Should you be concerned about post-menopausal bleeding?

The term "menopause" can be daunting on its own, but couple it with the words "abnormal bleeding," and you may find the hair on the back of your neck standing up.

Menopause is a normal, physiological event that can occur naturally or be induced through medical interventions, such as surgery, pelvic radiation therapy, chemotherapy or systemic illness. Women are considered in menopause if they have not had a menstrual cycle for at least a year. With life expectancy of women increasing to up to age 80, women may spend more than one-third of their life beyond menopause.

Is the return of bleeding normal?

During menopause, women may experience a return of vaginal bleeding. They may spot for a day or a week, and then bleeding may go away. When bleeding stops, it's natural not to think about it again.

Although bleeding may have been caused by some form of physical activity, vaginal discharge, yeast infection or vaginal itching, it could be a symptom of something more serious, such as hyperplasia, which is an increase in abnormal cells, or cancer.

As women age, they are at greater risk for hyperplasia and cancer of the uterus. The increase is nearly 75% greater for women who are 70 to 74.

Other causes of bleeding, including polyps, fibroids, thyroid abnormalities or coagulation defects, can be related to thinning of the lining of the uterus, otherwise known as atrophic lining of the uterus.

Seeking medical attention

Women who have experienced a return of bleeding after a year without periods should consult with their health care provider immediately. Also, address pain or bleeding with sexual activity with your health care provider. Your provider may perform a biopsy of the lining of the uterus or conduct an ultrasound to look at the thickness of the lining of the uterus.

A biopsy is a procedure that entails removing a small amount of tissue from the uterus that will be sent on to viewed by the pathology lab. A biopsy can be performed in the clinic, and it is most often is tolerable. However, it can be painful at times or when the provider is not able to get a sample because the cervix is closed and cannot be dilated.

During the ultrasound, if the lining appears to be more than 4 millimeters, the provider will want to proceed with a biopsy. It is not always necessary to have an ultrasound performed before a biopsy.
If a biopsy is not an option for you or if bleeding continues despite a normal biopsy, your provider may suggest a hysteroscopy. During this surgical procedure, the inside of the uterus can be visualized with the help of a scope.

The advantage of this approach is that the biopsy can be taken under direct visualization, and if any polyps or fibroids are present, they can be treated and removed. Simply put, women who experience post-menopausal bleeding should seek medical attention immediately. Early detection of abnormal cells or cancer increases the survival rate.

Sarah Monson is certified nurse-midwife in OB-GYN in La Crosse, Wisconsin.