Vaginal bleeding after menopause

Menopause is a natural process in which you gradually become infertile. In the Western world, this happens to most women when they are between 45 and 55 years old. The average age is 51 years. Menstruations become irregular and eventually fail to occur altogether. If you lose blood again more than a year after your last period, it is always wise to see your doctor. However, in 90% of cases the cause is relatively harmless.
The transition is a process that does not happen overnight. Menopause consists of three phases, which occur at a different pace for each woman. In the first phase, pre-menopause, the amount of female hormones (estrogen and progesterone) in your body slowly decreases. This changes menstruation and may initially occur more often and more heavily. Ultimately, however, the intervals become longer and the menstrual period disappears. Menopause (second phase) has arrived. This phase actually only lasts one day; it is the day of your last menstrual period. After this day we speak of post-menopause. Your ovaries no longer have fertile eggs and the body almost no longer produces estrogens and progestins (progesterone). You are no longer fertile. The age at which you get your last menstrual period is largely hereditary.

Blood loss due to atrophic vaginitis

It is not normal to suddenly lose blood again more than a year after your last period. Even if it only lasts a few days, it is always a reason to go to the doctor or gynecologist. Nine times out of ten, the blood loss has an innocent cause. The increasingly thinner and drier mucous membrane of the uterus and vagina is vulnerable and can easily become damaged and infected. If this happens, there may be some bleeding after sex, for example.
Inflammation of the mucous membrane of the vagina is the most common, harmless cause of blood loss after menopause. More than half of women experience atrophic vaginitis after menopause. Normally, the hormone estrogen thickens and moistens the mucous membrane of the vagina and maintains the number of lactobacilli (lactic acid bacteria). However, after menopause, estrogen production decreases drastically. The mucous membrane becomes thinner and drier and can easily become inflamed due to irritation. A dry vagina, pain and itching are often the first symptoms. Sex can be painful and cause some blood loss. The vaginal wall also becomes painful and may bleed when touched. In addition, the risk of bacterial and fungal infections increases because there are too few good bacteria present that provide natural protection. Such an infection usually causes a foul-smelling vaginal discharge and sometimes pain when urinating. Hormone treatment with estrogens often offers a solution for atrophic vaginits. Any bacterial or fungal infection should be additionally treated with antibiotics or antifungal medications.

Blood loss due to a polyp in the uterus or cervix

Another fairly common cause of postmenopausal bleeding is a polyp in the cervix or the uterus itself. A polyp is an overgrowth of the mucous membrane that is located on the inside of the uterus (neck). The growth usually has the shape of a grape and grows to about 2 cm in size. A polyp is almost always harmless, but can cause complaints such as blood loss and watery or bloody vaginal discharge. The cervix can also be sensitive and bleed easily, especially after sex. Multiple polyps may be present. A polyp often occurs when the mucous membrane of the uterus (neck) is stimulated too much, for example by inflammation. In more than 95% of cases, a polyp in the uterus (neck) is and remains benign. However, it is usually removed as a precaution.

Blood loss due to fibroids in the uterus

Blood loss after menopause can be caused by fibroids in the uterus (myomas). These are benign lumps of the muscle tissue of the uterine wall. The lumps vary in size from a pinhead to a large orange or larger. The fibroids prevent the uterus from contracting properly. In addition, they sometimes cause blood flow disorders in the uterine wall and the mucous membrane. This can lead to severe abdominal pain and (sometimes heavy) blood loss. However, fibroids almost always develop during a woman’s childbearing years. They grow under the influence of the female hormones estrogen and progesterone. Due to reduced hormone production, fibroids usually become smaller after menopause and from that moment on they also cause fewer complaints. Fibroids are generally only removed if they are very large or if they bother you a lot.

Blood loss due to erosion of the cervix

Sometimes the mucosal cells that line the inside of the cervix extend to the outside of the cervix. It is a common condition. The mucous membrane on the inside is more vulnerable and makes the cervix more sensitive to infections and inflammation. This allows the mucous membrane to bleed more easily. Sometimes there is increasing vaginal discharge and some blood loss after intercourse. Not infrequently, a bacterial infection, such as chlamydia or gonorrhea, is also involved. The cause of erosion can almost never be determined. The condition is harmless and usually does not require treatment. Only occasionally is it necessary to remove the mucous membrane cells with cryotherapy (freezing) or laser treatment. A bacterial infection must always be treated.

Blood loss due to a thickened uterine lining

Blood loss after menopause can also be caused by a thickened uterine lining (endometrium). In adenomatous endometrial hyperplasia, a glandular tumor (adenoma) occurs due to excessively rapid division of the cells in the mucous membrane. The condition is most common in women around or after menopause. Adenomatous endometrial hyperplasia occurs when the hormone estrogen is continuously produced and little or no progesterone is produced. Estrogen causes the cells in the uterine lining to divide and the glandular tissue to grow. Progesterone then normally causes the glands to produce mucus and stop growing. Because too little or no progesterone is produced, the uterine lining continues to grow. The condition leads to abnormal vaginal bleeding. The blood comes from the uterus.
Adenomatous endometrial hyperplasia can be caused by polycystic ovaries (ovaries containing cysts ), an estrogen-secreting ovarian tumor, the drug Tamoxifen (a drug given for breast cancer) or hormone replacement therapy. In the latter case, women are given estrogens after menopause to reduce menopausal symptoms. There is a small risk that abnormal cells will develop in adenomatous endometrial hyperplasia, which are a precursor to endometrial cancer. When there are only normal cells in the uterine lining, the condition is treated with progestin. This drug has the same effect as progesterone and inhibits the growth of the mucous membrane. In the case of abnormal cells, the uterus and possibly the ovaries are usually removed.

In 50% of cases no cause is found

Sometimes postmenopausal bleeding is caused by certain medications that contain hormones. In half of the women no cause is found at all. Unfortunately, in almost ten percent of cases a malignant condition is found that causes the blood loss. This usually concerns cancer of the cervix or uterine cavity. The risk of cancer of the uterine cavity increases slightly if you use estrogens after menopause to combat menopausal symptoms or if you use certain medications against breast cancer (for example Tamoxifen). Cancer of the vulva and vagina can also cause bleeding, but this is very rare.
If you suddenly lose blood again after menopause , it is important to have it checked where that blood comes from. Your GP will usually refer you to a gynecologist for this. This will take a smear of the cervix and perform an internal ultrasound scan. Ultrasound can provide a good picture of the condition and thickness of the lining of the uterus. If the mucous membrane cannot be measured or assessed properly, additional research is necessary. If no abnormalities are found, the doctor assumes that the blood loss is harmless. In all other cases, appropriate treatment will be instituted.

read more

  • Intermittent or irregular vaginal bleeding
  • Abnormal bleeding due to a polyp in the uterus
  • Pain in the lower abdomen: uterus, fallopian tubes and ovaries
  • Fallopian tube inflammation: severe abdominal pain, fever and blood loss
  • Vaginal infections: usually harmless, but annoying
© 2023 ApaFungsi.Com