The female body continually undergoes hormonal changes that control the female organs. A complex system of hormonal fluctuations controls the menstrual cycle. Menopause is the cessation of fertility and menstruation. Women who have gone through menopause are postmenopausal. Sometimes, women experience vaginal bleeding after menopause. This can result from many benign conditions, although cancer is a possibility.
Uterine Fibroid Tumor
Fibroids are uterine muscle tumors. They are dense muscle masses that may have calcifications. Some fibroids are within the muscular wall of the uterus. Some are around the periphery of the uterus and can hang off of the uterus much like a dog ear. These are pedunculated fibroids. Others either abut the endometrial lining or grow within the endometrium, the inner lining of the uterus, and they are most likely to cause spotting after menopause, or even heavy bleeding with cramps.
Polyps
The endometrium may become thickened and irregular in shape. This can be caused by endometrial polyps. Polyps are often benign masses. Due to their location within the endometrium, they are likely to cause bleeding or spotting. Polyps may be suspected if a thickened endometrium is visualized on a pelvic sonogram, but a hysterosonogram can differentiate a polyp from endometrial hyperplasia.
Cancer
Endometrial cancer can cause mild to significant thickening of the endometrial lining. Bleeding is likely and abdominal pain may be a symptom. Pelvic ultrasound is used to assess the endometrium. The thickness of the endometrium should measure less than 8 millimeters. It may have an irregular shape and may appear lumpy. It may have areas of increased echoes (brighter areas on ultrasound) and cystic areas (black areas on ultrasound, fluid collections).
Hormonal Changes
The menstrual cycle is controlled by the rise and fall of various hormones. Some hormones cause the endometrial lining to thicken, while others cause the uterus to expel the endometrium, a process called menstruation. Some postmenopausal women may experience hormonal changes that may lead to vaginal bleeding. Hormone replacement therapy may cause vaginal bleeding. This may occur in the presence of cancer, polyps, or fibroids, but it can also be an isolated case.
Weight Loss
Estrogen is stored in fat tissue. Women who have more fat tissue have more estrogen. Rapid weight loss can cause the release of high amounts of estrogen. This can cause the endometrium to thicken. When estrogen levels finally stabilize, bleeding may occur as the endometrium returns to its normal thickness. Rapid weight loss can result from excessive exercise and diet, surgery, and various medical conditions.
There are many explanations for postmenopausal bleeding, and many of them are not serious; however, the presence of postmenopausal bleeding warrants an appointment with a physician. Most conditions can be treated.
Reference
Hagen-Ansert, Sandra L. Textbook of Diagnostic Ultrasonography. Mosby, 2001.
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