Menopause occurs in a woman when she stops having her periods for more than a year. The average age of menopause is 45-55 years in women. Menopause happens because of the natural decline in female hormone (estrogen and progesterone ) production from the Ovaries. Ideally, if a woman has undergone Menopause she should not be having any bleeding.
However, if bleeding does happen, either as spotting or heavy bleeding then it is a cause for concern and one must visit a Gynaecologist.
Causes for Post Menopausal Bleeding
1- Endometrial Atrophy – When a woman’s estrogen production declines, it leads to thinning of the endometrium which sometimes leads to bleeding. This is also called as Senile Endometritis.
2- Polyps – these are non-cancerous benign growths that can grow either in the uterine cavity or in the cervical canal. These can lead to unusual spotting or heavy bleeding and sometimes may cause bleeding after sex.
3- Endometrial Hyperplasia – in this condition, the lining of the uterus becomes thicker rather than thinning out. This happens because of excess Estrogen production without the hormone progesterone to offset it. Endometrial Hyperplasia can sometimes lead to Endometrial Cancer. Endometrial hyperplasia is more common in women who are Obese.
4- Endometrial Cancer – This is cancer of the Uterine Lining. About 10% of women with postmenopausal bleeding have Uterine Cancer. The incidence of Endometrial Cancer increases in women who are Obese, Diabetic or Hypertensive.
5- Hormone Replacement Therapy– In the first 6 months of Hormone Replacement Therapy, women may experience breakthrough bleeding. Women on Tamoxifen may have post-menopausal bleeding.
Tests Done to Find the Cause of Post Menopausal Bleeding
Regardless of the cause, it is very important to visit your doctor to find out the cause of post-menopausal bleeding. The various tests done in this regard would be:
1- Transvaginal Ultrasound – this is the first test to be done. In this, an Ultrasound is done by inserting a probe through the vagina to visualize the Uterus. It helps to measure the endometrial lining, and how thick or thin it is. Ideally, the endometrial lining in post-menopausal women should be less than 5 mm.
2- Endometrial Biopsy – This can be done as an OPD procedure by inserting a small thin tube through the vagina into the uterus. Cells are taken from the lining of the Uterus and sent for biopsy to know whether they are normal or cancerous.
3- Dilatation and Curettage – This procedure involves admission on a daycare basis and is done under anaesthesia. In this the cervix is dilated, so that a larger piece of endometrium can be taken for sampling.
4- Hysteroscopy – This is a technique wherein a thin telescope which is attached to a camera is inserted inside the Uterine Cavity to visualize it for any polyps or growths inside the uterus. This procedure requires a daycare admission and is a safe, simple and minimally invasive procedure.
What are the treatment options?
Once the cause of bleeding has been diagnosed, treatment depends on the underlying cause. In most cases, it may not be necessary to remove the Uterus but regular monitoring may be needed.
1- Polyps – Removal of polyps is needed and this can be done by Hysteroscopy. If the polyps are Non-cancerous on biopsy, then removal of polyps is the complete treatment.
2- Endometrial Hyperplasia – For this condition, if the biopsy report shows no evidence of pre-cancer, then medications like Progesterones can be given. However, it is important to have regular checkups to ensure that the lining of the Uterus is not growing. Sometimes, for Endometrial Hyperplasia, removal of the Uterus may be needed.
3- Endometrial Cancer – Hysterectomy or removal of Uterus is the only option for Endometrial Cancer. Along with the uterus, the tubes and ovaries are also removed. Depending on the stage of the cancer, sometimes Chemotherapy or Radiotherapy may be needed.
4- Endometrial Atrophy – In this condition, the doctor may prescribe estrogens for a short period. About 10% of women may have Postmenopausal bleeding and in most cases, it may be because of simple curable causes. But in a few cases, it may need urgent attention as the cause may be life-threatening, so it is advisable to get yourself checked by a Gynaecologist at the earliest.