Abnormal Vaginal Bleeding (In Menopause)

Menstruation is the circular, smooth rupture of the lining of the uterus in response to the interactions of hormones produced by the hypothalamus, pituitary gland and ovaries. The average duration of a menstrual cycle is 28 days, with most wavelengths being between 25 and 30 days. This phenomenon is called 'normal vaginal bleeding' and ends with menopause. The onset of menopause is placed twelve months after the last menstrual period and marks the end of the menstrual cycle for the woman.

Disclaimer: Midwifery is a very inclusive and safe space for everyone, where your identity and your needs are valid and important to us. Thus, the terms used in this article aim towards making everyone feel comfortable and included.

Uterus owner (person with a uterus, uterus having person) <--> Woman
Parent <--> father (dad), mother (mom)
Birthing person <--> mother (mom)
Pregnant (pregnant person) <--> mother (mom)
Breastfeeding (Breast) <--> Chestfeeding (Chest)

[if you feel that you are not included at any point, please contact us and help us change that]

Vaginal bleeding is considered abnormal if:

• The patient did not expect her period.

• The menstruation is lighter or heavier than what it’s normal for her.

• It appeared at a time in life when it is not expected, such as before the age of 9, when pregnant or after menopause.

In these cases, the bleeding is characterized as abnormal and needs to be treated.

Introduction

Abnormal vaginal bleeding has many possible causes, some of which are infectious, caused by a woman being infected by a germ, and non-infectious, which are related to other factors.

The purpose of this article is to inform uterous owners about abnormal bleeding during menopause. It is especially important to provide them with certified and valid information on such issues, such as the symptoms that indicate the presence of abnormal bleeding and its causes. Thus, the rates of its valid diagnosis will increase and the complications that may arise from a delay in its treatment will be reduced.

Abnormal vaginal bleeding may be related to a problem with the reproductive system (a gynecological condition) or to other medical problems or certain medications. If the patient has reached menopause - defined as approximately 12 consecutive months without a menstrual period - subsequent vaginal bleeding may be a cause for concern and should be evaluated.

Infectious Causes

The infectious causes of such bleeding vary. Initially, one of the most common causes is Cervicitis. Cervicitis is an inflammation of the cervix, located in the lower part of the uterus inside the vagina. Most often, Cervicitis is caused by sexually transmitted germs or bacterial infections from the spread of bacteria that are usually found in the proctogenital area, in the context of a bacterial vaginosis. Symptoms of Cervicitis may include vaginal discharge, itching, pain during sexual intercourse, abnormal vaginal bleeding, or a feeling of discomfort or heaviness in the pelvis. If it develops into an inflammatory disease of the pelvis, there will be fever, severe pain in the lower abdomen and purulent discharge from the vagina.

Then, another common cause is Chlamydia. The disease is caused by the bacterium Chlamydia trachomatis which is a class of bacteria that can cause various diseases, such as cervicitis, endometritis or tubalitis in women at risk of installation and even infertility. Symptoms include unusual vaginal discharge, pain or burning in the urethra, vaginal bleeding outside the period, as well as pain in the lower abdomen or waist, nausea and fever.

Finally, another notable cause of infectious vaginal bleeding is inflammatory pelvic disease. Inflammatory pelvic disease is an infection of a woman's reproductive organs. It is a complication that is often caused by some sexually transmitted diseases such as chlamydia and gonorrhea. Other non-sexually transmitted infections can also cause pelvic inflammatory disease. The diagnosis is usually based on a combination of medical history, physical exams and other test results. Common symptoms include lower abdominal pain, fever, an unusual discharge from the vagina, pain and / or bleeding during intercourse, a burning sensation when urinating, and vaginal bleeding between periods.

Non-Infectious Causes

However, the causes of a menopausal hemorrhage are not always due to an infectious agent. It can often be caused by non-infectious causes for which it would be best for people to be informed.

Regarding the non-infectious causes of vaginal bleeding in menopause, one of the most common is Uterine polyps. The Uterine polyp is a benign mass that develops in the inner lining of the uterus, the endometrium. Symptoms associated with Uterine polyps include irregular periods, intermittent bleeding, uterine contractions, and dilation of the cervix. If infected, they cause foul-smelling secretions and the person is in pain. Some other symptoms are also vaginal bleeding after menopause and infertility. Some people with a uterus may experience only minor bleeding, bloodstains or even no symptoms at all. Because polyps are often asymptomatic, they can be discovered at random on a preventive gynecological examination, on intravaginal ultrasound, or on hysterosalpingography in the context of infertility testing, and the surgery of choice is hysteroscopy.

Also, another cause of vaginal bleeding is Uterine fibroids. Fibromyomas are spherical tumors that appear anywhere on the wall of the uterus. Uterine fibroids that grow inside the uterus are called submucosa and it is usually these fibroids that cause the most important problems. When the fibroids are on the outside of the uterus (subcutaneous uterine fibroids) or when they hang from it (squamous fibroids of the uterus) then no problem usually arises. The cause of their creation is unknown. When they grow large enough, their inside can die and this creates pain. Other symptoms include bleeding, a feeling of pressure in the pelvis and difficulty urinating or defecating. Fibromyomas regress spontaneously after menopause. The presence of fibroids can create a problem in the development of a pregnancy. Therefore, it is not always necessary to treat them, except when there are specific indications, where then their treatment is usually surgical.

Finally, one of the most common reasons for vaginal bleeding while the patient is menopausal is Endometrial hyperplasia. Endometrial hyperplasia can result from an ovarian tumor or from polycystic ovary disease or an abnormality of other endocrine glands or from the use of various medications. The diagnosis is then made with great reliability by transvaginal ultrasound where a thickened endometrium is found. Often, polyps coexist with hyperplasia. In some cases (eg. older people, obese, etc.) hyperplasia may be due to malignancy and in such a case the complete diagnosis and treatment is done with hysteroscopy.

The incidence of fattening endometrium increases dramatically if the patient has a history of breast cancer. This is largely due to medications given to patients to induce menopause and to stop the production of progesterone by the body, such as Tamoxifen. Tamoxifen is a type of hormonal (endocrine) treatment used to treat breast cancer in both premenopausal women (those who have not yet gone through menopause) as well as postmenopausal women, it works throughout the body (known as systemic therapy) and blocks the effects of estrogen on these receptors. This helps stop estrogen from encouraging breast cancer cells to grow. Excessive or continuous uninterrupted action of estrogen, which is the result of a lack of progesterone, is the pathogenesis of the disease.

In endometrial hyperplasia, as long as the histological examination after endometrial scraping does not reveal precancerous cells, the treatment is simple and usually pharmacological-conservative. Progesterone drugs often correct the problem and are the most tried and tested method of treatment. If the biopsy shows precancerous cells, then the treatment of choice is hysterectomy which is considered radical, especially if the uterus owner does not want to maintain her reproductive capacity. Whatever the method of treatment is, it is necessary to closely monitor the patient for a long time, as there is always the possibility of launching a new biopsy.

Conclusion

In conclusion, menopause marks the end of menstruation in every uterus-having person's life. Normally, a menopausal woman should not experience vaginal bleeding in any form (complete bleeding, drops of blood, bleeding during sexual intercourse). However, there are cases where such symptoms are observed in menopausal patients and are pathological findings. The causes vary and can be either infectious, ie due to an infectious agent, or they can be non-infectious and involve other factors, such as the formation of a mass in the uterus.

It is, therefore, generally accepted that informing people is the most key factor in how the patient's state of health will evolve. This is due to the fact that with a valid diagnosis, the treating physician prevents the exacerbation of symptoms, directs the monitoring of the woman more correctly and is more likely to be able to help the woman. Therefore, it would be good for them to be fully informed but also not to neglect some of their own possible findings so that, in collaboration with a doctor, they can fully deal with both infectious and non-infectious causes of vaginal bleeding and avoid flare-ups of their symptoms.

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