If you've gone a year without any bleeding, then start bleeding again (even if it's just spotting), you're having what's called postmenopausal bleeding. While most of the time it's not a cause for concern, occasionally postmenopausal bleeding can signal serious health problems. The American Congress of Obstetricians and Gynecologists advises women to get postmenopausal bleeding checked out ASAP.

What Causes Postmenopausal Bleeding?
Sometimes it's something simple like shifting hormones: maybe a rogue egg was released, or changes in your lifestyle or stress levels have triggered fluctuating hormone levels. But postmenopausal bleeding can also be a warning sign of abnormalities in the uterus or cervix (the lower part of the uterus). Common causes of postmenopausal bleeding include:

  • Polyps. Polyps are growths on the uterine lining (endometrium) or wall. They can be tiny or as big as a golf ball. Polyps aren't cancerous, but they can bleed, sometimes very heavily.
  • Endometrial atrophy. The uterine lining often thins after menopause. If it becomes too thin, abnormal bleeding can occur.
  • Endometrial hyperplasia. This is a thickening of the uterine lining, which can also trigger abnormal bleeding. Endometrial hyperplasia is usually caused by too much estrogen (as a result of hormone replacement therapy, for example) and not enough progesterone, which causes the uterine lining to shed. Sometimes endometrial cells develop abnormally, known as atypical endometrial hyperplasia. This carries an increased the risk of uterine cancer, but early treatment of the condition can often prevent uterine cancer.

How Do You Know If Your Bleeding Is a Cause for Concern?
Only your doctor can tell for sure. If you're experiencing postmenopausal bleeding, give your doctor a call. She'll bring you in for an office appointment, perform a vaginal exam, and may use one of these diagnostic techniques to identify the cause of your bleeding:

  • Transvaginal ultrasound. Ultrasounds use sound waves to create an image. Transvaginal ultrasounds use a vaginal device (a transducer) to get the best view of the inside of the uterus.
  • Sonohysterography. In this type of ultrasound, the uterus is filled with fluid to enhance the image.
  • Hysteroscopy. A thin, lighted tube with a tiny camera is threaded through the cervix and into the uterus. Depending on what your doctor sees, tissue samples might be removed and sent to a lab for examination.
  • Endometrial biopsy. Using a thin tube threaded through the cervix, tissue is removed from the uterus and sent to a lab for diagnosis.
  • D&C (dilation and curettage). The cervix is opened and tissue is scraped or suctioned out of the uterus, then sent to a lab for examination.

What Can Be Done to Treat Postmenopausal Bleeding?
Sometimes all that's needed is reassurance. If nothing's wrong, your doctor might recommend you just wait for your hormones to rebalance naturally. Alternatively, your doctor may suggest medication or hormones like estrogen and progesterone. If polyps are causing your bleeding, your doctor may propose surgery to remove them. If you have an extra-thick endometrium, your doctor might advise a D&C or regularly scheduled endometrial biopsies to keep an eye out for cancer. And if there's anything really problematic going on, you might need a hysterectomy to remove the uterus altogether.

Contact your doctor whenever you have unusual symptoms, and stay on track with your regular well-woman checkups.



American Congress of Obstetricians and Gynecologists.
"Perimenopausal Bleeding and Bleeding After Menopause." Web. May 2011.