Why am I bleeding after menopause?

Bleeding after menopause is quite common amongst postmenopausal women, and is rarely a cause for concern. In fact, in about 90 percent of cases, a specific cause for bleeding after menopause goes undiagnosed, as they are not deemed medically significant. However, in rare cases postmenopausal bleeding can be a sign of something more serious.

The majority of the time postmenopausal bleeding is caused by either: atrophic vaginitis (inflammation and thinning of the lining of your vagina), polyps (growths in the cervix or uterus), which are usually not cancerous, and endometrial hyperplasia (thickened endometrium), often due to hormone replacement therapy (HRT), or abnormalities in the cervix or uterus.

All of these conditions are generally not serious, and can be treated fairly easily. It is important to note around 10 percent of postmenopausal bleeding cases may be linked to cervical or uterine cancer, so it is imperative you get your symptoms investigated.

Inflammation (atrophic vaginitis)

Throughout the reproductive years, the tissue lining inside the vagina (the 'epithelium') thickens due to adequate levels of oestrogen, which in turn this produces glycogen cells. As the glycogen-rich cells die off, they provide by-products that feed a type of lactobacillus bacteria called Döderlein's bacilli, which produce lactic acid, and maintain an acidic pH in the vagina. As oestrogen levels decrease after menopause, it causes a number of changes in the vagina.

For one, the vaginal mucosa becomes thinner, drier, and fragile, and loses its elasticity, which means that the vaginal epithelium may become inflamed. This may cause urinary issues such as urinary tract infections (UTIs), or infections of the vagina, due to changes in its pH and flora. The decrease in oestrogen may also affect peri-urethral tissues, which could contribute to pelvic laxity (prolapse of the pelvic floor) and stress incontinence (leaking of urine).

Polyps

Uterine growths (polyps) can attach to the inner wall of the uterus, and extend into the uterine cavity. An overgrowth of cells in the endometrium (lining of the uterus) can lead to the formation of uterine polyps, which are also known as endometrial polyps. These polyps are usually benign (non-cancerous), although some can go onto become cancerous (precancerous). The size of a uterine polyp may range from a few millimetres to several centimetres, or even larger in some cases.

Endometrial hyperplasia

Endometrial hyperplasia is an abnormal proliferation (rapid reproduction) of the cells of the endometrium (lining of the womb). It is a risk factor for the development of endometrial carcinoma (cancer), however is not cancerous in itself.

Endometrial hyperplasia is often due to imbalance between oestrogen and progesterone. These changes may happen due to hormonal changes during menopause, because of drug treatment such as oestrogen only hormone replacement therapy (HRT) after a hysterectomy, or taking tamoxifen for breast cancer treatment.

Uterine cancer

Uterine cancer is the malignant (abnormal) growth of the cells that comprise uterine tissue. Common signs and symptoms of uterine cancer are abnormal vaginal bleeding or discharge, pain with urination and sex, or pelvic pain.

Cervical cancer

Cervical cancer, although not as common as the other conditions above, could in some cases be the cause of bleeding after menopause. Most cases are caused by the human papillomavirus (HPV), a common virus spread during sex. Cervical cancer often has no symptoms in its early stages. The most common symptom however is abnormal vaginal bleeding. This doesn't mean that you definitely have cervical cancer, but that you should investigate further with our GP to rule out anything serious.

How can nutrition help?

If you are experiencing postmenopausal bleeding, including foods high in iron into your diet may help to manage your symptoms, as they introduce risks of becoming anaemic, or experiencing symptoms such as tiredness and dizziness. For instance, you might eat more red meat, organ meats, green leafy vegetables, beans, and lentils.

A diet high in antioxidants such as vitamin A, C, E, and selenium as well as zinc, vitamin D, and omega 3 can also be beneficial in the prevention of cancer or general inflammation in the body.

Supplements that may be beneficial

It may also be beneficial to take an iron supplement, as loss of blood may put you at an increased risk of anaemia.

A general multivitamin and mineral, fish oil and probiotic supplement may also be good to take for optimal immunity, whilst probiotics also help to balance the beneficial flora of the gut and vagina.

For more advice and information about the menopause, select Menopause from the Your health menu.