Postmenopausal Spotting

Most women know that when they enter their postmenopausal years, their bodies have stopped ovulating and they will no longer be getting periods. This is because menstrual periods occur when the body discards tissue which will not be needed in a pregnancy. The body only builds that tissue when a woman is still ovulating and therefore still capable of becoming pregnant. Once a woman enters menopause, her production of the hormone estrogen slows and eventually her ovulating stops. When a woman has not been having periods - or ovulating - for a year, she is considered to be postmenopausal.

That is why it can be so frightening for a postmenopausal woman to find herself spotting or bleeding six months or more after her periods have stopped. A woman generally should be confident that her periods have stopped by this point and may see spotting or bleeding as an indication of a serious problem.

It may be helpful to realize that many women experience some post-menopausal bleeding or spotting, and in many cases this bleeding is found to be caused by something fairly simple and unthreatening, such as infection or injury. These may be common among postmenopausal women because the lining of the vagina becomes thinner and less well-lubricated during and after menopause. Sexual activity may rupture the thin walls of the vagina and cause bleeding, for example. For some women, benign growths in the uterus could cause this bleeding. In many cases, atrophy of the vagina causes some spotting.

That is, hormonal changes cause the vagina to diminish in size, a condition that can cause some spotting. Some doctors estimate that in as many as 90% of cases involving vaginal bleeding after menopause, the causes will be such fairly innocuous ones. Women undergoing hormone replacement therapies and obese women are more likely to experience postmenopausal bleeding because their estrogen levels may be different from the diminished levels of normal-weight women and those who have decided not to take HRT. In particular, the hormones used in HRT may cause the uterus lining to grow, eventually causing bleeding that resembles a menstrual period.

In some cases, however, the bleeding is more serious and may indicate a more serious underlying condition, such as uterine cancer, endometrial cancer, polyps, uterine tumors, cervical lesions, cervical cancer, or ovarian cancer . Although studies have suggested that only 5-10% of postmenopausal women who spot or bleed do so because of cancer, it is obviously critical to visit a doctor or gynecologist immediately upon discovering bleeding. Not only will it help ease anxiety about the cause of bleeding, but in the rare case that cancer is discovered, treatment can begin immediately. Luckily, uterine cancer is one of the most treatable cancers when detected early.

How to Tell?
Since vaginal spotting after menopause may indicate something as trivial as a small vaginal tear which will heal on its own or a more serious illness, it is important for any women experiencing such bleeding to check with a gynecologist or family doctor. There are a number of tests doctors can perform to determine what causes vaginal bleeding, and most of these tests attempt to determine what may be affecting the uterus lining:

•A physical exam: In a physical gynecological exam, a doctor will carefully examine the walls of the vagina for obvious tears, polyps, or signs of infection or atrophy. There may be symptoms which a woman is not aware of that a doctor may be able to see in such an exam. For this appointment, it is useful for a patient to bring in a detailed list of the bleeding she has experienced since she first began to notice the worrying symptom. Bringing a list of medications and therapies the patient is using will help the doctor assess whether any steroids, aspirin, or hormone treatments may contribute to the bleeding. For most women, this will be the first test or exam a doctor will recommend. Based on the findings of this exam, a doctor or gynecologist may recommend further testing or a possible solution to the bleeding.

•A hysteroscopy: A small camera is pushed through the cervix and allows doctors to clearly view the uterus from the inside. This will make any growths or imperfections on the uterus lining clear.

•D&C: The cervix is dilated and the lining of the uterus is scraped with a curette. This procedure, which is known as Dilation and Curettage, is commonly used for a number of gynecological ailments. Doctors can get a scraping of the uterine lining and also can remove any built-up tissue which may be causing vaginal bleeding.

•An ultrasound: A jelly is spread over the abdomen and a picture or video is taken of the uterus and ovaries using a computer. This is less invasive than a hysteroscopy or a D&C. Some doctors recommend a vaginal ultrasound, which is more invasive than an abdomen ultrasound but which may give a clearer view of the uterus lining.

What May be Going On?
It is necessary to see a doctor or gynecologist to be certain of the situation, but there are a number of possible causes for vaginal bleeding. If a woman is taking hormone replacements and has forgotten some pills or has recently changed her hormone regimen, some slight bleeding could occur from the hormonal changes this would cause. Just beginning a hormonal replacement therapy may cause some bleeding or spotting as the body adjusts to the hormones. Some studies have suggested that certain medications - including aspirin or steroid-based medicines - could cause spotting in some post-menopausal patients.

In the case of injury, a doctor may simply recommend a monitored period of rest and sexual abstinence to allow the vagina wall to heal. In case of inflammation or infection, treatment and medication are often given. If cancer is diagnosed, part of the uterus, ovaries, fallopian tubes, or cervix may be removed. In a small number of cases, vaginal bleeding persists, despite no apparent cause. In these cases, a number of treatments may be tried to stop the bleeding. Women may be advised by their physicians to alter or halt their hormone replacement therapies. Some women may be advised to adopt different and more healthful lifestyles. In cases where no such changes work and the spotting becomes worrisome, a physician may recommend a hysterectomy.

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