Dr Sarah Jarvis
Taking care after menopause
There are a few pluses to getting older, and not having regular monthly bleeding is one of the most welcome. Four in five women get symptoms around the menopause which can be debilitating, but what causes bleeding after the menopause and when should you worry?
To have postmenopausal bleeding, you have to have gone through the menopause – and working that out isn’t as straightforward as you might think. The word menopause comes from the Latin for end of (pause) monthly cycles (mensis). You’ve gone through the menopause once you’ve had your last period. But as every woman knows, periods become more irregular around menopause. So doctors say th hat you’ve stopped ha aving periods once you y haven’t had one for 1 2 months.
Regular monthly periods p are down to natural n ebb and flow of female f hormones. The closer c you get to the menopause, the more unpredictable these hormone changes become. That’s because your ovaries stop producing an egg every month reliably. This can lead to longer or shorter bleeds, irregular periods and heavier or lighter bleeding. More or less frequent periods in the
4-5 years leading up to the menopause are nothing to worry about. However, if you bleed between periods, after you make love, or you regularly flood through both pad and tampon, see your GP.
If you’re taking HRT, you’re likely to continue to have periods. If you’ve had a hysterectomy, you can take oestrogen-only HRT. But if you still have a womb, taking oestrogen on its own increases the risk of cancer of the womb.
That’s why women who haven’t had a hysterectomy are given combined HRT, which includes oestrogen and progestogen. Combined HRT is two main types – monthly cyclical HRT has oestrogen every day with progestogen added for 14 out of 28 days. This results in a bleed every 28 days. It isn’t strictly a period, but that’s what it looks like.
Combined continuous HRT has a low dose of progestogen every day along with the oestrogen. Some women get irregular bleeding in the first few months, but it doesn’t cause periods. If you are still having bleeding after
6 months on combined continuous HRT, or if you start bleeding after more than a few months without bleeding, see your doctor.
If you’re not taking HRT, you shouldn’t have any vaginal bleeding after the menopause. If you do, you should always see your GP. At least 90% of the time, there’s no serious cause, and it can often be treated quickly.
The most common cause is thinning of the walls of the vagina, as oestrogen (which plumps up the delicate walls of the vagina) falls after the menopause. Bleeding may start or be worse after sex, and you may have vaginal soreness. It can be treated with topical oestrogen in the form of cream, pessary or an oestrogen-containing ring placed in the vagina.
Cervical cancer can cause abnormal bleeding. While it can happen after menopause, it’s one of the few cancers that gets less common with age.
Endometrial or cervical
polyps are fleshy outgrowths from the lining of the womb or the cervix which can cause bleeding. They’re found on ultrasound, easily removed with a minor procedure and rarely cancerous.
Cancer of the womb lining is always going to be your doctor’s concern if you bleed after the menopause.
Although it obviously sounds worrying and must be treated promptly, treatment is usually successful if caught early.
And 9 in 10 women who have bleeding after the menopause don’t have cancer. Your doctor will arrange an ultrasound scan which may rule it out immediately – otherwise you may need surgery and possible radiotherapy (X-ray treatment).
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