Brown Spotting After Menopause: Causes and Solutions

Understanding Brown Spotting

A brown spotting is a light or dark brown coloured discharge from the vagina. This discharge is often lighter (in smaller quantity) than a regular menstrual period and occurs occasionally or at irregular intervals. This happens due to the presence of old blood in the uterus, vagina or cervix.

Why is the discharge brown in colour?

Brown discharge is nothing but blood. Isn’t blood red in colour? Yes! When the blood flows out of the body quickly, it remains red in colour. 

But when the blood takes time to flow out of the body, it gets oxidised when exposed to air and turns brown.

What Causes Brown Spotting After Menopause?

There are multiple reasons for brown spotting after menopause. It can be a simple, harmless issue or a severe condition. Understanding these causes will help you seek medical care at the right time. Here are a few causes of brown spotting after menopause that you need to know.

• Hormonal Changes: Menopause and hormonal fluctuations are best friends forever (BFFs). The main reason behind irregular spotting or bleeding, even after a complete stoppage of periods, is a decrease in oestrogen levels. It causes light bleeding from the endometrium (inner lining of the uterus), cervix or vagina.
• Endometrial Atrophy: It is a condition where the endometrial wall becomes thin and weak. This is a natural process that occurs during menopause because of decreased oestrogen levels. The fragile endometrium is more prone to injury or irritation during physical activity or intercourse. This leads to slight spotting or bleeding, which is sometimes brownish in colour. 
• Endometrial Hyperplasia: It is a condition where the endometrium grows abnormally thick. It occurs because of the imbalance in the oestrogen and progesterone ratio (oestrogen is more when compared to progesterone). The ideal thickness of the endometrium is 8-12mm. If it grows more than 12mm in thickness, it is called endometrial hyperplasia. This leads to abnormal vaginal bleeding or brown spotting. If it is left untreated, it may increase the risk of endometrial cancer.
• Polyps: They are non-cancerous growths that develop on the cervix or endometrium. They develop due to hormonal changes. They can cause irregular bleeding or spotting and sometimes abnormal vaginal discharge. 
• Infections: Post-menopausal women are more prone to vaginal infections such as bacterial vaginosis, yeast infections or sexually transmitted infections (STI). The decrease in oestrogen causes changes in the vaginal environment making it more susceptible to infections. These infections lead to vaginal irritation, inflammation and discharge, which may include brown spotting.
• Cervical or Uterine Cancer: It is a rare condition after menopause where brown spotting or vaginal bleeding is a sign of serious underlying cause such as endometrial, cervical or uterine cancer. If the spotting is continuous, unexplained or associated with other symptoms like pain, unexplained weight loss or changes in bowel or urinary habits, it is essential to seek medical help immediately.
• Vaginal Atrophy: The vaginal walls become thinner and drier after menopause due to a decrease in oestrogen levels. The tissue of the vagina is more fragile; this may cause irritation and slight bleeding or brownish discharge after physical activity, sexual intercourse or pelvic exam.
• Stress: Increased levels of stress or chronic stress leads to increased release of cortisol (stress hormones) in the body. Elevated levels of cortisol interfere with the regular process of hormone production and lead to menstrual irregularities, including brown spotting after menopause. 
• Medications: Medications that help manage menopause, like Hormonal Replacement Therapy (HRT) and others, can sometimes lead to brown spotting. These treatments help bring about a balance in hormonal fluctuations. They help reduce symptoms such as hot flashes and vaginal dryness during and postmenopause. Even though they help manage menopausal symptoms, they can lead to brown spotting or light bleeding due to changes in hormonal levels, especially in the initial stage. Once your body adjusts to the hormonal therapy, spotting decreases on its own.

Wondering When to See a Doctor?

Even though brown spotting after menopause is a common concern, it is not always a serious issue. However, it is best to consult your healthcare professional to seek medical advice in certain situations to be safer.

• Persistent (continuous) Spotting: If you have continuous spotting for over weeks or months, especially after a period of no bleeding; it is a warning sign. This suggests that there is an underlying condition which needs immediate medical attention.
• Heavy Bleeding: If you are experiencing bleeding for more than 7 days, it is important to see your doctor. This might be suggestive of polyp, endometrial hyperplasia or cancer.
• Associated Symptoms: If the spotting is associated with symptoms such as abdominal pain, foul-smelling discharge or any noticeable changes in the bleeding pattern, consult a healthcare professional.
• Ageing: Women after their 60s are more prone to cervical cancer, which also causes brown spotting. Therefore, regular follow-up is essential.
• Medical History: Women with previous medical history of gynaecological conditions such as polyps, fibroids or cancer must be cautious and seek regular evaluations to maintain optimal health.

Diagnostic Tests for Brown Spotting After Menopause

To identify the cause of the brown spotting or bleeding after menopause your healthcare expert will suggest some of the following tests to arrive at a conclusion.

• Pelvic Examination: A pelvic examination is the visual and physical examination of the female reproductive and sexual parts (vulva, vagina, cervix, uterus, fallopian tubes, ovaries and rectum) by a doctor. Here, the doctor carefully examines the parts for any abnormalities, such as infections, fibroids or polyps.
• Ultrasound: An ultrasound (USG) gives a clear view of the uterus, fallopian tubes and ovaries. It helps determine the thickness of the endometrium and the size of a polyp or fibroid.
• Endometrial Biopsy: In this test, a tiny piece of the endometrial tissue is taken and examined. It is mainly used to diagnose endometrial hyperplasia or cancer.
• Pap Smear: A pap smear test is mainly done to detect cervical abnormalities such as cervical cancer and precancerous cells. 

Treatment Options for Brown Spotting After Menopause

There are various treatment options for brown spotting. The appropriate treatment option for brown spotting after menopause mainly depends on the underlying cause. 

• Hormonal Therapy: As we know menopause is associated with hormonal fluctuations. If hormonal fluctuations are the cause of brown spotting or bleeding, then Hormone Replacement Therapy (HRT) or other hormonal treatment are the best available treatment options. They help regulate the hormone levels and reduce brown spotting.
• Vaginal Oestrogen Treatment: In case of vaginal dryness or atrophy, vaginal oestrogen treatment in the form of creams, gels, rings, or tablets helps restore moisture and elasticity of vaginal walls. This helps reduce vaginal irritation and the risk of spotting or bleeding.
• Polyps or Fibroids: In case of fibroids or polyps which are causing severe, it is best to be removed surgically. Your healthcare expert will suggest a hysterectomy or polypectomy.
• Progesterone Therapy: This therapy is used to treat endometrial hyperplasia, which is caused by an imbalance in the progesterone and oestrogen ratios.
• Dilatation and Curettage: In case of endometrial hyperplasia, this procedure is done to remove the thickened uterine lining.
• Antibiotics: If spotting is caused due to an underlying infection of a reproductive organ, antibiotics or antifungals help treat the infection.
• Surgical Intervention: In case of cancer of the endometrium or cervix, surgery is recommended. This is followed by radiation and chemotherapy, depending on the severity of the condition.
• Watchful Monitoring: For some women, it is normal to experience brown spotting after menopause. This might resolve on its own without any treatment. Always consider regular follow-ups with your doctor to ensure that no serious issues develop.

Prevention Tips for Brown Spotting

Even though it is not always possible to prevent brown spotting, here are some tips you can take to reduce the risk of brown spotting after menopause and maintain overall health.

• Healthy Balanced Diet: A well-balanced diet that includes whole grains, vegetables, and fruits plays a vital role in maintaining hormonal balance. You can include food containing phytoestrogens, such as flax seeds and soybeans, which help balance postmenopausal oestrogen levels. Consuming leafy greens and berries provides essential nutrients, antioxidants and fibres that support the immune system and regulate hormone levels.
• Regular Exercise: Regular physical activities like yoga, walking, cycling or swimming improve blood circulation in the body and improves body response to stress. This helps in maintaining hormonal levels. Studies have proven that exercise reduces or prevents the risk of endometrial hyperplasia. 
• Routine Checkups: A routine gynaecological examination of a woman from the age of 21 years is essential. This helps detect issues at an earlier stage. Regular pelvic examination and pap smears help identify conditions like fibroid, polyps or cancers of the cervix and uterus. A routine pap smear also helps detect precancerous changes in the cervix, allowing early intervention and cure.
• Quit Smoking and Alcohol: Smoking and alcohol causes hormonal imbalance. They reduce oestrogen levels and reduce fertility. It also leads to other reproductive conditions, such as early menopause, cervical cancer and pregnancy-related complications. Quitting smoking helps bring back normal hormonal levels and improves overall health.
• Stress Management: Engage yourself in stress-management techniques such as yoga, meditation or exercise to improve the quality of life. This can help lower cortisol levels and improve both mental and hormonal health.

Wrapping Up

Brown spotting after menopause can be disturbing and worrisome. It is a common issue caused due to a sudden drop in oestrogen levels during menopause. Certain causes of brown spotting, such as hormonal imbalance, vaginal atrophy or endometrial thinning, are harmless and can be easily treated. However, some conditions like cervical or endometrial cancer require immediate medical attention. However, regular gynaecological checkups play an important role in maintaining postmenopausal health.

Ladies, do you wish to embrace menopause with ease and confidence? Then you are just one click away! Connect with professionals at Nirva Health, where we specialise in women’s health through a holistic approach that combines  Ayurveda, Yoga, and a balanced diet.