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    Mayo Clinic Q and A: Spotting after menopause

a happy, smiling middle-aged woman outside in a wooded area, leaning on a railingDEAR MAYO CLINIC: I am 52 and had recently gone 10 months without a period, so I had assumed I was postmenopausal. But, over the past few months, I’ve had light spotting. Does this mean I’m not past menopause? Do I need to see my health care provider about this?

ANSWER: It’s possible that you haven’t reached menopause yet. Clinically, menopause is defined as going without a period for one year. At 10 months, you don’t quite meet that threshold. But it’s also possible that you are postmenopausal, and the bleeding is a result of something else. It would be a good idea to make an appointment to see your health care provider and check your condition.

Menopause is the natural process that marks the end of a woman’s reproductive years when menstrual cycles stop. It typically happens during the 40s or 50s, with the average age of menopause in the U.S. at 51.

Skipping periods as you approach menopause — a stage sometimes called perimenopause — is common and expected. During that time, menstrual periods often will skip a month and return, or skip several months and then start monthly cycles again for a few months. Periods also tend to happen on shorter cycles during perimenopause, so they may be closer together than is typical for you.

Ten months between periods is longer than usual in the perimenopause stage. But it is possible, and the spotting you’ve noticed may not signal anything other than the fact that your body isn’t to menopause at this point. However, if you have gone through menopause, then the bleeding could be cause for concern.

Bleeding after menopause is not normal, and it must be evaluated by a health care provider. Postmenopausal bleeding can have various causes.

One of the most serious underlying conditions that could lead to this type of bleeding is cancer. For example, cancer that begins in the uterus, called endometrial cancer, often triggers abnormal vaginal bleeding. For many women with this form of cancer, bleeding is their only symptom. That’s why it’s so important to have postmenopausal bleeding evaluated as soon as possible.

If your health care provider suspects endometrial cancer, she or he may recommend removing a sample of tissue from your uterine lining with a procedure called endometrial biopsy. The tissue that’s removed then is examined in a laboratory for signs of cancer. An endometrial biopsy may be performed in your health care provider’s office, and it usually doesn’t require anesthesia.

Less-common kinds of cancer that also could cause abnormal bleeding are cancer of the cervix or vagina, as well as uterine sarcoma. Other underlying medical concerns that may lead to vaginal bleeding after menopause include conditions that thin the tissue that lines the uterus or the vagina, called endometrial atrophy and vaginal atrophy. In some cases, uterine fibroids or polyps may trigger bleeding, too.

The bleeding also could be the result of a condition known as endometrial hyperplasia, in which there is a precancerous overgrowth of cells that make up the uterine lining. An infection, injury or other pelvic trauma, and certain medications also have been known to cause postmenopausal bleeding.

Despite this list of disconcerting possibilities, please know, too, that the bleeding you are experiencing may be harmless, without any serious underlying medical condition causing it. But, at this time, you should see your health care provider to find out what’s going on. — Dr. Jamie Bakkum-Gamez, OB-GYN, Mayo Clinic, Rochester, Minnesota

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