To be considered officially menopausal, a woman must have gone a full year, 365 days, without having a period. If you have gone six months or even eight or 10 months without a period, and suddenly have one, then you are not completely menopausal. However, if you have definitely been period free for a year or more and then experience light bleeding, this is considered post-menopausal bleeding (PMB).
HRT and PMB
Dr. J. Glenn Bradley, OB/GYN.net editorial adviser (See References 1), explains that there are various causes for PMB. Most commonly, the culprit is HRT, or hormone replacement therapy. When undergoing this type of therapy, a woman may develop PMB because of the oestrogen that she is taking. The uterus is very sensitive to this hormone, which prompts growth of the endometrium, just as it did in the normal pre-menopausal reproductive cycle. Conversely, a lack of oestrogen can result in atrophy of the lining. When this happens, uterine-lining blood vessels can become so fragile that they break and bleed.
Sometimes, uterine lining overgrows and this results in a condition referred to as hyperplasias. This can cause post-menopausal bleeding. Sometimes, this can be indicative of a malignancy. According to Bradley, 20 per cent of post-menopausal bleeding may be the result of cancer of the uterine lining, which is the endometrium.
If fibroids or polyps have developed in the post-menopausal uterine cavity, these benign growths can cause spotting, staining and light bleeding. Fibroids may actually cause heavier bleeding than polyps.
Hormones Still Not Settled
Light spotting after menopause is usually the result of continued hormonal imbalances, according to Menopausetohealth.com (See References 2.) If you are also experiencing breast tenderness, along with the bleeding, it may be a normal period, even though you thought you were through with all of that. Once again, consider how long you have gone without a period. If it has been less than a year, you may not be finished.
Oestrogen and Progsterone Specifically
Oestrogen, in particular, may still be haunting you. If you have low levels, this can cause irregular spotting. If you have high levels, you may miss several periods in a row and then have a bout of flooding. If your progesterone levels are high compared to your oestrogen levels, this can result in atrophy of the endrometrium lining and cause bleeding. It takes awhile for these hormones to settle down, once and for all.
Symptoms Not to Ignore
If, along with post-menopausal bleeding, you are experiencing pressure on the pelvic floor, on the bladder or on the bowels, along with vaginal discharge, discuss this with your physician.