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What Causes Post Menopausal Vaginal Bleeding?

Posted on Tue, 10 Feb 2015

Question: I've written before about this problem but I need more information. I have postmenopausal bleeding from the upper part of my vagina. Two doctors have checked my cervix and they couldn't see any blood. Where could this bleeding be coming from?

Answered by Dr. Shanti Vennam (28 minutes later)

Brief Answer:
Likely from the vagina.

Detailed Answer:
Hello,

Thanks for posting your query.

If on a speculum exam, no bleeding spot can be identified, it is likely to have come from the vagina. As you are postmenopausal, the mucosal lining of the vagina is thinned out and slightest trauma can erode it leading to bleeding and spotting.

In the current scenario, you need to get a pap smear, vaginal and cervical swab. You may benefit with local estrogen creams if the bleeding is persistent. Also, please take care of infections. Blood counts are also needed along with coagulation profile.

Hope your query has been clarified. Please feel free to contact for further suggestions. I will be happy to help.

regards,
Shanti.V.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shanti Vennam (42 minutes later)

Hi, thanks for the answer! I had some vaginal bleeding in the lower part of my vagina due to the speculum. I used some cotton swabs and there was no bleeding until I reached the top of my vagina/cervix. Do you still think it's my vagina causing the bleeding. Thank you!!!

Answered by Dr. Shanti Vennam (11 minutes later)

Brief Answer:
More likely.

Detailed Answer:
Hi,

Thanks for writing back.

The fact that you had some bleeding at the point of insertion of the speculum suggests that you might be having atrophic vaginitis, which bleeds sometimes even on touch. So, I feel the cause of the bleeding is the vaginal surface, but, I insist on the investigations as no speculations can be done.

Hope I have answered your query. Please get back for any more information. I will be glad to do so.

regards,
Shanti.V.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shanti Vennam (7 hours later)

Thank you again. I'm still not convinced though. The bleeding from the speculum was bright red and only lasted a few hours. The bleeding from higher up is a red/brown colour and has been there for about 5 weeks.
I really appreciate your genuine concern and prompt answers!!!

Answered by Dr. Shanti Vennam (2 hours later)

Brief Answer:
Detailed below.

Detailed Answer:
Hi,

Thanks for writing again.

The symptoms point to a bleeding high up in the vagina, almost near the vault. Old collected blood turns brown in color and this could be the cause of the discharge you have been observing.

If you are sexually active, there is a possibility that the trauma of the intercourse might have caused this.

As part of the procedure, you should get investigated further and can even go for a colposcopy in expert hands. This is a safe outpatient procedure wherein we can observe things better than a speculum exam, take samples and test them.

Since it is obvious that you have a bleeding point somewhere in the vagina or cervix, further investigation helps to locate this and helps plan further management.

Hope your query has been clarified. Please contact if you need anymore information. I will be available to help.

regards,
Shanti.V.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar