After Menopause Spotting, Should You Be Concerned?

After menopause spotting of course refers to spotting or bleeding after menopause.

As women approach menopause the menstrual bleeding pattern changes with periods usually becoming lighter and shorter in duration. So that once you are in menopause and post menopause there is no more bleeding.

However, there can be unexpected post menopause spotting and bleeding. For the most part this after menopause spotting and/or bleeding can be caused by something benign such as an infection or a tear of the uterine or vaginal lining.

The decline of estrogen levels in menopause cause the vaginal mucosa to become thinner and dryer and less elastic and predisposed to bleed. Sometimes this lining can be broken or easily inflamed and bleed. It can also become injured during intercourse or even during a pelvic exam.

One of the most common causes of after menopause spotting or bleeding is synthetic hormone replacement therapy, especially estrogen replacement therapy.

Women who are on HRT may often develop post menopause spotting because the uterine lining is very sensitive to estrogen, which promotes the growth of the endometrium; the uterine lining that builds up and is discharged during a normal menstrual cycle.

Hence bleeding and spotting so this lining can be released. On the other hand, lack of estrogen may cause the atrophy of the uterine lining in which case the blood vessels of the uterine lining become so fragile as a result of lack of estrogen that they spontaneously break and then bleed causing spotting.

Some other causes of after menopause spotting are the development of polyps and fibroids. These are benign growths that develop in the uterine cavity.

Polyps are most often associated with irregular light spotting, staining or light bleeding. Fibroids may also produce the same light symptoms but are also associated with much heavier bleeding.

Overgrowths of lining of the uterus called hyperplasias may also be the cause of abnormal post menopausal spotting and bleeding.

This condition can have some malignant potential. About 20% of women who have this type of post menopausal bleeding may have cancer of the endometrium, the uterine lining.

What To Watch For In Menopausal Spotting

If you have any unusual or unexplained menopausal spotting or bleeding or post menopausal bleeding, you should consult your doctor.

Endometrial hyperplasia, the abnormal thickening of the uterine wall may indicate a pre-cancerous condition. Endometrial cancer is the highest incidence of cancer in post menopausal women.

However, abnormal bleeding from uterine cancer occurs early in the disease when it is highly curable.

Some of the early signs of uterine cancer are:

  • Post menopausal spotting or bleeding, especially after intercourse. This occurs after there has been no menstruation for 12 months. A watery or blood-streaked vaginal discharge may precede spotting or bleeding.
  • Cramps in the lower abdomen
  • Enlarged uterus
  • In later stages the cancer may have spread to other organs causing abdominal pain, chest pain and weight loss

Some of the options your gynaecologist may use in evaluating after menopause spotting that concerns you are:

  • A D&C;, dilating your cervix and scraping the lining of the uterus
  • A hysteroscopy, looking inside your uterus with a small viewing device inserted through the cervix
  • An endometrial biopsy, taking a small sample in the office without having to dilate the cervix
  • An ultrasound to measure the thickness of the uterine lining

Recent studies suggest that if the uterine lining is very thin, the chance of uterine cancer is lower.

If you are having symptoms of after menopause spotting and you are concerned about being at risk for more serious complications, then make sure you see your doctor for regular pelvic examinations and Pap smears every six to twelve months.

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