Any bleeding one year following menopause should be taken seriously and given due consideration unless proven otherwise.
1. Endometrial Cancer
Endometrial cancer which is cancer of the lining of the womb can happen after menopause and the exact cause for this is not known. It has been noted that women who consume a high fat diet or have had PCOS or diabetes, are at an increased risk of endometrial cancer. Women who have had breast or ovarian cancer similarly are at a higher risk of endometrial cancer. Once it is suspected, a few things must be carried out as soon as possible for example, taking a sample of the lining of the womb by an endometrial biopsy or a hysteroscopy. The biopsy can be taken under hysteroscopy guidance. A vaginal ultrasound scan should be carried out to check the thickening of the lining and also to see the endometrial cavity etc.
2. Cancer of the Cervix
Another cause of post-menopausal bleeding is cervical cancer, which is cancer of the neck of the womb. Women who have had regular screening and have not had any previous abnormalities are not at such a high risk of having cervical cancer at the post-menopausal age. Routine screening is of the utmost importance.
3. Other Causes
Although I mentioned about two serious diseases causing post-menopausal bleeding, I must emphasise that not all post-menopausal bleeding is due to malignancy of the uterus or the cervix. Sometimes vaginitis (inflammation of the vagina, vulva or urethral caruncle can also cause bleeding. It is also important to ascertain the actual site of the bleeding. Patients have presented to me with suspected post-menopausal bleeding but in fact the bleeding originated from the rectum due to piles. It is therefore of the utmost importance that the patient can realise the source of the blood whether it be the urethra, vagina or the rectum.