Menopause occurs when there has been no menstruation for a year. A period, or any bleeding, after menopause is unusual and may be a sign of a health condition that needs medical attention.

Menopause results from a natural decline in hormones that usually starts when a person is in their 40s. In the United States, it happens on average at the age of 52 years.

Bleeding affects 4–11% of females after menopause, and it can happen for various reasons. Some bleeding stems from a problem in the ovaries or another part of the reproductive system. However, it is possible to confuse this type of bleeding with bleeding from the bladder, urethra, or gastrointestinal tract.

In this article, find out about some possible reasons bleeding may occur after menopause and what to expect when seeking medical help.

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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 most common reason for bleeding after menopause.

What is atrophic vaginitis?

Endometrial hyperplasia

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 lead to endometrial cancer.


Bleeding can be a sign of various types of cancer, including:

Endometrial cancer, or uterine cancer, is cancer of the endometrial lining. Around 1–14% of cases of bleeding after menopause are due to endometrial cancer, and 92% of people with endometrial cancer experience bleeding.


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 can cause pain and bleeding during the reproductive years and after menopause.

What is a polypectomy?


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.

They affect 70% of white Americans and 80% of Black Americans by the age of 50 years. Pain, pressure, and bleeding are common symptoms, but the size of fibroids may decrease after menopause.

Experts have called for more focus on how fibroids affect Black American females. As well as having a disproportionate susceptibility to this disease, Black American females overall have a lower chance of accessing quality care due to racial and socioeconomic disparities.

Learn more about how fibroids affect Black women.


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 causes

Other possible causes include:

Postmenopausal bleeding can also be a side effect of hormone medications, such as tamoxifen, some herbal supplements, and medications that aim to reduce the risk of blood clotting.

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.

Endometrial 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.

Transvaginal ultrasound

In a transvaginal ultrasound, a doctor will inject fluid through the vagina into the uterus and examine the uterus with a special ultrasound probe. It is also called sonohysterography.

An ultrasound test can show whether the uterine lining is thicker or thinner than expected. If the thickness is 4 millimeters or less, the chance is 99% or higher that endometrial cancer is not present.

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.

What are the best and worst lube alternatives?

Endometrial hyperplasia

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.

Endometrial cancer

If tests show that endometrial cancer is present, a doctor will recommend an appropriate treatment plan.

This may include:

The options will depend on individual needs.

A person who receives a diagnosis at the early stage, before cancer has spread, has a 96% chance of surviving another 5 years or longer compared with someone who does not have endometrial cancer. If they receive a diagnosis when cancer has spread throughout the body, the chance is 20%.

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 5% of polyps contain cancerous cells.

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.

How can you reduce fibroid pain?


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 1–14% of cases are related to endometrial (uterine) cancer. For this reason, it is essential to seek medical advice if any bleeding occurs after menopause.

How common is postmenopausal bleeding?

Postmenopausal bleeding affects around 4–11% of people, and 1–14% of cases stem from endometrial cancer.

Less than 11% of females experience vaginal bleeding after menopause. It usually indicates a health issue. Some causes, such as atrophy, are benign and may not need treatment. However, bleeding may indicate a more serious condition, such as endometrial cancer.

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.