Menopause marks the end of periods and all the hassles that come with it. No more worrying about PMS, sanitary pads, tampons, or diva cups. No more fretting that your period will coincide with your once-in-a-lifetime holiday to Europe & no more worrying about contraception. Many women are actually quite thankful when they hit menopause. Yet, one morning you go to the bathroom for your daily ablutions and find blood on your underwear. And here you thought you were done with it for the rest of your life. So why the spotting after menopause? What’s going on here?
If you have not had a period in over a year, you are said to have reached menopause. You should not be getting your period after this point. Spotting after menopause is not normal and you should see your doctor if there is any bleeding or spotting after menopause as it indicates a problem, even though the problem may not be fatal or serious. About 30% of all women will experience spotting after menopause. Let’s take a look at some of the main reasons for spotting after menopause.
Causes of Spotting After Menopause
- In most cases, the reason for spotting after menopause is the thinning of the uterine wall. The lowered levels of estrogen produced by the body cause the tissues on the wall of the uterus to thin out, thus resulting in pieces of it easily breaking away and being expelled from the body through the vagina, which is interpreted as spotting after menopause. This is harmless and requires no treatment.
- One of the symptoms of menopause is the thinning out of the lining of the vagina. There is a significant amount of thinning which can lead to some spotting after menopause. The thinning can also cause the vaginal wall to get weaker, thus allowing pieces of it to break away, say, after sex.
- Hormone replacement therapy (HRT) has also been known to cause spotting after menopause.
- There is a condition called endometrial hyperplasia where the uterine lining grows too much. This can cause spotting after menopause. 10% of all cases of spotting after menopause are caused by endometrial hyperplasia.
- Spotting after menopause may also be a symptom of endometrial cancer or cervical cancer.
- Another reason for spotting after menopause may be the growth of fibroids or polyps in the uterus. These are usually benign (non-cancerous). And generally they shrink after menopause. But in some cases, they grow enough to cause spotting after menopause. This could indicate that they can transform into cancerous cells.
- If you have generally had a very unhealthy diet, then your body has probably been starved for certain nutrients over the years. This lack of nutrition can manifest as spotting after menopause.
Risk Factors of Spotting After Menopause
Your risk for spotting after menopause can be determined by assessing your risk for the conditions that cause spotting after menopause.
- Spotting after menopause seems to affect women who have had more exposure to estrogen than is normal such as with multiple pregnancies or if your periods started at a young age.
- If you have ever had polycystic ovarian syndrome, your risk for spotting after menopause is high as having this condition means you are more likely to develop uterine fibroids or polyps.
- Women who have never had children are at greater risk for spotting after menopause in addition to an increased severity of other menopause symptoms.
- Late menopause also puts you at higher risk for spotting after menopause.
- Hormone replacement therapy or HRT is usually recommended as a remedy for extreme menopausal symptoms. However, since HRT is not a natural part of your body’s development at the time of menopause and since HRT has not yet been thoroughly studied, problems are likely to occur. One of the risks of HRT is spotting after menopause.
- Obese women are more likely to have spotting after menopause.
- Diabetic women are at higher risk for spotting after menopause.
- Any kind of drastic weight loss – such as the type that would occur after gastric bypass surgery or in case of anorexia nervosa or crash dieting – can increase your risk for spotting after menopause.
- Stress has always been known to cause several health problems, and it is no different with spotting after menopause. Any kind of emotional upheaval or underlying stress can raise your risk for spotting after menopause. The highest number of cases of spotting after menopause ever seen were recorded after the 9/11 tragedy.
Treatment for Spotting After Menopause
If you have spotting after menopause, treat it as an emergency until your doctor tells you’re otherwise. Although it will probably be harmless, you can see from some of the more dire causes of spotting after menopause that it could be a serious matter. Call your doctor, schedule an appointment, and note down the nature of your spotting after menopause episode with details like color of bleeding and any other symptoms you might have noticed like pain or dizziness.
Your doctor will do a Pap smear and an endometrial biopsy to evaluate the uterine tissue. An ultrasound may also be performed to check that your fallopian tubes and ovaries are OK. Some other tests that may be used to diagnose spotting after menopause include a Pipelle test where a long instrument called a pipelle is inserted through the vagina and cervix to get a uterine sample, a hysterescopy which involves inserting a thin, long microscope into the uterus through the vagina and cervix, and finally a biopsy or a D&C to collect uterine samples if the other two methods do not work to confirm a diagnosis.
The treatment for spotting after menopause will depend on what the underlying cause for spotting after menopause is. Once the cause of spotting after menopause has been determined, your doctor will probably suggest the following treatments.
- If spotting after menopause is caused by the thinning out of the vagina, your doctor will prescribe vaginal estrogen to treat it. Since the thinning happens because of lowered levels of estrogen, the vaginal estrogen will maintain a balance of estrogen only in the vagina so that the lining regrows and does not cause spotting after menopause.
- Is your spotting after menopause caused by uterine fibroid or polyps? They will have to be removed. If they are left alone, they can act as a potential site for cancerous cells to grow.
- If endometrial hyperplasia is the reason for your spotting after menopause, then it will need to be diagnosed and treated either with surgery or medication as soon as possible as it puts you at high risk of developing endometrial cancer.
- If the diagnosis for your spotting after menopause is endometrial cancer or cervical cancer, then you will have to undergo surgery to remove the infected parts. The whole uterus or cervix may have to be removed. The ovaries and fallopian tubes may also have to be removed as a precaution at your doctor’s discretion.
Preventing Spotting After Menopause
There’s not much your can do to prevent spotting after menopause. As you have seen, some of the causes of spotting after menopause are out of your control. But it is widely accepted that you can lower your risk and perhaps prevent spotting after menopause plus other severe symptoms of menopause by following these preventive measures.
- Be regular with your gynecological checkups. The tests and examinations that are conducted at your visits like papa smears and blood tests can help to assess your risk for spotting after menopause in addition to other health conditions that you are more susceptible to as a menopausal woman such as osteoporosis and heart disease.
- Quit smoking. This is one of the main preventive measures you can take to keep spotting after menopause and a number of severe menopausal symptoms at bay.
- Have a healthy diet. Since lack of nutrition is one the reasons for spotting after menopause, you can reduce your risk for spotting during menopause or prevent it altogether if you have a balanced diet. Eating right can also help you to combat the other menopausal symptom of weight gain around the waist. Say yes to fruits, vegetables, nuts, seeds, whole grains, lentils and lean meat. Avoid processed foods, foods that are high in sugar, fat and simple carbs.
- It is not always possible to get all the nutrition you need from the food you eat. So make sure you take a multivitamin or at least a calcium supplement to prevent spotting after menopause.
- Exercising and generally leading a healthy life can also help to prevent spotting after menopause as well as other menopausal symptoms. Aim for 30 minutes of exercise at least 3 to 4 times a week. This again will help with the extra tire that turns up around the waist after menopause.
- If you are overweight, make an active effort to lose weight to reduce your chances of spotting after menopause.
- However, make sure that your efforts at weight loss are healthy and that you lose the pounds slowly and at a steady pace. A sudden weight loss will just make spotting after menopause more of a probability since it is a risk factor of spotting after menopause.
- Reduce your stress levels. Do whatever it takes to find some peace in your day. If needed, confront stressful situations or people so that you can effectively deal with them and put them behind you. You may want to speak to a counselor if you are particularly stressed out and are having a hard time with your day to day life. We all need a little help sometimes. Managing stress should ideally apply not just to prevent spotting after menopause but throughout your life.