Post-menopausal bleeding (PMB) or spotting, is a medical condition in which, women in their mid 40s and early 50s have sudden instances of bleeding, usually after ten or twelve months of menopause. This condition should not be taken casually, and an immediate appointment with a gynaecologist is recommended.
Bleeding, even if minimal is not a natural phenomenon for women in this age and must be investigated immediately, as it may be caused by some other serious health factor requiring medical attention. Post-menopausal spotting as such can be caused by several health factors. Some of the common ones are given here:
Affecting Post Menopausal Spotting
One of the key factors that lead to PMB, re-balancing the level of hormones in the body causes bleeding. The hormone replacement therapy itself, or any alterations made to this therapy can cause uncalled for bleeding. Any form of progesterone therapy, can cause spotting and bleeding in the uterus, especially if there existed any kind of tissues build-up tissues.
The therapy is not harmful as it only ensures that the previously existing tissues are shed away. However, if the bleeding is prolonged it must be taken up with a gynaecologist.
Research shows that most cases of PMB are a result of endometrial atrophy. Post menopause, there is the possibility of the estrogen level decreasing, which in turn causes the womb linings to naturally thin down. This is another cause of bleeding. To determine if this is the cause of bleeding, proper evaluation has to be conducted of the endometrium. This evaluation will ensure that accidentally uterine cancer is not diagnosed as the cause of bleeding.
These are not growths that are tantamount to cancer, though they are usually seen in cervices and uterus, which results in the bleeding. Unlike fibroids, polyps occupy smaller areas which results in light bleeding.
There are mainly two dominant forms of cervical polyps- Endocervical polyps, which appear as cherry-red tumours and can be upto 3cm in size; and Ectocervical polyps, which usually do not cause bleeding. In cases of multiple polyps an operation is the suggested way out. Research shows that for women having PMB roughly 2-12% have cervical polyps formed.
Research in this field shows that a mere 5-10% women have PMB caused by this factor. If there is a condition in the body by which there is an excess of estrogen while the progesterone level is much lower, it will result in the thickening of the uterus lining. This is the case of endometrial hyperplasia that causes the bleeding.
Endometrial hyperplasia can be classified as simple and complex. In simple hyperplasia there is an increase in the stroma ratio in glands. Hormone replacement therapy can also lead to endometrial hyperplasia. Endometrial hyperplasia is more common in women suffering from obesity. In cases of some women, this can also lead to uterine cancer.
Also known as uterine cancer, it ranks fourth, for the common form of cancer, women are prone to and tops the list for the form of cancer in the female genital parts. This itself explains the bleeding caused post menopause. Strangely enough, it has been seen that the modern lifestyle women are accustomed to, is one of the major factors causing uterine cancer.
As such, this form of cancer is more frequently seen in urban women. Some factors that accelerate uterine cancer are: increased levels of estrogen, obesity, diabetes, tamoxifen and hypertension. Almost 10% of all women suffer PMB because of uterine cancer. In this case, treatment happens in the form of surgery or chemotherapy, though it is dependent on the medical stage of the patient.