What is menstruation? – Menstruation refers to monthly vaginal bleeding, originating from the uterus, in reproductive age women. This does not occur after menopause. Therefore, vaginal bleeding after menopause cannot be referred to as menstruation.

What is menopause?

Menopause refers to a situation in which a reproductive age woman has stopped having menses for one year or more. Menopause commonly sets in between age 45 and 55 years, with 51 years being the average. However, menopause may set in anytime from 40 years and above. 

Is vaginal bleeding after menopause normal?

No; bleeding from the vagina after menopause is not normal. This may be due to mild (benign) medical conditions that may not be life-threatening but the risk of cancer of the endometrium (lining of the womb), ovary or cervix (cancer of the neck of the womb) at that age is significantly high. This is the reason such bleeding should be taken seriously. 

What are causes of bleeding after menopause?

The following are common causes of vaginal bleeding after menopause:

1. Uterine polyps: This refers to soft tissue growth from inside the uterus.
2. Endometrial hyperplasia: This refers to excessive growth of the endometrial lining (inner lining of the womb). When it grows excessively as such, it may contain abnormal cells which may transform to cancer.
3. Cancer of the uterus: Vaginal bleeding after menopause is one of the foremost signs of cancer of the uterus, which is often experienced my majority of those affected before their diagnosis.
4. Cancer of the cervix: This is cancer affecting the neck of the womb. In addition to vaginal bleeding, it also manifests with foul-smelling vaginal discharge.
5. Ovarian cancer: Certain ovarian cancers produce hormones responsible for menstruation (oestrogen and progesterone). These hormones stimulate the lining of the uterus as they do during menstrual cycle to cause vaginal bleeding.
6. Injury to the vagina: This may be from sexual intercourse or other sources.
7. Cervicitis: This refers to inflammation of the cervix, which may be caused by infection.
8. Vaginal atropy: This refers to thin and dried lining of the vagina, making it to bleed easily.
9. Hormone replacement therapy: These hormones stimulate the growth of the lining of the womb as they do during menstrual cycle, with bleeding following withdrawal of the drug or change of medication.

What are the risk factors for bleeding after menopause?

Though any woman can be affected by vaginal bleeding after menopause, certain risk factors make it more likely in some women. These include:

1. Obesity
2. Late menopause (reaching menopause above 55 years)
3. Polycystic ovarian syndrome (numerous cysts on the ovaries, producing hormones that stimulate the lining of the uterus)
4. Medical conditions such as diabetes or thyroid disease
5. Smoking 

How is bleeding after menopause treated?

The treatment of bleeding after menopause depends on the cause. It may be through medication or surgery.

1. Antibiotics for infection
2. Oestrogen therapy (cream, ring or tablet) for vaginal dryness
3. Progestin therapy (tablet, injection or intrauterine device) for endometrial hyperplasia
4. Surgical treatment: This may be by scraping the endometrial lining or removing the whole uterus, after properly diagnosing the cause and evaluating surgery as the most appropriate treatment problem.