By Dr. Tripti Raheja, Gynaecology
Menstruation is a natural process in women that begins in puberty and continues for a substantial period of time. This process ensures not only the health of a woman but also indicates the time till which she can conceive. Generally after 45 and 55 years of age, women no longer have any vaginal bleeding for more than a year, initiating a period known as menopause.
Though this period is marked by no bleeding, sometimes women may experience intermittent postmenopausal bleeding. This condition, though apparently may seem harmless, requires the immediate medication and a visit by the doctor.
What causes bleeding after menopause?
Bleeding after menopause is rarely cause for concern. It does need to be investigated, however, because in very few cases it will be an indicator of something more serious.
- Development of Polyps: Sometimes, development of polyps either on the uterus or on the cervical canal can be held as an important reason for instances of post menopausal bleeding.
- Thinning of Endometrium: The uterus is lined by a tissue known as endometrium. After menopause, owing to low estrogen level, the wall may be thinned which can contribute to bleeding post menopause.
- Thickening of Uterus: Often times, after menopause, the walls of the uterus may become thickened leading to bleeding after menopause.
- Uterine Cancer: If bleeding persists after menopause, it may be indicative of uterine cancer which will subsequently require immediate medication.
- Infection: Sometimes infections in the uterus or in the cervix can be a reason for the bleeding.
These are generally not serious problems and can be cured relatively easily. However, about 10 per cent of the time, post-menopausal bleeding is linked to cancer of the cervix or uterus and so it is very important to have it investigated.
Symptoms postmenopausal women may experience include:
- vaginal dryness
- decreased libido
- stress incontinence
- increased urinary tract infections
- weight gain
How is postmenopausal bleeding treated?
Treatment depends on the cause of the bleeding, on whether bleeding is heavy, and if additional symptoms are present. In some cases, bleeding may require no treatment. Treatment may include the following:
- Estrogen creams: Your doctor may prescribe estrogen cream if your bleeding is due to thinning and atrophy of your vaginal tissues.
- Polyp removal: Polyp removal is a surgical procedure.
- Progestin: Progestin is a hormone replacement therapy. Your doctor may recommend it if your endometrial tissue is overgrown. Progestin can decrease the overgrowth of tissue and reduce bleeding.
- Hysterectomy: Bleeding that cannot be treated in less invasive ways may require a hysterectomy. During a hysterectomy, your doctor will remove the patient’s uterus. The procedure may be done laparoscopically or through conventional abdominal surgery.
If bleeding is due to cancer, treatment will depend on the type of cancer and its stage. Common treatment for endometrial or cervical cancer includes surgery, chemotherapy, and radiation therapy.