What is the reason for bleeding during menopause?

Patient's question:

My mother is 54 years old this year. She has been menopausal for more than a year, but recently there have been a few instances of blood in her urine during urination, though the amount is not significant. There is no blood when she does not urinate. She is generally in good health and has had cervical erosion for many years. Currently, apart from toothache (which sometimes hurts and sometimes doesn't), she does not feel any other discomfort. Could you please explain why this might be happening?

Doctor's answer:

Hello
Women who experience vaginal bleeding after natural menopause for more than 2 years are referred to as "menopause recurrence," also known as "postmenopausal bleeding."
This condition is equivalent to postmenopausal bleeding in Western medicine.
Women are generally considered to be in menopause around the age of 50, and those who experience consecutive amenorrhea for more than a year are referred to as postmenopausal. Vaginal bleeding after menopause is called postmenopausal vaginal bleeding. Vaginal bleeding in elderly women is a symptom that should not be ignored, and postmenopausal vaginal bleeding should be given more attention. It is important to seek timely medical examination to rule out malignant lesions.
The causes of postmenopausal vaginal bleeding include:
1. Menopausal bleeding caused by endogenous and exogenous estrogen. After menopause, the physiological function of the ovaries gradually declines, leading to a decrease in estrogen levels in the body, which cannot support the effective proliferation of the endometrium. However, the endometrium of postmenopausal women still responds to estrogen. After menopause, the interstitial tissue and adrenal cortex of the ovaries can also secrete androgens, which are converted into estriol. Therefore, fluctuations in estrogen levels can cause vaginal bleeding. Similarly, vaginal bleeding can also be caused when the endometrium is exposed to external estrogen.
2. Bleeding caused by benign organic lesions: Common conditions include endometritis, submucosal fibroids, benign ovarian tumors, cervical polyps, senile vaginitis, intrauterine devices, etc.
3. Malignant diseases: Such as endometrial cancer, cervical adenocarcinoma, uterine sarcoma, and ovarian malignancies, etc.
Clinical manifestations:
Postmenopausal vaginal bleeding can be light, moderate, or heavy in amount, often occurring intermittently, with varying intervals.