Dr Usha BR, Consultant – OBGYN, Fertility & Laparoscopic Surgeon, Fortis Hospital, Bannerghatta Road, Bengaluru

Menopause marks the end of a woman’s menstrual cycle, typically occurring around the age of 51. After twelve months without a period, bleeding becomes abnormal and is known as postmenopausal bleeding (PMB). While it can be alarming, PMB often has benign causes, but it’s crucial to seek medical evaluation to identify the underlying reason and ensure proper treatment.

Causes of Post-Menopausal Bleeding:

• Atrophic vaginitis: This is the most common cause, affecting up to 60% of cases. Due to decreased estrogen levels, the vaginal lining thins and becomes dry and inflamed, making it prone to minor bleeding, especially after intercourse.
• Endometrial hyperplasia: This refers to a thickening of the uterine lining, often caused by an imbalance of estrogen and progesterone. While usually benign, it can increase the risk of endometrial cancer, hence requiring evaluation.
• Uterine polyps: These are benign growths on the inner lining of the uterus that can cause irregular bleeding, spotting, or heavy periods.
• Endometrial cancer: Though less common, around 10% of PMB cases are linked to this condition. Early diagnosis and treatment are crucial, and any postmenopausal bleeding warrants investigation.
• Cervical cancer: While less frequent than endometrial cancer, cervical cancer can also present with abnormal bleeding after menopause.
• Other causes: Certain medications, hormonal therapy, bleeding disorders, and non-gynecological conditions like infections or injuries can also contribute to PMB.

Symptoms:

The nature and severity of symptoms in PMB can vary depending on the underlying cause. Some common signs include:

• Spotting or light bleeding
• Heavy bleeding similar to periods
• Bleeding after intercourse
• Vaginal discharge

Importance of Medical Evaluation:

While PMB can be caused by benign conditions like atrophic vaginitis, it’s essential not to ignore it. Seeking professional medical advice is crucial for several reasons:

• Early detection of serious conditions: Prompt evaluation can help identify and address potential concerns like endometrial or cervical cancer.
• Ruling out other causes: PMB can sometimes be a symptom of other underlying medical conditions that require specific treatment.
• Selecting appropriate treatment: Once the cause is identified, the doctor can recommend the most suitable treatment plan based on individual needs and health factors.

Diagnosis:

To diagnose the cause of PMB, your doctor will likely ask about your medical history, symptoms, and medications. A physical examination, including a pelvic exam, might be performed. Depending on the findings, further tests like:

• Endometrial biopsy: A sample of the uterine lining is taken to analyze any abnormalities.
• Transvaginal ultrasound: This imaging test helps visualize the uterus and ovaries to detect any structural abnormalities.
• Pap smear: This test screens for precancerous changes in the cervix.

Treatment:

The treatment for PMB depends on the underlying cause. Some common treatment options include:

• Hormone therapy: This can help regulate hormone levels and address symptoms like vaginal dryness and bleeding caused by atrophic vaginitis.
• Progestin therapy: This can be used to treat endometrial hyperplasia and prevent recurrence.
• Removing polyps: Depending on their size and location, polyps may be removed through surgical procedures like hysteroscopy or curettage.
• Cancer treatment: Early diagnosis and appropriate treatment are essential for managing endometrial or cervical cancer, potentially involving surgery, radiation therapy, or chemotherapy.

Postmenopausal bleeding can be a cause for concern, but it’s important to remember that it’s often not a sign of anything serious. Seeking medical evaluation is crucial for proper diagnosis and treatment. Early detection and intervention can ensure optimal health outcomes and peace of mind. If you experience any postmenopausal bleeding, consult your doctor promptly for a comprehensive evaluation and personalized care plan.