Bleeding after the menopause or
"post-menopausal bleeding" ("PMB") can be defined as the resumption of
vaginal bleeding at least 6 months after a woman experiences her last
menstrual period. This assumes of course that she is indeed menopausal
ie. in her late 40's, perhaps having hot flashes and night sweats, mood
swings, insomnia, perhaps experiencing some vaginal dryness. The
bleeding pattern most women experience as they approach menopause is
one where the periods become lighter, shorter in duration, and the
interval between periods changes so that the periods are either
somewhat closer together (between 21-26 days apart) or intervals
greater than her customary 28 days. Cycles may be missed entirely for a
couple of months.
There are many causes of
postmenopausal bleeding, and the most common is hormone replacement
therapy. Women who are taking hormone replacement therapy very often
may develop PMB because the uterine lining is very sensitive to
estrogen, which promotes growth of the endometrium, just as it does in
the normal reproductive cycle that was operative prior to menopause.
Lack of estrogen, on the other hand, may cause atrophy of the lining,
and in this condition, the blood vessels of the uterine lining become
so fragile because of estrogen lack that they spontaneously break and
then bleed.
