Post Menopausal Bleeding

Menopause is that time in your life when you stop getting your period permanently. It usually occurs between the ages of 45 and 55 years.

You could also go through menopause if you have undergone a hysterectomy (surgical removal of the uterus or ovaries.)

If you resume vaginal bleeding after a year of not getting your period, it may be Post Menopausal Bleeding (PMB).

Why does it occur?

There are many causes that can trigger post menopausal bleeding.

• If you are undergoing hormone replacement therapy, there is a greater chance of developing bleeding. This is because the uterine lining is very sensitive to estrogen.

Lack of estrogen weakens the blood vessels in the uterine lining, which could lead to it breaking spontaneously and bleeding.

• Polyps and fibroids are common benign growths that develop in the uterine cavity. Polyps can cause light bleeding, whereas fibroids are associated with heavy bleeding.
• Hyperplasia, which is overgrowth of the cells of the uterine lining could also cause bleeding post menopause.
• Cancer of the uterus, vagina or cervix or an ovarian tumour could lead to bleeding.
• Consuming blood thinning medicines may also cause to bleed.
• Stress, strain or sudden weight gain or loss can also cause PMB.

Raising the Red Flag

Contact your doctor immediately if you:

• Start to bleed, one year into menopause.
• Bleed for more than two weeks.
• Require a pad every hour for more than a day.

Tests to Diagnose

The first thing that your gyneac or obstetrician will do is check your medical history, symptoms and any medications that you have been taking.

You will then undergo a physical exam with certain tests like blood test, ultrasound scan, biopsy (examining a small tissue from the vagina, cervix or uterus) and a Pap smear test.

How is it treated?

The treatment options of course will depend on the cause of the bleeding.

A hormonal related bleeding is usually controlled through alterations in medications. However, polyps or fibroids can be removed through hysteroscopy.

Cancer obviously requires a much more aggressive surgery, namely hysterectomy.

If the bleeding is within three months of your last regular period, then it is normal. However, if you experience it anytime after it has stopped, then don't write it off as a common menopausal experience. Visit your gynaecologist immediately.

Besides this post menopause, live healthy with the right diet and exercise.

(With inputs from Dr. Reshma Rafi, Laparoscopic surgeon & Infertility Specialist, Saifee Hospital, Mumbai)