Menopause Periods: What You Need to Know

TEAM KNIX / MENOPAUSE

Once a woman has gone through menopause, any bleeding is not considered normal. During this stage, women do not have periods and any other bleeding that may occur should be discussed with your doctor.

In this article, we’ll explain why a “menopause period” is considered an oxymoron (i.e. the words contradict each other) and what else might be happening if you experience something like a period when you’re in menopause.

What Is Menopause?

Menopause is when a woman’s menstrual cycle stops permanently. Once in this stage, a woman can no longer become pregnant.

Some people refer to the time leading up to a woman’s last period as menopause, but this is actually called perimenopause. During perimenopause, periods grow infrequent.

Menopause is confirmed 12 months after your last period. Bleeding after this point is called post-menopausal bleeding (PMB) and it is considered abnormal bleeding.

Bleeding After Menopause Isn’t Considered Normal

If you Google "vaginal bleeding after menopause", the search results are likely to send you into a panic.

Please don’t panic. There are many explanations for spotting after menopause. And despite what Dr. Google says, it does not automatically mean you have cancer.

According to this study published by JAMA Internal Medicine, “postmenopausal bleeding occurs in approximately 90% of women with endometrial cancer; however, only 9% of women with postmenopausal bleeding were diagnosed with endometrial cancer.”

So, why the urgency to see a doctor? 

Well, endometrial cancer cannot be screened for, which means it can go undetected if symptoms are ignored. 

So, even though postmenopausal bleeding can occur for a variety of reasons, understanding that it can allow for early detection of endometrial cancer means it’s always worth investigation.


Are You Really in Menopause? What Is Perimenopause

One possible explanation of a period in menopause is that you’re not yet in menopause, but still in perimenopause.

During perimenopause (the stage before menopause), your menstrual cycles and periods gradually come to an end. The average length of perimenopause is four years and, during that time, your period can become irregular and there can be irregular bleeding between periods.

Just as periods maybe started out irregularly when you went through the changes of puberty, so they become irregular as you go through the changes of perimenopause. From a hormonal standpoint, perimenopause is characterized by irregular estrogen and progesterone levels. 

Because of this gradual change, many individuals are unsure when perimenopause ends and menopause begins. In medical terms, menopause is confirmed 12 months after women have their last period.

Symptoms of Perimenopause Periods

During perimenopause, women may notice changes to your menstrual period. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of your hormone levels.

Many women may experience all of these changes, others will just experience some. Below are some of the possibilities. If it reads like perimenopause is a bit of a rollercoaster ride, that’s not surprising - many feel that way!

Less Frequent or Irregular Periods

Because you will start ovulating less as you approach menopause, your entire menstrual cycle may not run like clockwork anymore. This can mean less frequent and irregular periods, including skipped months.

These infrequencies will increase as perimenopause progresses. This is part of the reason why doctors wait a full 12 months before confirming that you have passed into menopause.


Spotting or Lighter Periods

Due to fluctuating hormones, you might experience very light periods or spotting between periods.  Considering periods become irregular at this stage, it can be easy to mistake the stage you’re in for menopause. It’s worth tracking your periods and any irregular bleeding in a journal or app.

Longer Periods or Heavy Bleeding

As periods become infrequent, sometimes the lining of the uterus has more time to become thicker. This means that when your uterus sheds its lining, there will be a longer and heavier period. 

Other symptoms of menopause and perimenopause include:

  • Hot flashes
  • Vaginal atrophy
  • Accelerated skin aging
  • Vaginal dryness
  • Bone loss
  • Mood swings

Note: Even as your menstrual cycle becomes less regular it is important to know that you’re still ovulating (even if it’s infrequent).  If you want to avoid pregnancy, use birth control .


Bleeding After Menopause: What Could Cause it?

If you are confirmed to be in menopause (i.e. you haven’t had a period for one year) and you experience bleeding there are a few different explanations.

While we strongly urge you to see a doctor to understand these symptoms, don’t panic. Not all explanations are serious. But you will want to have the more serious explanations ruled out quickly.

Here are some of the most common explanations:

Vaginal Atrophy (Thinning Tissue in the Vagina)

Vaginal or endometrial atrophy occurs in some women. The body produces less estrogen after menopause, which can lead to the thinning, drying and inflammation of the vaginal walls.


According to the Mayo Clinic, “Because the condition causes both vaginal and urinary symptoms, doctors use the term "genitourinary syndrome of menopause (GSM)" to describe vaginal atrophy and its accompanying symptoms.” You may also notice brown spotting or other bleeding.


Endometrial Atrophy or Endometrial Hyperplasia

The endometrium is tissue that lines your uterus. Fluctuating or irregular hormone levels during menopause can affect this tissue in two possible ways:

  1. Thinning of the Endometrium (Atrophy): According to the American College of Obstetricians and Gynaecologists, low estrogen levels can cause the tissue of the endometrium (or uterine lining) to thin, which can result in some bleeding.
  2. Thickening of the Endometrium (Hyperplasia): The uterine lining becomes thickened, most often due to increased estrogen and decreased progesterone. This condition can sometimes lead to cancer, though it may be prevented if detected early (source). Early indicators include unusual bleeding.

Polyps

Polyps are usually benign, noncancerous growths in the uterus, cervical canal, or on your cervix. While they are not usually harmful, they can grow quite large, which can cause discomfort. Women with polyps can experience bleeding. 


Infection

Sexually Transmitted Diseases (STIs) and other infections like Pelvic Inflammatory Disease (PID) can all be explanations of spotting. 

Most infections are treatable. But infections can become more serious if ignored, so it’s worth getting routinely tested for STIs.


Strenuous Exercise

While exercise is essential for good all-round health, strenuous exercise after menopause can cause some bleeding (or perhaps brown spotting). Generally, this is not something to be concerned about. But if it happens for the first time, it’s good to seek reassurance from your doctor.

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy is a form of hormone therapy used to treat symptoms associated with female menopause, including:

  • Hot flashes
  • Vaginal atrophy
  • Accelerated skin aging
  • Vaginal dryness
  • Bone loss

Side effects of HRT medications include unusual bleeding, though this is considered a less common side effect. More information about HRT can be found on the Mayo Clinic.

Other Medications

In addition to HRT, a side effect of other medications can include unusual bleeding. For example blood thinners may cause unusual postmenopausal spotting.

If you are on any medications you think might cause spotting, discuss this side effect with your doctor. She will help you determine if there’s any additional risk.

Cervical or Uterine Cancer

According to the Dana-Farber Cancer Institute, spotting in post-menopausal women can, in some cases, be an early sign of cancer and should always be investigated further.

“Any post-menopausal bleeding should warrant a visit to a gynecologist,” says Ursula Matulonis, MD, chief of the Division of Gynecologic Oncology at Dana-Farber Cancer Institute.


Time to Seek Medical Advice: What to Expect…

In general, any bleeding post-menopause is worth a trip to your health care provider. Even if the spotting is minor, it’s worth eliminating the (slight) risk that it could be an early indicator of cancer. 

But don’t take this caution as a reason to panic. Odds are, there’s another explanation for your bleeding. And your health care provider may be able to help you address the symptoms.