Bleeding after menopause can be surprising—and sometimes frightening. While it’s not always a sign of something serious, it should never be ignored.
Menopause is defined as the absence of menstrual periods for 12 consecutive months, marking the end of a woman’s reproductive years. So if you experience vaginal bleeding after this phase, it's known as postmenopausal bleeding (PMB)—and it always warrants medical evaluation.
Common Causes of Bleeding After Menopause
There are several possible reasons why postmenopausal bleeding may occur:
1. Thinning of the Vaginal or Uterine(Womb) Lining (Atrophy)
With decreased estrogen levels after menopause, the vaginal and uterine tissues become thinner and more fragile. This can lead to bleeding, spotting, or irritation, especially during or after intercourse.
2. Polyps
These are noncancerous growths that can form on the cervix or inside the uterus. Polyps are a common cause of bleeding after menopause and are generally benign but may need to be removed.
3. Endometrial Hyperplasia
This is a condition where the lining of the uterus becomes too thick, often due to an imbalance of estrogen and progesterone. In some cases, hyperplasia can progress to or signal an early stage of endometrial cancer.
4. Uterine or Endometrial Cancer
Although rare, postmenopausal bleeding can be the first sign of uterine or endometrial cancer. This is why it’s crucial not to delay seeing a healthcare provider if bleeding occurs.
5. Hormone Replacement Therapy (HRT)
Some women take estrogen or a combination of estrogen and progesterone to manage menopausal symptoms. This can sometimes cause light or irregular bleeding, particularly when the therapy is first started.
When to See a Doctor
The golden rule? Any bleeding after menopause should be evaluated by the doctor. It doesn't matter if it's light, occasional, or painless—it's not considered normal and should be checked.
You should seek medical attention if you notice:
- Spotting or bleeding months or years after menopause
- Bleeding after sex
- A sudden return of menstrual-like bleeding
- Brown or pink discharge
How Is It Diagnosed?
Your doctor will likely recommend:
- Pelvic exam
- Transvaginal or pelvic ultrasound to check the thickness of the uterine lining
- Endometrial biopsy to examine the uterine tissue
- Pap smear or cervical screening
These tests help identify the exact cause and rule out or detect cancer early—when treatment is most effective.