Is Spotting Normal During Menopause?

Menopause, which happens on average at the age of 51, marks the end of your menstrual cycle, as in you haven’t had one for 12 consecutive months. And yet, even after your periods have come to a complete stop, there could be more fun in store as many women continue to experience spotting, or light vaginal bleeding.

So, what’s going on? Is spotting normal during menopause?

Here’s what happens: You might notice a bit of blood on the toilet paper that you wipe yourself with after urinating. It might appear in your underwear, or if you wear one, your pantyliner. The color of the bleeding from spotting during menopause can range from light (pinkish-gray) to brown or even resemble a regular period. No matter the color, it usually does not involve any pain.

This kind of bleeding is different

Experts agree that spotting during menopause, which is a common complaint, does not necessarily mean there’s a serious medical problem. Some research finds up to 11 percent of postmenopausal women experience some menopausal bleeding.

Yet it’s not entirely normal, either. It’s worth learning the facts and exploring the source of your spotting during menopause.

Even though you’re in menopause, there are many reasons you could be spotting. Don’t panic – research finds most of the probable conditions are benign. But it’s always imperative to see your healthcare professional, just to rule out serious causes.

Some reasons for menopause and spotting?  

• You think you’re in menopause but you’re actually not. Remember, menopause is defined as going 12 consecutive months without a period. If you’ve made it to 10 months, and then bleed, go back and begin counting again.

• You might be in perimenopause. During perimenopause, the time leading up to your last menstrual period, your hormone levels  are in flux and it’s normal to have irregular periods. Your menstrual periods could be heavier or lighter than usual and your flow may vary, too.  Some months, your ovaries might not release an egg at all, and you’ll skip a period entirely. Other months, your period may be so light that it resembles spotting, rather than its usual robust flow. This transition can last as long as 14 years.

• Vaginal dryness. Less estrogen means less moisture, lubrication and elasticity to your entire vaginal area. Lovingly termed “vulvovaginal atrophy,” these fragile tissues are more prone to injury and tearing, especially during sexual activity. Even exercise can cause bleeding in a susceptible vagina.

• Hemorrhoids. Sometimes bleeding from these swollen veins in your anus is mistaken for vaginal bleeding. (Inserting a tampon into your vagina can help solve that mystery.)

• A uterine, vaginal, urinary or gastrointestinal infection. 

• Herbal supplements, like phytoestrogens, or hormone therapy with estrogen, which may stimulate the lining of your endometrium.

• Varicose veins in your vagina. Varicose veins are not just limited to the legs or feet; sometimes they can appear in or around your genitals too.

• Endometrial cancer. Ninety percent of women diagnosed with endometrial cancer (cancer of the lining of the uterus) report bleeding prior to their diagnosis. Fortunately, if it’s found early, there’s a high cure rate.

• Postmenopausal hormone therapy.

• Polyps. These are noncancerous, or benign, growths that can attach to the wall of the uterus or the lining of the uterus (endometrium). They can also grow on the cervix, where they might cause bleeding after sex. Most polyps can be removed with surgery.

• Endometrial hyperplasia. This is when the lining of your uterus becomes too thick. Untreated, it can lead to uterine cancer. Treatment options include dilation and curettage (D&C) to remove the excess tissue, hysterectomy to remove your uterus, or progesterone therapy.

• Endometrial atrophy. Rather than become too thick, the lining of your uterus could become too thin (due to  low hormone levels), which can trigger bleeding. 

• Uterine cancer. About 10 percent of the time, postmenopausal bleeding points to uterine cancer, the most common type of reproductive cancer. Treatments may include surgery, hormone therapy, chemotherapy or radiation therapy. 

• Cervicitis. Cervicitis is an infection or inflammation in your cervix or uterus. which is usually treated with antibiotics. 

• Endometriosis. This is when the tissue that is similar to the tissue growing inside your uterus ventures outside your uterus and attaches itself to other organs in the pelvic area. 

• A sexually transmitted disease (STD) like genital herpes, chlamydia or gonorrhea.

Playing detective (or finding the cause of spotting during menopause)  

The only way to know the cause of your abnormal bleeding is to seek expert help. Visit your healthcare provider for a thorough pelvic exam of your vagina and cervix. This may include:

• A pap smear to check for abnormal cervical cells.

• An ultrasound (either done on top of the abdomen or in the vagina) to locate any uterine polyps or thickening of the uterine lining.

• A biopsy of the endometrium or uterus, performed in-office with a small, narrow tube, to collect cells to test for any abnormalities.

• A sonohysterography, a special type of ultrasound. Fluid is inserted into the uterus via a thin tube and the inside of your uterus is then examined with ultrasound images.

• A hysteroscopy, a procedure that examines the inside of your cervix and uterus using a thin lighted tube with a camera at the end.  

• A D&C. Short for dilation and curettage, tissue is removed from the lining of your uterus with an instrument called a curette. The cells are then tested for cancer. 

• A transvaginal ultrasound, which can check for growths and evaluate the thickness of your endometrium. 

• Antibiotics for STDs and to treat uterine or cervical infections.

How spotting during menopause is treated

Once the cause for your menopausal bleeding is established, there are a number of options if you have menopausal spotting, including removing polyps if present via a hysteroscopy, adjusting the dose and type of hormone therapy if you are on it or adding topical (vaginal) estrogen if thinning tissue is the culprit.  Sometimes a hysteroscopy and D&C is performed if the spotting is continuing and is annoying.  Once endometrial cancer is ruled out, sometimes tincture of time is in order.  

If you’re concerned by your spotting during menopause, talk to your healthcare provider and get the information that’s right for you.

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