Menopause occurs when there has been no menstruation for a year. After menopause, bleeding is unusual. If it does happen, it may be a sign of a health condition that needs medical attention.
In this article, find out about some possible reasons bleeding may occur after menopause and what to expect when seeking medical help.
Postmenopausal bleeding can stem from a range of issues.
Common causes include:
Endometrial or vaginal atrophy
Around the time of menopause, the body stops producing the hormone estrogen. As a result, the linings of the vagina and uterus become thinner and more likely to bleed. This is the
This condition causes the uterine lining to become thicker instead of thinner, and bleeding can result. A person with this condition usually has too much estrogen and not enough of the hormone progesterone to offset it. Endometrial hyperplasia can sometimes
Bleeding can be a sign of various types of cancer, including:
- endometrial (uterine) cancer
- ovarian cancer
- vaginal cancer
- colorectal cancer or another gastrointestinal cancer, if the bleeding is from the rectum
- bladder cancer, if blood leaves the body with urine
Endometrial cancer, or uterine cancer, is cancer of the endometrial lining. Around
Endometrial polyps are growths that develop on the lining of the uterus. Most are not cancerous, but they can cause unusual or heavy bleeding. Polyps can sometimes grow inside the cervical canal. They
Submucous leiomyomas, also known as uterine fibroids, are benign or noncancerous tumors that grow on smooth muscle. They can happen during the reproductive years or after menopause.
Bleeding may result from infections of the uterus or cervix, such as:
- cervicitis, an infection of the cervix
- endometritis and infection of the lining of the uterus
- cystitis, a bladder infection
Cystitis is a urinary tract infection. The bleeding will not be vaginal, but it can be hard to tell.
Other possible causes include:
- urethral carbuncle
- clotting problems
- trauma to the pelvis
- thyroid disorders
Gastrointestinal bleeding often results from hemorrhoids but may be a sign of other health issues. People may confuse it with vaginal bleeding.
No type of bleeding should occur after menopause.
A person should consult a doctor if they notice:
- any instance of bleeding
- small amounts or spotting of blood
- brown or pink discharge
- something that may or may not be blood
It is essential to seek medical help and advice if any bleeding occurs to rule out less likely but more serious conditions.
A doctor will start a diagnosis by asking the person about their symptoms. They may ask:
- when the symptoms first appeared
- when they notice the bleeding, for example, after sex or when wiping
- how much bleeding occurs, for example, spotting or a flow of blood
- what a person’s personal and family medical history involves
They will also carry out a physical exam.
Depending on the symptoms, a doctor may recommend one or more tests, such as:
Dilation and curettage (D and C)
A D and C involves dilating or widening the cervix to obtain a tissue sample. The doctor will use a special tool called a hysteroscope to see inside the uterus, identify potential growths, and take a tissue sample for a biopsy.
The doctor will insert a small, thin tube into the vagina as far as the cervix to take a sample of tissue lining from the uterus. The biopsy sample will go to a laboratory for testing.
The doctor inserts a tool with a thin, lighted camera through the cervix and into the uterus. They will use it to examine the uterus and its lining. A hysteroscopy can help identify polyps or other growths.
An ultrasound test can show whether the uterine lining is thicker or thinner than expected. If the thickness is
Treatments for postmenopausal bleeding will depend on the cause.
A doctor can consider the information gathered from the testing to work out the best course of treatment. Some examples of treatments for specific underlying causes include:
Endometrial or vaginal atrophy
Bleeding usually resolves on its own, but a doctor may recommend treatment to protect the vagina, such as:
- lubricants to use during sex
- topical hormones, such as estrogen or DHEA, as a cream to apply to the vagina
- oral hormones, such as ospemifene (Osphena), to take as a tablet
Hormonal medications can reduce the effects of thinning tissues.
Treatment options include hormonal medications known as progestins. These can help prevent the endometrial lining from becoming too thick. A doctor may also recommend regular testing for cancerous cells inside the uterus.
If tests show that endometrial cancer is present, a doctor will recommend an appropriate treatment plan.
- surgery to remove the uterus, known as a hysterectomy, and any nearby lymph nodes where cancer may have spread
- radiation therapy
- hormone therapy
- targeted therapy
The options will depend on individual needs.
A person who receives a diagnosis at the early stage, before cancer has spread, has a
For this reason, it is essential to seek help as soon as possible if bleeding or other symptoms occur.
Treatment of polyps may include surgical removal of the polyps so they can no longer bleed. Around
A doctor will sometimes recommend a risk-reducing surgery, especially if the person has large polyps, obesity, or type 2 diabetes, or is using tamoxifen. These are all risk factors for uterine cancer.
A doctor may remove or ablate fibroids during a hysteroscopy. If this does not help and fibroids are troublesome, the person may undergo a hysterectomy.
If a bacterial infection is present, a doctor will prescribe antibiotics.
Here are some questions people often ask about postmenopausal bleeding.
What is the most common cause of postmenopausal bleeding?
Vaginal or endometrial (uterine) atrophy is the most common cause. This is when the lining of the uterus or vagina becomes thin due to reduced estrogen levels. However, bleeding can indicate a more serious condition, such as cancer.
Should I worry about postmenopausal bleeding?
Often, the cause is not serious, but
How common is postmenopausal bleeding?
It is best to speak with a doctor if bleeding occurs after menopause to identify the reason, get appropriate treatment, and rule out serious conditions.