Bleeding 10 Years After the Menopause – When You Should Be Concerned

The menopause ought to be a time of transition, a time when a new balance settles in. That's what we've been told, isn't it? In reality, though, the menopause brings many changes with it: some expected, others rather surprising. Bleeding after the menopause has begun is one of the less expected changes.

What does bleeding during the menopause mean? Is it normal? Is it a warning sign? Let's take a look together. Here you'll find out why bleeding can occur after the menopause and why you should always discuss it with your doctor.

What is menopausal bleeding? 

Menopausal bleeding refers to any vaginal bleeding that occurs after the menopause has been confirmed. This may be light bleeding (spotting) or heavy bleeding for which you need period products.

If you are going through the menopause, you should have any kind of bleeding checked by a doctor straight away, so that the cause can be found quickly and you know early on whether there is any cause for concern.

When is the menopause considered confirmed? 

The menopause is the point at which the menstrual cycle ends and periods stop. However, because the final periods can be very irregular – they may stop and then start again after a few months – the menopause is only considered confirmed once 12 months have passed since the last period.

Any bleeding that occurs after this time is known as postmenopausal bleeding and requires medical assessment.

Menopausal bleeding – causes and possible conditions 

In most cases, bleeding during the menopause is a sign of harmless problems. Only in around 10% of cases does it point to cancer.

Even so, it's advisable to have any postmenopausal bleeding medically investigated – so you can be sure there's no serious condition and that your body is protected. The most common causes and conditions associated with postmenopausal bleeding include:

• Atrophic vaginitis (inflammation and thinning of the vaginal lining as a result of low oestrogen levels)
• Thinning of the womb lining
• Uterine polyps (growths in the womb or on the cervix, usually benign)
• Endometrial hyperplasia (thickening of the womb lining and the possible presence of abnormal cells, often as a result of hormone replacement therapy)
• Changes to the cervix or within the womb
• Endometrial cancer

Is bleeding during the menopause normal? 

Even though the cause is often not serious and the bleeding is more likely to be triggered by harmless factors or easily treatable problems: bleeding during the menopause is not normal. Any kind of bleeding – whether spotting, light pink or brownish bleeding, or heavy bleeding – is unusual. Even if it only happens once or twice.

Speak to your gynaecologist if you notice such bleeding after your menopause has been confirmed, as it can point to underlying conditions. The important thing is that the necessary investigations are arranged, the cause is identified and you receive the right treatment early on.

Postmenopausal bleeding – how is it diagnosed? 

To establish the cause of menopausal bleeding, your gynaecologist may recommend the following examinations:

• Examination of the vagina and cervix.
• A smear test (cervical screening), to detect any abnormal cells on the cervix.
• Transvaginal ultrasound
• A biopsy of the womb lining or the womb itself, to take and examine cells from the uterine lining.

Alongside the examinations themselves, your medical history will also be taken: how long ago was your last period, do you have any other conditions and what treatments are you currently receiving?

Menopausal bleeding – treatment options

Since vaginal bleeding during the menopause can have various causes, treatment depends on the underlying condition. Infections are treated with medication, bleeding linked to falling oestrogen levels with hormone treatment, and in certain cases surgery may be required.

Medical treatment 

Medical treatment for postmenopausal bleeding may include:

• Antibiotics, if the bleeding is the result of an infection.
• Oestrogen, which can be used as a tablet, cream or vaginal pessary for atrophic vaginitis.
• Progestogen, which can be given as a tablet, injection, cream or intrauterine device to treat endometrial hyperplasia.

Surgical treatment 

For more serious conditions, where medical treatment isn't sufficiently effective, surgery may be recommended:

• Hysteroscopy, to diagnose and treat uterine polyps or other growths causing bleeding.
• Dilatation and curettage, which may be carried out alongside hysteroscopy to remove the womb lining and uterine contents in certain forms of endometrial hyperplasia.
• Hysterectomy, carried out in cases of uterine cancer to remove the womb and cervix.

Postmenopausal bleeding – prevention  

Not all causes of postmenopausal bleeding can be prevented. There's little you can do about hormonal changes or age-related conditions, for example.

What you can do, however, is establish healthy habits to reduce the risk of gynaecological problems – and with it the risk of bleeding and other unusual symptoms after the menopause.

Recommendations for gynaecological health during the menopause 

Take the menopause as an opportunity to make your intimate health – and your health overall – a priority. Rethink your relationship with your body and aim for as healthy a lifestyle as possible to help prevent gynaecological and other complaints.

Try to adjust your diet and include as many nutrient-rich foods as you can – fruit, vegetables, sources of fibre and unsaturated fats – to support hormonal balance and the health of your womb.

The rest of your lifestyle habits matter just as much. Regular exercise, drinking enough fluids, getting proper rest and avoiding alcohol and nicotine all help to lower the risk of health problems.

And of course: always listen to your body. Attend every routine gynaecological check-up. Mention any unusual bleeding at the very first sign. Follow your doctor's advice and take up the examinations and screenings on offer: smear test, transvaginal ultrasound, hormone tests. Look after your body well – just as you deserve.

Frequently asked questions about menopausal bleeding 

To finish, we'd like to leave you with this thought: the menopause is not a break from your health. It's a new stage of life, and you're entitled to enjoy its beauty.

So allow yourself to ask questions and seek answers, so that you're prepared for any situation. Because we want to be there with you, we've gathered some of the most common questions about menopausal bleeding below, along with clear answers.

Is it normal to bleed during the menopause? 

No. Once the menopause has been confirmed (at least 12 months since your last period), any vaginal bleeding is a warning sign and needs to be medically assessed – even though the causes are often harmless.

Can hormone replacement therapy cause bleeding during the menopause? 

Yes, hormone replacement therapy can sometimes cause vaginal bleeding, particularly in the first few months of treatment. If the bleeding is heavy, persists or starts later on, speak to your doctor. The dose may be adjusted or a different treatment recommended.

Can menopausal bleeding be prevented? 

Not all the conditions that can cause bleeding during the menopause are preventable. However, keeping as active and healthy a lifestyle as possible, eating a nutrient-rich diet, getting enough rest and attending regular gynaecological check-ups can reduce the risk of many conditions and complications.

How often should gynaecological check-ups take place during the menopause? 

As a rule, gynaecological examinations should take place at least once a year – including after the menopause has begun. Depending on your medical history, your doctor may recommend more frequent check-ups.

Are there effective natural treatments for menopausal bleeding?

Some natural remedies may help to ease symptoms, but they are no substitute for a gynaecological examination. If the bleeding is caused by a health problem, it's essential to know the exact cause and to treat it accordingly, as advised by your doctor.

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