What is the cause of menopausal bleeding?

Some female friends experience bleeding after menopause. This is most likely not menstruation, but caused by other reasons, such as functional uterine bleeding, bleeding caused by tumor diseases, bleeding caused by inflammation of the reproductive tract, etc.

1. Malignant tumors:

In the past, it was believed that the incidence of malignant tumors in postmenopausal uterine bleeding was very high, so postmenopausal uterine bleeding was considered to be a signal of malignant disease. However, in recent years, it has been found that malignant tumors occur in only a small part of patients with postmenopausal bleeding. The highest incidence rate reported in China is about 22.7%, and the lowest incidence rate is only 8.8%.

Among the malignant tumors that can cause postmenopausal uterine bleeding, endometrial cancer is the most common, followed by cervical cancer, and ovarian malignant tumors are relatively rare. Although the proportion of malignant tumors in patients with postmenopausal uterine bleeding is not very high, we still need to be vigilant. For patients with unexplained postmenopausal uterine bleeding, repeated examinations and strict follow-up are required to facilitate early diagnosis and treatment to improve the quality of life of elderly women.

2. Functional uterine bleeding:

According to clinical investigation results, more than half of patients with postmenopausal uterine bleeding have no obvious organic lesions, but functional uterine bleeding caused by endocrine disorders has become the main cause of postmenopausal bleeding.

Medical experts explain it this way: Postmenopausal women have high levels of follicle-stimulating hormone, which stimulates the interstitial cells in the ovaries to secrete estrogen, which has a cumulative stimulating effect on the endometrium, leading to varying degrees of hyperplasia of the endometrium and cervix, and even the formation of polyps.

However, the secretion of this hormone is unstable and fluctuates greatly. Therefore, when the hormone secretion level drops, the endometrial hyperplasia will suddenly stop and shedding bleeding will occur, forming dysfunctional uterine bleeding.

It can be seen from this that after excluding organic lesions, patients with postmenopausal uterine bleeding should first undergo vaginal B-ultrasound examination to understand the thickness of the endometrium, and perform curettage when necessary to assist in the diagnosis of functional uterine bleeding and differentiate it from endometrial cancer. Generally speaking, although functional uterine bleeding is accompanied by endometrial hyperplasia, the thickness of the endometrium generally does not exceed 4 mm. If it is more than 4 mm, a diagnostic curettage should be performed to rule out or detect endometrial cancer.

3. Genital tract inflammation:

As the time of menopause prolongs, the level of sex hormones in women's bodies becomes lower and lower, the endometrium gradually atrophies, and the vaginal mucosa also shows atrophic changes.

The atrophy of the endometrium and vaginal mucosa reduces local resistance and makes them susceptible to invasion by pathogenic microorganisms such as bacteria and chlamydia, leading to endometritis, cervicitis and vaginitis.

On the basis of inflammation, superficial capillaries are easily damaged, and a few may form superficial ulcers, causing bleeding. About 1/3 of postmenopausal uterine bleeding is related to genital tract inflammation.

Therefore, on the one hand, we need to strengthen reproductive tract health care after menopause, and on the other hand, we can give small amounts of sex hormone supplementation therapy. Preventing the occurrence and development of reproductive tract inflammation is the key. At the same time, when examining patients with postmenopausal uterine bleeding, attention should be paid to the presence of genital tract inflammation. Once confirmed, active treatment should be given to reduce bleeding.

4. Other reasons:

Vaginal caruncle, genital tract trauma, uterine prolapse, benign ovarian tumors, rupture of endometrial gland cysts, etc. can all be causes of postmenopausal uterine bleeding. These situations should be understood, carefully investigated, promptly diagnosed and actively treated to reduce the incidence of postmenopausal uterine bleeding.