Women around the ages of 45 and above experience menopause. This means you should not expect to have any form of menstrual bleeding anymore. In recent times, there have been reports of women experiencing some forms of bleeding after menopause.

Sometimes, it might not be menstrual blood; it could be spotting of different colours like pink or brown discharge. However, it is very important that you check with your gynaecologist once you notice any form of discharge or drops from your vagina, no matter how often it happens, or even if it is just once. Even though it might not be serious, post-menopausal bleeding could be an early sign of cancer.

Causes of post-menopausal bleeding

Post-menopausal bleeding is caused by some major factors, and they include;

  • Thinning of the uterine lining (endometrial atrophy)

Lower hormone levels like oestrogen cause thinning of the endometrium and can trigger bleeding. The tissue that lines the uterus known as the endometrium responds to hormones such as oestrogen and progesterone.

  • Thickening of the uterine lining (endometrial hyperplasia)

Imbalance of the progesterone and oestrogen after menopause can cause thickening of the endometrium. It could be as a result of too little progesterone and too much oestrogen. As a result of this, the endometrium becomes thicker and bleeds. Sometimes this could lead to cancer, so it is best to get treatment as quickly as possible.

  • Polyps

These are growths of tissue inside of the womb or cervical canal, or even on your cervix. These are not cancer cells, but they cause heavy bleeding, spotting or bleeding after sex.

  • Medications

Post-menopausal bleeding is often a side effect of some drugs such as blood thinners and hormone therapy drugs.

  • Cancer

Post-menopausal bleeding is mostly an early symptom of cancer. It usually signifies the presence of uterine cancer or endometrial cancer. It can also signify the onset of vaginal or cervical cancer.

  • Thinning of vaginal tissue (vaginal atrophy)

This is similar to endometrial atrophy, as it is also caused by lower oestrogen levels. Oestrogen helps to keep the tissues of the vaginal walls healthy. A decrease in the level of oestrogen causes these tissues to break down and become dry, thin and inflamed. This leads to bleeding after sex.

Other less likely causes of post-menopausal bleeding are

  • Thyroid disorder
  • Clotting problem
  • Bleeding from urinary tract
  • Infection of the uterine lining (endometritis)
  • Trauma to the pelvis

Testing for causes of uterine bleeding

Once you notice the spotting or bleeding from your vagina after menopause, it is highly advisable to visit your gynaecologist. Once you visit your doctor, there are a series of tests that will be conducted to confirm the cause of the bleeding and its effects so far. The tests are;

  1. Vaginal ultrasound

The vagina hole will be checked through the insertion of a small probe in the vagina. This probe sends off sound waves that create a picture of the inside of your body. It is through these images produced that the doctor will determine the cause of the bleeding. The doctor will check for growths and also check the thickness of your endometrium.

  1. Hysteroscopy

To conduct this test, a thin camera that looks like a telescope is passed through your vagina to your womb to search for any problems. It also enables a sample of tissue to be collected for further testing.

  1. Examination

An examination of your pelvis and vagina is also a method to test for the cause of post-menopausal bleeding.

Treatment of post-menopausal bleeding

Post-menopausal bleeding is treated based on the cause of the bleeding. There are various treatments available and can be prescribed by your physician.

They include;

  1. Hysteroscopy

This is a procedure that is used to remove polyps. It is used by specialists and doctors to remove thickened parts of the uterine lining caused by endometrial hyperplasia.

  1. Dilation and curettage (D &C)

This is also used to remove polyps and thickened areas of the endometrium. It is a surgical procedure, carried out by the doctor. The cervix is opened (or dilated) and a thin tool is used to remove polyps.

  1. Oestrogen therapy

This is a hormonal treatment administered to treat vaginal and endometrial atrophy. It could take different forms like pills, vaginal creams, vaginal rings or tablet. Aside from the pills which are ingested orally, the rest are supposed to find their way into your body through your vagina on a weekly, daily basis.

  1. Progestin therapy

This is a treatment of progesterone artificially produced in the lab. It is administered for the treatment of endometrial hyperplasia. It can be prescribed in the form of pills, injection shots, vaginal creams or IUDs.

  1. Hysterectomy

This is the removal of the womb, and it is an option when uterine cancer is a cause of bleeding.

  1. Hormone replacement therapy

Change treatment or stop the treatment entirely.