Irregular Bleeding Continuing Years After Menopause
Menopause marks the end of menstrual bleeding. A person has reached menopause when they have not had a menstrual period for 12 months. When bleeding does occur after menopause, it's referred to as postmenopausal bleeding. It is relatively rare; only about 10% of people who have reached menopause experience postmenopausal bleeding.
This article discusses the causes and risk factors associated with bleeding after menopause.
Common Causes
There are several common causes for spotting or light bleeding after menopause.
Vaginal and Vulvar Atrophy
Vaginal and vulvar atrophy occurs when the vaginal walls or the vulva (outer part of the female genitals) begin to thin and become dry and inflamed. When this happens, a person may experience irritation or soreness in the area.
It is caused by a decrease in the female reproductive hormone estrogen. Although it can happen at any age, it is most common following menopause. It affects as many as 50% of women who have reached that stage of reproductive health.
Vaginal and vulvar atrophy can cause bleeding, although spotting is most common during sexual intercourse because of the increase in irritation to the area.
Treating Vaginal and Vulvar Atrophy
Typically, treatment involves relieving irritation and restoring moisture to the area. Some options include:
- Moisturizers
- Lubricants
- Hormonal therapy to restore levels of estrogen
- Laser therapy
Polyps
Polyps are growths that can develop from any tissue in the body. Typically, polyps are noncancerous, however, they do have the potential to morph into cancerous growths if left untreated.
The various types of polyps that can develop and cause vaginal bleeding after menopause include:
- Endometrial polyps (growths attached to the inner wall of the uterus that extend into the uterine cavity)
- Cervical polyps (growths in the cervical canal, the lower part of the uterus)
Endometrial Polyps and Cancer Risk
Although it's possible for endometrial polyps to develop into cancer, the risk associated with postmenopausal endometrial polyps is low, at 1.3%.
Endometrial Hyperplasia
Endometrial hyperplasia is a condition characterized by the thick growth of endometrial tissue that lines the uterus.
After a person reaches menopause, they may decide to undergo certain types of therapies that increase their levels of estrogen to cope with symptoms. However, this extra estrogen can actually bring on endometrial hyperplasia.
This excessive and thick growth of endometrial tissue can lead to vaginal bleeding following menopause because the tissue has to be shed.
Why Does Estrogen Cause Endometrial Hyperplasia?
Estrogen is the reproductive hormone that causes the cells of the uterine lining to grow. When there is too much growth because of excessive estrogen, endometrial hyperplasia can result.
Endometrial Cancer
Endometrial cancer is a type of cancer that forms within the endometrial tissue. According to the National Cancer Institute, roughly 9% of menopausal people were diagnosed with endometrial cancer after experiencing vaginal bleeding.
It's worth noting that although the connection between vaginal bleeding and endometrial cancer is clear, most people who have postmenopausal bleeding do not go on to develop the disease.
Rare Causes of Postmenopausal Spotting
There are many other causes of spotting after menopause. Some are easily treatable, while others may require more extensive treatment.
Postmenopausal bleeding can be caused by:
- Cervical cancer
- Ovarian cancer
- Endometritis, which is an infection of the endometrial lining
- Trauma or injury to the vagina
- Estrogen replacement therapy
- Certain medications, such as blood thinners
- Certain sexually transmitted infections (STIs) that cause bleeding to occur following sexual intercourse
Genetics
Genetics does not play a role in whether a person will experience postmenopausal bleeding. However, some women may be more susceptible to developing endometrial cancer, which can go hand in hand with vaginal bleeding in a small number of cases.
Most people who have postmenopausal vaginal bleeding will not develop endometrial cancer. So, genetic susceptibility to endometrial cancer is not a good risk marker for the development of postmenopausal bleeding.
Risk Factors
The risk factors associated with postmenopausal vaginal bleeding are not well-known because there are many different underlying causes for why it occurs. According to research, the most common risk factor was having either diabetes or hypertension.
Summary
Postmenopausal bleeding is not normal and should be discussed with a healthcare provider. Some causes include polyps, vaginal and vulvar atrophy, endometrial hyperplasia, estrogen replacement therapy, and cancer. Although many of these aren't serious, others, like cancer, can be life-threatening if not caught early and treated appropriately.
The most common risk factors for postmenopausal bleeding are preexisting conditions such as diabetes and hypertension. Genetics doesn't typically determine whether you will experience spotting after you have entered menopause.
A Word From Verywell
Spotting after menopause can be alarming, because you probably assume vaginal bleeding is behind you. While you shouldn't worry about it too much, you do need to have it evaluated by a healthcare provider since it can be serious. A provider can identify the cause and determine treatment options to address the bleeding.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Source: https://www.verywellhealth.com/light-spotting-after-menopause-causes-and-risk-factors-5182467
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