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MENOPAUSE: WHAT'S HAPPENING
Why am I Bleeding After Menopause?
May. 02, 2022
Here’s why you may be seeing red again.
Of all the silver linings of menopause, not having to deal with the mood swings, bloating, cramps, and blood that come with your period may be the biggest. So, when suddenly they all start up again, it can be a shock — and a reason to see your gynecologist, stat.
“Women’s bodies give us warning signs,” says Carolyn DeLucia, MD, FACOG, a board-certified OBGYN in private practice in New York City and Hillsborough, New Jersey. By definition, menopause is the cessation of monthly menses for the entirety of one year, so any vaginal bleeding after that point is considered abnormal and should be communicated to your doctor. Although there are many reasons a woman can experience post-menopausal bleeding, the most serious concern is cancer of the cervix or endometrium. “Very often it’s not cancer, but that needs to be ruled out,” says Dr. DeLucia.
As adamant as Dr. DeLucia is that a woman seek out care from her gynecologist if she’s bleeding after menopause, she also notes that the culprit may not be dangerous — for example, shrinking uterine fibroids or one last spontaneous period. “Yes, it can happen. I call it the last hurrah,” she says.
Bleeding can also be linked to hormone replacement therapy says Kourtney Sims, MD, a board-certified gynecologist in Houston, TX, who is also Phenology’s chief medical advisor. “The bleeding is in relation to the progesterone in hormone replacement therapy. Some women [in menopause] will need to do combined therapy of estrogen and progesterone rather than estrogen alone and they can have bleeding in response. Typically, the bleeding is for a short period of time, less than 6 months, and lasts less than 7 days a cycle. But again, you must never assume because there could be things like malignancies,” says Dr. Kourtney.
Some other reasons you may be bleeding post-menopause: You could have a yeast infection, which can cause inflammation, or an undiagnosed urinary tract infection. “Bladder infections don’t always burn and hurt and torture us,” says Dr. DeLucia, who adds that the tell-tale sign in those cases is that the there is only blood evident when you wipe after urinating rather than spotting. The blood could also be coming from the vagina and not the uterus. During menopause, as the amount of estrogen to the vaginal canal declines, the blood supply to the vaginal tissue dwindles, and it can become thin, and lose elasticity and lubrication — making it more vulnerable to tears and irritation. “Vaginal atrophy is the only symptom of menopause that gets worse over time rather than better. Every other symptom of menopause minimizes over time,” says Dr. DeLucia, who is also the author of Ultimate Intimacy: The Revolutionary Science of Female Sexual Health.
Trauma leading to bleeding may also occur if a woman hasn’t had sex for a while and then does: “I had one woman who had a gash in her vaginal walls. It took a couple months for it to heal, and for her to be able to resume activities,” says Dr. DeLucia. The good news? Women can use moisturizers and lubricants, apply estrogen or DHEA cream locally, or turn to intra-vaginal laser and radio frequency treatments, as well as shockwave therapies, to encourage the formation of new collagen and elastin and improved blood circulation in the vaginal canal.
Bottom line, however, is to see your doctor. “If you have a cycle but it’s been 13 months since your last, should you still call your provider? Yes, yes, yes,” says Dr. Kourtney.
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