In the early stages of perimenopause, when a woman experiences the first symptoms of the transition from the fertile years to menopause, she may experience light bleeding even if her periods have already stopped. The bleeding is usually brown, but may sometimes be bright red. This is known as “menopausal bleeding” and may occur within 12 months after the last menstrual period.
When should you be concerned?
It is important to note that this bleeding is not considered normal if it occurs more than 12 months after the last menstrual period, when a woman has technically entered menopause. In such cases, it is important to consult a gynecologist to rule out serious conditions. Excessive bleeding during perimenopause, both in terms of duration and volume, also requires careful evaluation.
What are the causes of bleeding during menopause?
Among the most common causes of bleeding during menopause, vulvovaginal atrophy should be mentioned first. Statistics indicate that it affects approximately 50% of patients over the age of 50. This condition is also known as atrophic vaginitis. Symptoms include vaginal dryness, pain during sexual intercourse, burning, and itching. Bleeding may occur immediately after sex or within a few days afterward due to reduced lubrication and tissue fragility.
Hormone therapy, which is often prescribed to relieve menopausal symptoms, may also be associated with bleeding as a side effect. This can happen, especially if the hormone dose is too high or if hormone absorption is impaired.
It should be noted that spotting during menopause or perimenopause may sometimes be a sign of benign conditions, such as polyps or endometrial hyperplasia.
Endometrial polyps: These are growths that develop in the endometrium, the inner lining of the uterus. These polyps occur more frequently in women during the premenopausal period and less frequently during menopause. Endometrial polyps are diagnosed during a gynecological examination using an ultrasound scan of the pelvic organs.
Endometrial hyperplasia: This is a group of functional conditions that lead to the formation of glands with abnormal shapes and sizes. Risk factors for developing endometrial hyperplasia include: · Age: after approximately 45 years of age, the incidence of endometrial hyperplasia increases due to hormonal imbalance caused by irregular ovarian activity; · Obesity and diabetes; · Prolonged exposure to estrogen therapy, especially when it is not balanced with progestins.
Endometrial lesions can be detected using hysteroscopy. This minimally invasive method is considered the most suitable for directly examining the uterine cavity. During hysteroscopy, a thin metal tube approximately 4 millimeters in diameter is inserted through the cervix, allowing the doctor to directly examine the uterine cavity and the openings of the fallopian tubes and, if necessary, perform a biopsy.
The specialists at Boholyuby Medical Center remind patients that a timely gynecological examination can lead to an accurate diagnosis at an early stage. This is extremely important because endometrial hyperplasia is considered to have the potential to progress to cancer.
More serious conditions associated with abnormal bleeding may include precancerous and cancerous lesions of the cervix. These are generally caused by certain strains of human papillomavirus and are detected through routine screening, such as cervical cytology and HPV testing. If the results raise suspicion, a biopsy may be necessary. When diagnosed early, these conditions can be treated using various surgical methods, including minimally invasive procedures.
Many women feel embarrassed to talk about bleeding after menopause and keep this symptom to themselves. This is dangerous. Informing your gynecologist about any discomfort or asking questions about unusual sensations in the intimate area demonstrates that you care about yourself and your body. A routine examination may be enough to reassure you and help select the right and most appropriate treatment.
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