There are various causes of bleeding during menopause, including normal menstruation and ovulation, hormonal replacement, and cysts or polyps. Uterine cancer is a rarer cause of bleeding, especially after menopause, but it happens frequently enough to consider it as a possibility. On occasion, lack of hormonal replacement may also lead to light bleeding during menopause, although it is most common after the change of life has taken place.
Menopause is the cessation of menstruation, meaning a woman no longer ovulates and is not capable of getting pregnant naturally. This generally occurs sometime near the beginning of the second half of life, most commonly in the late forties or early fifties. All women go through this change at some point, and most experience some irregular bleeding during menopause or shortly thereafter.
The most common cause of bleeding during menopause is normal menstruation. Although periods may become irregular and more sporadic in nature, menopausal women often still ovulate as they go through the changes which occur during this time. Some experience more frequent ovulation due to hormonal surges, while others may skip several months and then sporadically have a menstrual period. Menopause is said to be complete when a woman has gone longer than six months between menses, although some doctors place the benchmark at one year.
Using hormone replacement therapy may also cause bleeding during menopause. Most therapies contain estrogen, which causes the lining of the uterus to thicken in preparation for a fertilized egg. Although menopausal women do not always ovulate, the lining still develops in response to estrogen and then breaks down and exits through the vagina. Bleeding in this situation may be very light or very heavy, depending on how sensitive each individual’s body is to hormonal therapies.
More common in postmenopausal women is bleeding associated with no uterine lining. When estrogen therapies are not given, sometimes the uterine wall can shrivel and atrophy, and blood vessels may burst and cause light spotting or bleeding. While this most often occurs after a woman has been without menstruation for a long time, it sometimes may occur and cause bleeding during menopause.
In some instances cysts, polyps, or tumors may cause bleeding during menopause that is accompanied by abdominal pain in many cases. It may become very heavy or light. Tumors may also result in tenderness in the abdomen, bloating around the middle, and fatigue. Cysts and polyps often clear up on their own and require no treatment. Larger cysts and cancers often result in a partial or full hysterectomy.
