What Does Spotting After Menopause Mean?

Many women use their menstrual cycle as a way to determine the overall health of their bodies. If a woman is used to having very regular periods and then they become irregular, it can be very upsetting and may cause her to come in for a check-up. Also, if she has always had irregular, unpredictable menstrual cycles she may imagine something is wrong with her and seek medical help to find out the cause and treatment for the "problem".

Menopause is when a woman’s menstrual cycles naturally stop altogether. When a women stops having her cycles for a year or more and is sure she is in menopause, it can be alarming to wake up or use the bathroom and notice she is spotting or bleeding.

So what is the first thing we do when something like this happens to us? Go to the Internet, right? I know you out there! And what is the first thing that is says when you look it up? Cancer, right? And so you rush into my office like your house is on fire, so fast that your shoes are mis-matched, moving like a New York taxi driver with an attitude to match. But hold on, it's the Internet, the doctor’s archenemy, the bearer of generic, one-size fits-all, non-individualized information. If I can stress anything to you right now it is that YOU are NOT a car or a mechanical device!! I wish medicine was so easy that anyone could just pick up a textbook or surf the web and become an honorary doctor. The one thing they emphasize to us in medical school is, DON'T be your own doctor; it's just too hard to be objective.

Yes, it could be cancer, everything and anything can be cancer, and that is the #1 thing most of us worry about and want to make sure we don't have. Fortunately, cancer is rarely the case, but you probably missed all those other things it said after cancer mainly because they are not as scary and possibly because you don't know what they are.

Some of the more common reasons for post-menopausal bleeding are things like hormone replacement, stress, rapid weight loss, insulin resistance, degenerating fibroids, polyps, atrophic endometrium (from lack of hormones), atrophic vaginitis (from lack of hormones), endometrial hyperplasia, and yes, cancer (cervical or uterine). See all those you missed on the way to cancer?

Cancer is no joke. I know it is a legitimate concern, and it is definitely the first thing I will check for. I want you healthy and informed. I want you to come in as soon as you can, so if it were to be cancer or pre-cancer, we have the best chance for cure. Bleeding caused by uterine cancer is heavier and longer than that of a normal period. It is not spotting.

Menopause is a time of shifting hormones, so the normal rise and fall is out of synchronization. This causes a majority of the irregular bleeding cycles and spotting. Some of you are on hormone replacement to help with symptoms and to control bleeding, but even that can take time and create bleeding problems.

Stress releases many hormones like cortisol into our bloodstream. This can have a profound affect on our thyroid and female hormone system and throw our bodies completely out of balance. I know any of you who have experienced extreme stress have felt this.

Rapid weight loss will release estrogens that are stored in the fatty tissue, thus raising estrogen levels in the blood. Once this happens the estrogen can have the affect of thickening the lining of the uterus, (endometrium) causing abnormal uterine bleeding.

Insulin resistance is a blood sugar abnormality that not only increases insulin but estrogen and other hormones. The increase in estrogen, as I stated above, can have an affect of thickening the endometrium and causing abnormal bleeding.

Anatomic defects like degenerating fibroids and polyps cause spotting and bleeding and can be easily detected with ultrasound or by endoscopic procedures.

Atrophy is a term used after menopause when the vaginal and uterine tissues are depleted of hormones. They become very pale, thin and easily torn or damaged. The tiny vessels in the vagina and uterine lining become fragile, causing more spotting.

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Postmenopausal Bleeding

Lately, we have been discussing menopause and its associated hormone imbalance, vaginal atrophy, vaginal dryness and irregular bleeding and spotting. This can be really upsetting, as it ruins clothing/panties because it comes when we don't expect it. For those of you who have not had a period for a while, it can be scary, because there is so much information about abnormal or post-menopausal bleeding and cancer.

If you have been in menopause for a while and gone without a period for more than one year, you should not experience any menstrual bleeding. Even a little spotting is not normal after menopause unless you are on hormones.

Hormones can cause the lining of the uterus to thicken, and this can occasionally cause a small period and spotting. No matter what the cause of bleeding, it is important to see your doctor and have it checked out.

There are several health conditions that can cause postmenopausal bleeding, like polyps, which are growths in the uterus that are usually noncancerous. They can develop in the uterus or the cervical canal.

Endometrial atrophy (thinning of the endometrium) is when the endometrium, the tissue that lines the uterus, becomes very thin after menopause because of diminished estrogen levels. This can cause unexpected bleeding.

The opposite is Endometrial hyperplasia, which is a condition where the lining of the uterus becomes thickened - usually as a result of hormone imbalance.

Other bleeding causes besides hormone therapy can be things like uterine or cervical infections or use of certain medications, such as blood thinners.

Transvaginal ultrasound, endometrial biopsy, hysteroscopy, or a D&C (dilation and curette) can be done to help aid diagnosis.

Treatment depends on what is causing the bleeding. The most important thing is, whether you are very young or nearing menopause or even in menopause, find out what is happening and go talk to your doctor about it.

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