What Causes Fluid in the Uterus After Menopause? Symptoms And Treatment

Last updated 12.05.2023 | by Dr. Karen Pike | 8 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.


Menopause can bring on several physical and emotional changes for women, and one of the less common changes that can occur is fluid in the uterus.

According to one study, more than 14% of post-menopausal women have a buildup of intrauterine fluid. This fluid, also known as endometrial fluid, can come in many forms, including blood, cervical mucus, and discharge. And while it doesn’t always indicate an underlying condition, it can cause alarm. 

During menopause, our hormones shift, and estrogen dips to much lower levels. For this reason, post-menopausal women are at an increased risk of developing certain health conditions. 

So, it’s important to understand the various causes and symptoms of uterine fluid after menopause, so that you can seek the correct advice and treatment if needed.

I’ve encountered multiple postmenopausal women in the ER who have presented with symptoms of uterine fluid. Some of these cases have been medical emergencies which require immediate treatment. However, others are due to less serious conditions which are able to be treated outside of the hospital, in their doctors office, or at home. 

So, are you a postmenopausal woman who is concerned about uterine fluid? Are you unsure if it’s time to visit your doctor? Rest assured, you’ve come to the right place.

In this post, I’ll share some of the potential causes of fluid in the uterus in post-menopausal women. Plus, I’ll discuss the signs and symptoms to look out for and when it might be time to speak to a healthcare professional.

What Causes Post-Menopausal Uterine Fluid?

Causes Post-Menopausal Uterine Fluid?

There are multiple potential causes for fluid in the uterus after menopause, including:

Polyps

Uterine polyps are one of the leading causes of fluid in the uterus after menopause(1). These usually benign masses develop on the inner lining of the uterus, where they create a build-up of fluid that can lead to unexpected bleeding.

Endometrial Atrophy

Many women are familiar with vaginal atrophy, a common condition in post-menopausal women characterized by a drying, weakening, and thinning of the vaginal walls. This can lead to inflammation. Like most symptoms of menopause, it’s caused by a lack of estrogen, but this hormonal change can also affect the uterus.

Atrophy of the uterus, also known as endometrial atrophy, can cause the lining of the uterus to become inflamed and irritated(2). This can cause fluid to accumulate, leading to light bleeding or spotting.

Adenomyosis

Adenomyosis causes the lining of the uterus, known as the endometrium, to grow into the organ’s muscular walls. It can cause heavy bleeding and an accumulation of fluid. In some cases, it can also lead to bouts of extreme pain, and I have treated several patients in the ER with this condition.

Many women find relief from adenomyosis after menopause, but it’s possible to continue experiencing side effects in later life. 

Hormone Replacement Therapy (HRT)

Hormone replacement therapy (HRT) is a popular treatment that can help to alleviate many of the symptoms of menopause.

There are several types of HRT available, many of which are estrogen-dominant. In some cases, a sudden influx of estrogen in the body can lead to the build-up of uterine fluid in post-menopausal women.

Infection

Infections of the uterus, cervix, or surrounding organs can cause a build-up and retention of fluid in the uterus. Examples include sexually transmitted diseases, which can lead to pelvic inflammatory disease.

Fibroids

Fibroids are benign growths that develop inside and on the surface of the uterus. They’re common, and they often don’t present any symptoms; many women don’t even realize they have them. However, large fibroids can cause the cervix opening to become constricted, leading to a build-up of fluid in the uterus. While fibroids usually shrink after menopause, in rare instances, they can continue to cause problems.

Cervical Stenosis

Cervical stenosis is a condition characterized by the narrowing or tightening of the cervix. It becomes more common as a woman ages, and while it often doesn’t present any symptoms, it can lead to a build-up of uterine fluid.

Endometrial Hyperplasia

Endometrial hyperplasia is a thickening of the lining of the uterus, which often leads to abnormal bleeding after menopause.

A lack of progesterone causes the condition. When the progesterone/estrogen ratio is out of balance, endometrial fluid and blood can build up inside the uterus. It’s more common in older women and leads to an increased risk of developing endometrial cancer.

Endometrial Cancer

Endometrial cancer also causes a build-up of fluid in the uterus, and one of the key symptoms of the disease is bleeding, spotting, and irregular discharge after menopause.

While it’s relatively rare, it’s important to report any unexpected bleeding or discharge to your doctor. Early detection can significantly improve the chances of successful treatment.

What Are the Symptoms of Fluid in the Uterus After Menopause?

Symptoms of Fluid in the Uterus After Menopause

Fluid in the uterus isn’t always a sign of a serious underlying condition, but it is a cause for concern. So, if you experience any of the following signs or symptoms of uterine fluid after menopause, speak to your doctor right away.

  • Unusual discharge
  • Bleeding and spotting
  • Changes to vaginal discharge
  • Excess vaginal discharge
  • Pelvic pain
  • Feeling of heaviness, fulness, or pressure in the lower abdomen
  • Abdominal cramps
  • Bloating

How to Treat Post-Menopausal Uterine Fluid

Treatment for post-menopausal uterine fluid depends on the cause of this condition. However, doctors typically advise one of 3 treatment options.

Watch-And-Wait

If uterine fluid is not due to a serious underlying condition and it doesn’t cause any significant discomfort or pain, you may be advised to take a watch-and-wait approach.

You will likely need regular checkups to ensure your condition isn’t progressing. Likewise, you will need to monitor your symptoms at home and report any changes to your doctor as soon as they arise.

Medications

If postmenopausal uterine fluid is due to an infection, you will be prescribed a course of antibiotics.

If endometrial atrophy is the cause, your doctor may prescribe estrogen therapy in the form of pills, patches, or creams.

Likewise, if endometrial hyperplasia is the cause of fluid buildup in the uterus, synthetic progesterone, known as progestin, may be prescribed. This form of treatment works by stimulating the uterus to shed its excess lining.

Surgery

Some cases of postmenopausal uterine fluid will require further investigation via a hysteroscopy. This procedure works by placing a hysteroscope (a very thin tube with a camera) inside the vagina, past the cervix, and into the uterus to gain detailed images of any growths that may have developed. When performed by a surgeon, a hysteroscopy can also remove any growths.

Another possible surgical treatment is a dilation and curettage (D&C) procedure, which involves taking a sample of the uterus lining and uterine fluid. This procedure can also be performed to clear the uterine lining.  If you are diagnosed with a serious condition such as uterine cancer, you may need a full hysterectomy. This is a surgery to remove the uterus and cervix, and in most cases, the ovaries too.

FAQs

What should I do if I experience vaginal bleeding or abnormal discharge after menopause?

There are a variety of reasons why you might experience vaginal bleeding after menopause. If you notice spotting, bleeding, or unusual discharge, speak to your healthcare provider immediately to identify the underlying cause.

How common is endometrial cancer?

Around 50,000 US women are diagnosed with endometrial cancer every year. Statistics show that it is the most common form of gynecological cancer in America.

Can fluid in the uterus after menopause go away on its own?

The answer depends on the underlying cause. Some less serious conditions may resolve themselves over time. However, if you’re a post-menopausal woman, it’s essential to see your doctor at the first sign of fluid in the uterus.

Conclusion

Many of the women I’ve worked with throughout my research are understandably concerned when they notice the signs and symptoms of uterine fluid after menopause.

However, it’s important to remember that there are a wide variety of conditions that can cause fluid in the uterus in postmenopausal women. Some of these conditions are relatively harmless, while others are potentially life-threatening. So, the symptoms discussed in this post should never be ignored.

Be sure to speak to your doctor or healthcare provider as soon as possible if you notice signs of uterine fluid. They can assess your symptoms, identify the problem, and provide any necessary treatment.

Author

  • Dr. Karen Pike

    Dr. Pike is a senior physician administrator and board-certified emergency room doctor actively working in northern California. She received her undergraduate degree at Dartmouth College, where she graduated Phi Beta Kappa and played collegiate soccer. She attended Georgetown University for medical school and performed her residency in emergency medicine at Stanford University. She was part of the first-ever, women-majority emergency medicine program in United States. Dr. Pike is also the primary medical consultant for “Grey’s Anatomy,” a role she has held since the pilot episode when she partnered with Shonda Rhimes as the show’s original medical consultant. At her hospital, she was the second woman Chief of Staff. Today serves as the Director of the Emergency Department. Whether in leadership or direct patient care, her dedication to excellence in communication, quality, and collaboration is unwavering.