Bleeding after menopause
Menopause is officially confirmed 12 months after your last menstrual period. Any vaginal bleeding or spotting that happens after this point is called postmenopausal bleeding (PMB) — and it’s not considered normal.
While the cause is often minor and treatable, postmenopausal bleeding can sometimes be an early sign of a more serious condition. That’s why it’s important to have it checked by a healthcare provider right away.
What causes bleeding after menopause?
In most cases, postmenopausal bleeding is linked to non-cancerous or easily treatable conditions. Common causes include:
- Vaginal atrophy (atrophic vaginitis): thinning and inflammation of the vaginal lining after menopause
- Endometrial atrophy: thinning of the uterine lining
- Polyps: small, usually benign growths in the uterus or cervix
- Endometrial hyperplasia: thickening of the uterine lining, often linked to hormone replacement therapy (HRT)
- Cervical or uterine changes: abnormalities that may require further evaluation
Most of these conditions are not serious. However, in about 10% of cases, postmenopausal bleeding can be linked to uterine or cervical cancer. Early detection greatly improves treatment outcomes, so evaluation is essential.
How doctors diagnose postmenopausal bleeding
If you experience bleeding after menopause, your doctor may refer you to a gynecologist for further evaluation. Depending on your history and symptoms, your provider may recommend:
- Pelvic exam and cervical screening (Pap test): to check for abnormalities in the cervix or uterus
- Blood tests: to check hormone levels, anemia, or other conditions
- Pelvic ultrasound (transabdominal or transvaginal): to view the uterus, cervix, endometrium, and ovaries
- Endometrial biopsy (pipelle test): a thin tube is inserted into the uterus to collect a small sample of tissue
- Hysteroscopy: a thin, lighted scope is used to look inside the uterus; biopsies may be taken during this procedure
- Dilation and curettage (D&C): scraping of the uterine lining under anesthesia to collect tissue samples
These tests help determine the exact cause of bleeding and guide treatment.
Treatment for postmenopausal bleeding
Treatment depends on the underlying cause:
- Vaginal or endometrial atrophy: often treated with estrogen therapy (pills, creams, patches, vaginal rings, or gels)
- Polyps: surgically removed, sometimes in a same-day procedure
- Endometrial hyperplasia: treated with progesterone medications and/or surgical procedures
- Cancerous or precancerous changes: may require surgery or other specialized treatments, which are most effective when detected early
Your gynecologist will explain each option, ensuring you understand why a particular treatment or test is recommended.
Don’t ignore bleeding after menopause
Even though most cases of postmenopausal bleeding are not serious, it’s always important to get evaluated. Prompt care can rule out cancer, give you peace of mind, and ensure that if there is a serious condition, it is treated early and effectively.
If you notice bleeding after menopause, schedule an appointment with your doctor right away.