Is Bleeding After Menopause Always Cancer? Doctors Share the Most Common Causes
Don't panic—odds are a far less serious culprit may be to blame
If you’re experiencing postmenopausal bleeding, your mind may go to the worst possible scenario: cancer. While it’s true the “c word” is one potential cause, bleeding after menopause can happen for many other reasons—most of which are far less serious and can be treated effectively. So if you’re wondering “Is bleeding after menopause always cancer?,” we’re happy to report the answer is no. Still, it’s important not to write off this symptom, either. Here we explain what causes bleeding after menopause, how to treat it and when it’s time to check in with your ob-gyn.
Bleeding after menopause explained
Here’s the good news: The majority of women don’t experience vaginal bleeding after menopause. In fact, postmenopausal bleeding only occurs in up to 10 percent of women, according to an article in StatPearls. But if you do happen to experience abnormal bleeding, it’s happening for a reason.
“If you have any amount of bleeding after menopause, you should make an appointment to see your ob-gyn no matter what,” says Mary Farhi, MD, a board certified ob-gyn, certified menopause specialist and an associate professor of obstetrics and gynecology at Rush University System for Health in Chicago, IL. “You don’t want to ignore it or let it go because if it is something concerning, such as endometrial cancer or endometrial hyperplasia (a precancerous condition of the uterine lining), the sooner it’s treated, the better the outcome.”
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So while postmenopausal bleeding doesn’t mean you should immediately press the panic button, you should still get it checked out to determine the underlying cause and best way to treat it.
Common causes of bleeding after menopause
Yes, certain gynecological cancers can cause abnormal bleeding. But they’re not the only culprit. More common causes of postmenopausal bleeding include:
Hormonal changes
Vaginal atrophy, also called genitourinary syndrome of menopause (GSM), and uterine atrophy are two conditions where thinning of the lining occurs due to decreased estrogen levels.
“Estrogen keeps your vaginal tissues moist and elastic, but as it drops, those tissues thin and become more fragile,” says Dr. Farhi. This means they’re more susceptible to tearing, which can result in abnormal bleeding.
The most common cause of postmenopausal bleeding is uterine atrophy, adds Angela Koenig, MD, an ob-gyn at the Dartmouth Hitchcock Medical Center in Lebanon, NH, and an assistant professor of obstetrics and gynecology at Dartmouth College’s Geisel School of Medicine. “The (uterine) lining becomes so thinned out from a lack of estrogen that the arteries that provide blood supply to the uterus can lead to spotting or sometimes slightly heavier bleeding.”
When it comes to vaginal atrophy or GSM, it’s estimated that up to 90 percent of postmenopausal women may experience it, according to a study in Menopause. Having sex could bring this on, says Dr. Koenig. “Vaginal tissue can become more easily irritated from intercourse and cause spontaneous bleeding, especially if you’re not using any lubricant, which is why it’s suggested you should use some,” Dr. Koenig says.
Typical treatments include vaginal moisturizers or lubricants, low-dose vaginal estrogen therapy (such as creams or vaginal rings) or systemic estrogen therapy (such as pills, skin patches, gels or sprays). Your doctor may suggest an OTC product, or give you a prescription.
Endometrial polyps
Polyps, or growths, can attach to the uterus and irritate the surrounding tissue, causing spotting or bleeding. “Endometrial polyps are just an outgrowth of your endometrial glands and are hormonally driven,” explains Dr. Farhi. “They’re pretty common and about 95 percent of them are benign (noncancerous).”
According to the National Institutes of Health, endometrial polyps grow where there’s more estrogen in the body, which explains why women ages 20 to 40 are more likely to have them. However, they can show up in postmenopausal women, particularly those who may be on hormone replacement therapy (HRT). Endometrial polyps account for about 30 percent of postmenopausal bleeding cases, reports the study in StatPearls.
Polyps can be discovered through various exams and tests, including a transvaginal ultrasound, hysteroscopy and/or a special kind of ultrasound called a hysterosonogram. If you’re postmenopausal, your doctor will most likely remove them with a minimally invasive surgery, since the risk of a polyp being cancerous increases with age. In some cases, removal may require a dilation and curettage (D&C), which involves scraping of the uterine tissue.
Uterine fibroids
These are non-cancerous growths that can sometimes bleed, however, they’re more likely to show up in premenopausal and perimenopausal women when their reproductive hormone levels are high. In general, uterine fibroids shouldn’t really be an issue because they shrink postmenopause, says Dr. Farhi.
That said, fibroids in older women can become calcified or hardened, which is part of the natural aging process. In some instances, the edges of a calcified fibroid can irritate the uterine lining and cause spotting or light bleeding.
Women who experience pre- or perimenopausal bleeding due to fibroids may be prescribed medication to shrink the growths. Postmenopausal women who are still having issues with fibroids may have to undergo a surgical procedure to remove them.
When bleeding after menopause may signal cancer
The American Cancer Society estimates that roughly 69,000 new cases of endometrial cancer (a type of uterine cancer) are diagnosed in the U.S. each year. Endometrial cancer is one where cancer cells form in the lining of the uterus. This type of cancer is more common in postmenopausal women, and bleeding is the most common sign of endometrial cancer in women who have gone through menopause. Other symptoms may include pelvic pain and unexplained weight loss.
But Dr. Farhi assures that out of all the women who experience bleeding after menopause, your chances of having endometrial cancer are quite low. In fact, one study in JAMA Internal Medicine found approximately 9 percent of postmenopausal women who experienced bleeding were later diagnosed with endometrial cancer. More positive news? The five-year survival rate is 95 percent when endometrial cancer is caught early.
Doctors will diagnose endometrial cancer based on your symptoms, family history and risk factors as well as through screening tools and procedures such as an ultrasound and endometrial tissue sampling. Treatment options include surgery, chemotherapy and/or radiation therapy, the CDC reports.
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