Once a woman begins menopause, she will no longer menstruate. Any bleeding experienced in menopause, is abnormal, and is in no way related to the bleeding experienced in menstruation. Most of the causes of bleeding after menopause are benign, although in some cases it can be cancerous.
Bleeding in Menopause
Menopause has three stages: perimenopause, menopause and post-menopause. In perimenopause (menopause transition) irregular menstrual cycles are very common, as the levels of the hormone oestrogen fluctuates up and down. There is still enough oestrogen left in this stage to continue menstruation. In menopause, oestrogen has declined enough to stop periods, but the hormonal changes may cause slight bleeding, similar to that of a light menstrual cycle. In post-menopause, you will have missed 12 monthly cycles in a row. The changes attributed to this low circulation of oestrogen, may also cause, uterine and vaginal bleeding.
Hormone Replacement Therapy
When menopause begins, many women experience symptoms such as hot flashes, night sweats, mood swings, insomnia and depression due to decrease stores of the hormone oestrogen. In order to minimise these symptoms your physician might suggest you take hormone replacement therapy (HRT), which not only stabilises your oestrogen level, but your progesterone as well. In menstruation, oestrogen surges causing the uterine lining to thicken and then shed. In taking HRT, the lining of the uterus may start to overgrow (hyperplasias), and since the oestrogen levels are low, the lining fails to shed all at once, causing sporadic bleeding and spotting.
After menopause begins, the uterine and vaginal walls become thinner. Due to this thinning, the blood vessels within the walls become weak and burst. With the case of uterine atrophy these blood vessels burst spontaneously, causing periodic vaginal bleeding. In the case of vaginal atrophy (atrophic vaginits) the vagina also becomes thin, dry and inflamed. Women with vaginal atrophy often complain of bleeding, stinging and burning during and after sex.
Abnormal uterine growths may be problematic in menopause and post-menopause. The most common of these uterine growths are uterine polyps. These are bulb-shaped growths that start in the uterine lining and protrude into the uterine cavity (womb). Uterine polyps may appear as one or many, and they vary in size, from just a few millimetres to the size of a golf ball. Symptoms associated with uterine polyps are vaginal bleeding after menopause, and light bleeding or spotting in post-menopause.
Other less common forms of bleeding after menopause are due to ovarian cysts, uterine fibroids, or cervical, uterine or ovarian cancer. Bleeding after menopause is usually light, scanty or spotty, and should never be heavy or coupled with pain. Even after diagnosis, if you find that you are experiencing these symptoms, contact your physician immediately.