Bleeding During or After Sex In Menopause

Experiencing bleeding during or after sex during menopause is not uncommon. According to Dr. Krychman, a gynecologist, vaginal bleeding during or after sex is a common issue among perimenopausal and menopausal women. This symptom, medically referred to as postcoital bleeding, occurs when there is spotting or bleeding during or after vaginal sex unrelated to menstruation.

Common Causes of Bleeding After Sex in Menopausal Women

Vaginal Atrophy (Genitourinary Syndrome of Menopause)

The most prevalent cause of postmenopausal bleeding, including light spotting after sex, is vaginal atrophy. This condition, also known as atrophic vaginitis or genitourinary syndrome of menopause, affects about 50% of menopausal women. Due to decreased estrogen levels, the vaginal walls become thinner, dryer, and more prone to irritation. This can lead to discomfort or pain during sex, as well as spotting or bleeding caused by friction or minor tears in the vaginal tissue.

Sexually Transmitted Infections (STIs)

Sexually transmitted infections can cause vaginal spotting or bleeding due to underlying mucosal irritation. STIs, such as syphilis, genital herpes, and trichomoniasis, can cause sores in and around the vagina that may bleed if irritated during sex. STIs may also be asymptomatic, so it’s important to consult a healthcare professional if you suspect you might have an infection.

Benign Growths

Benign growths such as uterine polyps, cysts, and fibroids can also cause vaginal bleeding after sex. Uterine polyps are common in perimenopausal and postmenopausal women, and while they may not always cause symptoms, they can lead to spotting or bleeding if irritated. Cervical polyps and nabothian cysts are other benign growths that might cause postcoital bleeding if they become irritated.

Endometrial Hyperplasia

Endometrial hyperplasia occurs when the lining of the uterus becomes too thick due to excess estrogen without progesterone. This condition is more common after menopause and can lead to abnormal bleeding. Risk factors for endometrial hyperplasia include underlying conditions such as diabetes and polycystic ovarian syndrome (PCOS).

Gynecologic Cancers

While most postcoital bleeding is not caused by cancer, some gynecologic cancers can present with this symptom. Cancers of the cervix, vagina, vulva, endometrium, ovaries, and uterus can cause unexplained vaginal bleeding. Bleeding from cancerous tumors can occur if the blood vessels feeding the tumor burst, which is more common in larger tumors.

Risk Factors for Bleeding After Sex During Menopause

Having risk factors does not guarantee you will experience postcoital bleeding, but it can increase your chances. Risk factors include:

• Being on unopposed estrogen therapy

• Being overweight or obese

• Age-related increase in the risk of gynecologic cancers

Prevention and Treatment

The most important step is to consult your healthcare provider if you experience abnormal vaginal bleeding. Conditions such as vaginal dryness, infections, cysts, polyps, or hormonal imbalances can often be easily treated. For example, vaginal dryness can be managed with hormone-free moisturizers like Revaree®, which contains hyaluronic acid.

Regular examinations with your gynecologist are crucial for early detection of more serious conditions, such as cervical cancer. If abnormal vaginal bleeding is due to cancer, treatment will depend on the type and stage of the cancer.

Conclusion

Sex during menopause should be comfortable and pain-free. If you experience bleeding during or after sex, it's important to see your healthcare provider to identify the underlying cause and receive appropriate treatment. With the right care, you can manage symptoms and maintain a healthy, fulfilling sex life during menopause.