Post Menopausal Bleeding

A woman is considered to have attained menopause after a year of having no menstrual bleeding. Any form of bleeding, even slight spotting following a gap of one year is termed as postmenopausal bleeding. A woman must consult a doctor if she experiences any amount of vaginal bleeding following menopause. Bleeding after menopause is rarely cause for concern but it does need to be investigated, however, because in very few cases it will be an indicator of something more serious.

Causes

There are multiple conditions that can lead to a postmenopausal bleeding. Some common causes are:

• Growth of polyps inside the cervical canal or uterus are usually not cancerous but can result in bleeding in the form of spotting or heavy bleeding.
• Post menopause, lack of the hormones can lead to thinning of endometrium and vaginal mucosa. The atrophy and inflammation of the lining can cause bleeding.
• Excessive thickening of endometrium can result because of hormone replacement therapy, excessive obesity or higher level of estrogen in body. This is a serious concern, as this condition has a potential to become cancerous later on. A close watch must be kept, and treatment must be initiated as soon as a diagnosis is made.
• Cancer of the uterus, endometrium, vagina or cervix following menopause can also lead to bleeding which needs to be considered as an immediate sign and must be treated accordingly.
• Some sexually transmitted diseases have the potential to cause post coital bleeding like Chlamydial infection, Gonorrhea, and Herpes.
• Certain medications like hormone replacement therapy, blood thinners and tamoxifen can also cause postmenopausal bleeding.

Diagnosis

Diagnosis is usually made after a complete physical examination and proper reviewing of medical history. Important tests that might be advised include

• Trans vaginal ultrasound
• Endometrial biopsy
• Sonohysterography
• Hysteroscopy
• Dilatation and curretage

Treatment

Treatment will depend on the exact cause of the bleeding.

• For estrogen related issues, medications in the form of pills, vaginal creams, vaginal rings, or vaginal tablets may be given.
• For cases where progesterone hormone is the primary reason for the bleeding, artificially synthesized progesterone hormone in the form of pills or shot, creams or intrauterine devices may be advised.
• Hysteroscopy can help in removing the polyps or the parts of the endometrium which have undergone undue thickening. Depending on the underlying cause of thickening ,you may be offered pills or intrauterine hormone system or hysterectomy.
• Hysterectomy is considered when the bleeding is uncontrollable with any medication and is interfering with the overall health of the female. While performing a hysterectomy the tubes and the surrounding areas may also be removed.
• For cancerous growths, apart from complete hysterectomy, radiation and chemotherapy might be advised along with hormone replacement therapy.
• For sexually transmitted diseases ,antibiotics along with other medications might be prescribed.