Many women experience heavy bleeding at some point, often in the years before menopause and typically due to the effects of estrogen dominance. And most women have been told that any bleeding after menopause is abnormal.
Yet, did you know that postmenopausal bleeding is often not caused by cancer or any other abnormality? In fact, there can be any number of causes for this, including taking a new supplement, starting a new exercise routine, and even falling in love!
In this blog, I tell you what’s really happening when you have bleeding after menopause and when you should seek medical advice.
7 Conditions That Can Cause Bleeding after Menopause
Women in our culture have been conditioned to believe that bleeding after menopause is a sign of cancer. That’s why bleeding after menopause is a common reason for women to seek medical advice.
If you are postmenopausal and have bleeding that is not normal for you, be sure to get checked by your health care provider. While bleeding can be a symptom of uterine, vaginal, or cervical cancer, a vast majority of cases are not cancer.
Here are 7 common conditions that may cause bleeding after menopause:
- Uterine polyps. Polyps are growths that can occur inside your uterus. They can also grow in the cervix and sometimes the vagina. Polyps usually vary in size from a few millimeters to several centimeters. Typically, polyps are not cancerous, but they can cause bleeding that can range from light spotting to a heavy flow like a period. They are also a common cause of bleeding after sex. Uterine polyps can increase in size and number due to high estrogen levels. Other risk factors for developing uterine polyps include high blood pressure, obesity, and taking tamoxifen.
- Fibroids. Uterine fibroids are more common during perimenopause, but you can experience symptoms related to fibroids during menopause. Fibroids are the most common benign tumors. It has been my experience that even small fibroids if located submucosally—just underneath the endometrial lining of the uterus—can cause abnormal bleeding. Some risk factors that increase your chance of fibroids that cause bleeding include high blood pressure, inadequate vitamin D levels, obesity, chronic stress, being African American, and having a family history of fibroids. Like uterine polyps, fibroids are estrogen-sensitive and are also associated with low progesterone, too much prostaglandin F2-alpha, and frequently too much insulin. If you experience bleeding, menstrual-like cramping, fullness in the lower belly, low back pain, frequent urination or incontinence, or painful intercourse due to fibroids, you may want to look into treatment options.
- Endometrial hyperplasia. Endometrial hyperplasia is when the uterine lining becomes thick. Again, after menopause, this can be due to having too much estrogen and too little progesterone. As a result, the endometrium grows thicker and can bleed. Risk factors can include obesity, diabetes, polycystic ovarian syndrome (PCOS), history of anovulation, and certain estrogen-mimicking medications. In many cases, endometrial hyperplasia can be treated with natural progesterone, which will help the thickened lining shed itself. Other common treatments include synthetic progesterone (progestins), birth control pills, D&C (dilation and curettage), or endometrial ablation.
- Vaginal atrophy. Vaginal atrophy is when the tissues in the vagina become thin, dry, and inflamed. It can result from too low levels of estrogen, typically caused by menopause. However, vaginal atrophy may also occur due to estrogen-blocking medications such as tamoxifen and aromatase inhibitors, luteinizing hormone-releasing hormone (LHRH) agonists such as Lupron and gonadotropin-releasing hormone (GnRH) agonists such as Synarel. A sign that bleeding may be due to vaginal atrophy is that it commonly occurs after sex. Vaginal atrophy is easily treated with vaginal moisturizers and lubricants, and with low-dose vaginal estrogen. Plant-based products, such as Pueraria mirifica, can be game-changers for symptoms of vaginal atrophy.
- Hormone replacement therapy. One of the more common side effects of hormone replacement therapy is breakthrough bleeding. If you are taking hormones and develop breakthrough bleeding, you may want to see your health care practitioner. You can also take a DUTCH test (Dried Urine Test for Comprehensive Hormones) to see where things stand with your hormones.
- Medications. In addition to hormones, estrogen-blocking medications, and LHRH and GnRH agonists, other medications can cause bleeding in postmenopausal women, including blood thinners. Be sure to discuss your medications with your health care provider.
- Other. Other causes of postmenopausal bleeding include sexually transmitted diseases, bleeding that originates in the rectum or urinary tract, clotting disorders such as Von Willebrand disease, infections of the uterus, thyroid disorders, and trauma to the pelvis. Again, be sure to check with your health care provider to rule out any abnormalities.
Tests You May Need to Get a Diagnosis
If you are experiencing bleeding after menopause, your health care provider will probably recommend doing some tests to look for the cause. The tests your health care provider recommends in order to identify the physical causes of bleeding may depend on several factors, including your age, medical history, and the symptoms you are experiencing. Some of these tests may include:
- Transvaginal ultrasound: Using an ultrasound probe that is inserted into the vagina, your health care provider will look at your uterus, vagina, cervix, Fallopian tubes, ovaries, and bladder to identify anything that may be causing bleeding. It is a safe and painless test.
- Sonohysterography: A sonohysterography uses fluid that is injected through the vagina into the uterus so that your health care provider can see the lining of your uterus. Once the fluid is injected, your provider will use ultrasound. The fluid can help your provider get a better picture than when using ultrasound alone.
- Hysteroscopy: During a hysteroscopy, a thin, lighted tube with a camera on the end is inserted into your vagina and allows your provider to examine your cervix and uterus to identify any abnormal growths, such as polyps.
- Endometrial biopsy: Your provider will insert a small, thin tube into your vagina and through your cervix to take a sample of the tissue lining your uterus. The tissue is then tested for the presence of abnormal cells.
- Dilation and curettage (D&C): This procedure involves dilating or widening the cervix to obtain a larger tissue sample by scraping the lining of the uterus. Your provider may also use a hysteroscope to see inside your uterus to identify any potential growths.
While most of these tests can be performed at a doctor’s office, others, such as a D&C, are often performed at a hospital or surgery center.
5 Lifestyle Changes to Create Pelvic Health at Any Age
In my #1 New York Times bestseller The Wisdom of Menopause, I laid out my master program for creating pelvic health. It is an effective program for addressing a host of pelvic disorders, including hormonal imbalance and bleeding.
Here are 5 components of that program that can help you create pelvic health:
- Follow a hormone-balancing diet. Eat a diet that is low in high-glycemic carbohydrates and adequate in protein and healthy fats. This will help balance insulin and cortisol levels and improve your overall hormonal health.
- Eliminate dairy and red meat. Both dairy and red meat are high in an eicosanoid precursor known as arachidonic acid and can cause inflammation in susceptible individuals. I recommend eliminating all conventionally produced dairy foods (even low-fat ones) and red meat for at least 3 months. These foods might be fine for you, but you’ll want to experiment to see if you feel better after not having them for a period of time.
- Take nutritional supplements. Supporting your body with the right nutritional supplements can help combat cellular damage due to free radicals, which is one of the key underlying mechanisms in chronic conditions and many cancers. You may want to include some or all of the following: magnesium, omega-3 fatty acids, vitamin C, B complex, and vitamins A and E. In addition, higher vitamin D levels are associated with a lower risk of pelvic floor disorders.
- Take a probiotic. Probiotics can recolonize your gut with “friendly” bacteria and can help in both preventing and treating infections of the genitourinary tract.
- Try acupuncture and herbs. Acupuncture can often alleviate pelvic pain. Yunnan Baiyao is a traditional Chinese medicine used to treat heavy bleeding. Pueraria mirifica is a plant used in traditional Thai medicine to help balance hormones and bring your body into harmony.
Is an Energy Vampire Draining Your Life’s Blood?
While targeted treatments and lifestyle changes may be your first steps toward healing from abnormal bleeding, you also need to address the other factors at play, including your emotions, thoughts, beliefs, and relationships. That’s because, in my professional and personal experiences, bleeding is always indicative of something that is going on in your life.
Whenever a woman tells me she is experiencing abnormal bleeding, I always ask if she is leaking her life’s blood into a dead-end job or relationship that doesn’t fully meet her needs.
When you give more than you receive on a regular basis, you are most likely in an energy vampire relationship.
I have experienced bleeding that was not normal for me on several occasions—most recently when I was visiting a Buddhist monastery in Thailand. I had bleeding very much like a period brought on by the fact that I was attempting to conform to a code of conduct that included living in complete silence, waking at dawn, eating only two meals per day (one at 6 AM and the other no later than midday), standing in line to wash our plates, and meditating 4 to 5 hours per day. None of this was bad in any way. People travel great distances for this kind of authentic spiritual experience. But truth be told, it didn’t suit me.
The renowned medical intuitive Caroline Myss teaches that blood is family—always. So, when you experience abnormal bleeding of any kind, think family lineage or legacy. While I am not blaming anyone, my body associated my experience at the monastery with the discomfort and deprivation I endured in my childhood during all my family’s forced march hikes and ski trips, which I did not enjoy. Realizing that the bleeding was a sign, I stopped going to the silent lunches and simply got food in town to eat in my room.
Stresses in your family that involve money, power struggles, or sex are all second chakra issues that can affect your uterus. In these cases, ridding yourself of the energy vampires (or situations) that are literally draining your life’s blood and then putting your own needs first are the keys to improving your health.
Now, putting yourself first when you’ve been in an energy vampire relationship can take some time. Start by shifting your perspective of yourself by saying this aloud every morning:
“I pledge allegiance to myself
and to my Soul for which it stands.
I honor my goodness, my gifts, and my talents.
I commit to remaining loyal to myself from
this moment forward for all of my days.”
You can also take some time alone to sit down on the earth and pray for guidance and a boost of energy for yourself.
Have you experienced abnormal bleeding? Please share your stories in the comment section below.