After menopause begins, all instances of bleeding from the vagina are abnormal. The hormone responsible for menstruation, estrogen, starts to decline two to eight years before menopause begins. In this stage (perimenopause) you will still have menstrual cycles. This is the only menopausal stage in which bleeding is considered normal.
Vaginal bleeding in normal instances comes from blood pooled in the uterus. During menopause, the decline in estrogen causes the vagina to shorten, the walls to become thinner, and the vaginal canal to become dry. Vaginal bleeding in menopause is usually due to a condition called vaginal atrophy. In this condition the vaginal lining becomes so thin that it causes the blood vessels inside to weaken and burst spontaneously. This causes bleeding, which may vary in flow volume. Some women notice bleeding from vaginal atrophy only after sexual intercourse.
Some uterine bleeding in menopause stems from the formation of uterine polyps. Uterine polyps are bulb-shaped growths that form in the womb. The Mayo Clinic states that researchers aren't really sure what causes them, but they can stem from abnormalities in the hormone estrogen. Uterine polyps range in size from as small as a sesame seed to as large as a golf ball.
Dysfunctional uterine bleeding (DUB) is any unexplained vaginal bleeding that happens without injury. According to the National Institutes of Health, this type of bleeding occurs in 40 percent of women over the age of 40. Researchers feel that DUB may be linked to hormonal imbalances, specifically in the hormones estrogen and progesterone. This health problem is not directly linked to menopause, but rather emotional stress, excessive exercise or obesity. Bleeding is just one of the many symptoms associated with DUB. Other symptoms include mood swings, hot flashes and tenderness of the vagina.
Bleeding Due to HRT
Most causes of bleeding in menopause can be corrected by the use of hormone replacement therapy (HRT). This treatment uses synthetic estrogen to help balance declined levels. By re-balancing estrogen, most problematic symptoms in menopause will dissipate. Ironically, HRT may also cause bleeding. In menopause the uterine lining becomes thinner, but when you take hormone replacements, the estrogen in them may stimulate the lining to thicken. This lining will not all shed at once as it normally would in a menstrual period, so you may experience periodic spotty bleeding.
Bleeding in any stage of menopause can be scary, but most instances are benign. In rare instances bleeding in menopause can be a symptom of a more problematic condition such as uterine, ovarian or cervical cancer. Your physician may need to perform several tests in order to pinpoint what the exact cause is. These tests may include blood tests (used to measure hormone levels), vaginal or uterine biopsy, and an ultrasound (used to view the uterus or ovaries).