Is Bleeding After Menopause Always Cancer?

Is bleeding after menopause always cancer? Not necessarily. So, what are the other potential causes to explore?

A variety of issues can cause you to bleed after menopause, such as an active infection, ongoing hormone therapy, or the use of certain medications like blood thinners. Some of the most common causes include the following:

Atrophic Vaginitis

Atrophic vaginitis refers to a condition where the vaginal skin becomes delicate, thin, and prone to reputing and bleeding. This phenomenon is widespread in postmenopausal women as their estrogen levels begin to decline. [3]

Estrogen is a key sexual hormone that supports the vaginal health and skin integrity, and as its levels plummet after menopause, the vaginal skin thins and gets damaged and inflamed very easily. The damage can extend to the womb, causing bleeding to sometimes occur from the inside.

Finding the site of bleed is not always possible in a postmenopausal woman who is actively bleeding. Hence, atrophic vaginitis remains a diagnosis of exclusion and is considered when a doctor has ruled out all other possibilities.

Endometrial hyperplasia

Endometrial hyperplasia refers to a condition in which the lining of the uterus grows faster than its normal pace. This fast-paced, uncontrolled growth causes the lining to thicken and bleed occasionally. Endometrial hyperplasia is typically benign and has little risk of becoming malignant.

However, in some cases, the hyperplastic cells may transform and become abnormal, increasing the risk of cancer.

Uterine Polyps

Polyps are abnormal growths that occur when the uterus lining thickens. As the peristaltic movement happens in the uterus, it pulls on the thickened area, causing the skin to outpouch in the form of a polyp.

Polyps are of different sizes, and despite being generally benign, they can sometimes bleed. [4] Their occurrence in postmenopausal women is quite common due to their higher tendency to develop endometrial hyperplasia.

Ovarian Cysts

The ovary can develop benign cysts that may bleed from time to time in postmenopausal women. These cysts are fortunately detectable through a pelvic ultrasound and can be treated.

Uterine Cancer

Also known as endometrial cancer, uterine cancer is the most common type of cancer presenting as postmenopausal bleeding. Even a one-off bleed following menopause is enough to indicate this cancer, but it typically presents as repeated bleeding episodes.

Fortunately, most cases of uterine cancers are caught early on as they immediately cause bleeding or spotting during menopause. Treatment is also available depending on how early it is seen and whether the cancer is localized or spread to other body parts.

Fibroids

These uterine muscle overgrowths can be another cause of postmenopausal bleeding. Fibroids are typically asymptomatic and may go unnoticed for years but can bleed after menopause, especially if you are on hormone replacement therapy. Other accompanying symptoms that point towards fibroids as a potential cause of postmenopausal bleed include lower back pain, pelvic pressure, and constipation. 

Cervical Cancer

Cancer of the cervix, the part of the female reproductive system immediately above the vagina, is one of the most common types of cancers in females and can often present as postmenopausal bleeding. [5] It is possible to catch it during the early stages through regular smear tests, and the cure rate is generally high.

Cancer of the Ovaries

Certain types of ovarian cancers can cause bleeding in postmenopausal women. These cancers often secrete estrogen, which causes destabilization of the delicate endometrium and causes it to bleed. If caught early, ovarian cancer is treatable, but once it has progressed, it becomes more difficult to cure.

As mentioned above, bleeding after menopause is not always cancer but warrants an in-depth assessment to rule it out. Moreover, certain risk factors may also predispose you to cancer, such as:

• Your age bracket (cancer is most common in ages 60 to 70)
• Late menopause (typically after 55 years)
• Early menarche (before 12 years) [6]
• No history of childbirth
• A history of endometrial hyperplasia
• Family history of uterine, ovarian, or colon cancer
• Taking estrogen therapy
• A history of irregular menstrual cycle
• Obesity
• Taking certain drugs (such as tamoxifen)
• Family history of Lynch syndrome
• Radiation exposure to the pelvic area