer. Uterine Cancer; Symptoms And Diagnosis. Patient.info. 2020. Available online: https://patient.info/doctor/endometrial-cancer#ref-1
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Kwon JS. Improving survival after endometrial cancer: the big picture. J Gynecol Oncol. 2015;26(3):227-31. Available online: https://www.ncbi.nlm.nih.gov/pubmed/18441173
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Newson D. Cervical Carcinoma . Cervical Cancer Information. Patient.info. 2020. Available online: https://patient.info/doctor/cervical-cancer-pro
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Olivia
Olivia Salter has always been an avid health nut. After graduating from the University of Bristol, she began working for a nutritional consultancy where she discovered her passion for all things wellness-related. There, she executed much of the company’s content marketing strategy and found her niche in health writing, publishing articles in Women’s Health, Mind Body Green, Thrive and Psychologies.
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