Beware of Post-Menopausal Bleeding

After a woman is menopausal (defined as one year without a period), she should no longer have any vaginal bleeding. Therefore, any vaginal bleeding in a post-menopausal woman is abnormal and should be reported to the woman’s healthcare provider so it can be evaluated.

Bleeding Stops After Menopause
Menopause occurs when the ovaries no longer have functional eggs that can secrete estrogen. Estrogen causes growth of the uterine lining, the endometrium. It is the endometrium that is shed monthly with menstruation. Since a post-menopausal woman’s ovaries no longer produce estrogen, the lining of the uterus does not grow and becomes atrophic. Menstruation no longer occurs because ovulation ceases and there is no endometrium to shed.

Potential Causes for Post-Menopausal Bleeding
While many benign diseases may cause post-menopausal bleeding, it is sometimes an early symptom of endometrial, cervical or other gynecological cancers. It is important to discuss any vaginal bleeding so cancer can be ruled out or early treatment can start.

Although cancer must always be ruled out, benign fibroids or polyps are commonly the cause of the bleeding. Post-menopausal bleeding also may occur after sexual relations due to dryness of the vagina, which is also caused by decreased estrogen production.

Intercourse may be easier and more comfortable for women whose bleeding is due to vaginal dryness by using lubricants such as Astroglide or K-Y jelly. Estrogen replacement therapy (pills, patches, vaginal rings or creams, etc.) may also help.

Hormone Replacement Therapy and Irregular Bleeding
If you are using hormone replacement therapy and still have irregular bleeding, discuss the bleeding patterns with your healthcare provider. Your provider will evaluate you to rule out any disease states that may cause the bleeding. If no diseases are responsible, your healthcare provider may try changing your hormone replacement regimen.

Hormone replacement therapy with estrogen and progesterone can be given continuously (every day) or sequentially. In sequential regimens, hormones are given so that bleeding should occur at an expected time. However, most women prefer not to bleed. Let’s face it, one of the perks of being menopausal is not getting a period. While I have heard some say that women like to have a monthly bleed, I have yet to encounter a patient who complains when she no longer gets her period. Therefore, continuous therapy without irregular bleeding would be ideal for most women on hormone replacement therapy.

Today, women and their healthcare providers have a wealth of options to choose from regarding hormone replacement therapy. Some of the newer preparations have literature- supported improved bleeding profiles. For some patients this may be an alternative if non-pathologic, irregular bleeding is occurring on hormone replacement therapy.