Causes of Post menopausal bleeding

Bleeding in menopause can be without any obvious cause or it may be due to some serious conditions like some urogenital cancers.

Post menopausal bleeding is one of the most common condition of an elderly woman above 45 years visiting a gynecologist.

In majority of cases the cause of postmenopausal bleeding is mild atrophic vagintis. Atrophic vaginitis is the inflammation of the vagina in menopausal women due to the lack of estrogen hormone which lead to thinning of vaginal wall and making prone to infection and inflammation. Atrophic vaginitis accounts for 60 to 80% of post menopausal bleeding.

Another important cause of bleeding in a menopause women use of estrogen, in menopause sometimes estrogen is used either orally to combat post menopausal symptoms like hot flushes, anxiety or as topically for atrophic vaginitis. Estrogen may lead to withdrawal bleeding in menopausal women. Almost 15 to 20% cases of post menopausal bleeding may be due to estrogen use.

The most dangerous cause of post menopausal bleeding which constitues about 10 to 20% od cases is either due to endometrial hyperplasia or endometrial cancer. Endometrial hyperplasia is excessive growth of uterine lining called endometrium leading to shedding and thus causing bleeding.

Endometrial cancer is the most concerned cause of postmenopausal bleeding, this is the reason why a thorough investigation is required in post menopausal bleeding especially in women having other risk factor associated with endometrial cancer like early menarche and late menopause, diabetes, nulliparity etc.

Post menopausal bleeding can also occur due to endometrial or cervical polyp which accounts for 2 to 8% of cases of postmenopausal bleeding. Polyp is a benign tumor connected with a stalk. This is not life threatening but bleeding may be profuse sometimes.

In about one tenth of cases there is no obvious reason for post menopausal bleeding and it may stop without any intervention.

There are few conditions when the bleeding is not actually menopausal bleeding but mimic the condition. Sometimes a biological reason may be the cause for cessation of menstruation for more than 12 months and when the reason is cured normal menstruation can occur, this may be confused as menopausal bleeding.

Hematuria or bleeding from rectum can be confused as menopausal bleeding and proper investigation and clinical history differentiate the condition.