Postmenopausal Uterine Bleeding

I hope you can help me until I can get to my doctor on Monday morning. I am 50 years old, will soon be 51 (September). I have not had a period since August/September of 2004. All of a sudden I started spotting on Thursday evening and it has progressed into a full fledged period. Is this normal or is there something wrong to cause this to happen out of the blue? I am a little worried and made an appointment to see my doctor but if I am still bleeding on Monday morning I’m sure he will want to wait until the bleeding has stopped so I am just curious as to the possible reasons for a period to show up after almost 2 years. Thanks for any help you can give me while I wait to see my doctor.

Dr. Joshua’s Answer:

I’m happy that you have scheduled an appointment. Postmenopausal bleeding is a symptom that always needs to be evaluated. Your doctor will take a history and perform a physical examination, and order either a transvaginal sonography (ultrasound) or an endometrial biopsy (tissue sample).

There are many possible reasons for uterine bleeding after menopause. Uterine cancer is the most serious possible cause, and while it is not the reason in most cases, it needs to be excluded, because early treatment provides good results. Uterine (endometrial) cancer is the cause of bleeding in less than 10% of all cases of postmenopausal bleeding.

Menopause results in various hormonal changes that affect the reproductive system. This can lead to atrophy of the vaginal walls, and changes in the mucous membranes of the uterus, which may cause bleeding. Other possible reasons for such bleeding include polyps and infection. In postmenopausal women receiving hormonal replacement therapy (HRT), bleeding problems are fairly common. Midcycle breakthrough bleeding during HRT is usually due to missed pills or other pharmacologic reasons, and needs to be evaluated if abnormal bleeding occurs for more than two cycles.

In the perimenopausal years, when menopause is just occurring, bleeding may be caused by hormonal imbalances and may be corrected with progesterone treatment or oral contraceptives. Even so, uterine cancer needs to be excluded as the cause.