Bleeding after menopause
Seeing blood after your periods have stopped is unsettling. Most of the time the cause is harmless, but it should always be checked. Here's what to expect.
The short answer: any vaginal bleeding or spotting after you've gone 12 months without a period should be checked within a few days. Most of the time the cause is harmless, such as thin, dry tissue or a polyp. In a large review, about 9 in 100 women with postmenopausal bleeding had uterine cancer, which means most did not, and when cancer is found this way it's usually early and highly treatable.
Seek urgent care for heavy bleeding, or if you feel dizzy or faint.
Common causes
Thin, dry tissue
The most common cause. Low estrogen thins the lining of the vagina and uterus, which can bleed easily, especially after sex. Vaginal health
Polyps
Small, usually benign growths in the uterus or cervix that can bleed. They're often simple to remove.
Hormone therapy
Spotting is common in the first months of continuous therapy, and a monthly bleed is expected on cyclic regimens.
Thickened lining
The uterine lining can overgrow, sometimes with precancerous changes that are very treatable when found.
Infection or irritation
Of the vagina or cervix, sometimes after a new product or sexual activity.
Uterine cancer
The reason bleeding is always checked. Found early, often because of this very symptom, it has a high cure rate.
What happens next
Bleeding after menopause is evaluated by a gynecologist. When you call us, we arrange a prompt referral and send along your history, including any hormones you take. Here is what the evaluation usually involves:
- A conversation and exam
When the bleeding started, how much, whether you take hormones, and a pelvic exam to look for a source such as dry tissue or a cervical polyp.
- A transvaginal ultrasound
Measures the thickness of the uterine lining. A thin lining is reassuring.
- A closer look, if needed
A small sample of the lining for testing (an endometrial biopsy, usually a quick in-office procedure), or a look inside the uterus with a thin camera (a hysteroscopy).
We stay involved throughout: the results come back to us too, and we go over them with you and fold them into the rest of your care.
Call us. Most answers are reassuring.
If you've noticed bleeding after menopause, call (908) 450-7002 and we'll arrange a prompt gynecology evaluation and stay with you through the results.
If you're on hormone therapy
Bleeding patterns on hormone therapy depend on the type you take:
- Cyclic therapy (progesterone for part of each month): a light monthly bleed is expected.
- Continuous combined therapy (both hormones every day): irregular spotting is common for the first three to six months, then usually stops.
Call if bleeding is heavy, continues beyond about six months, or starts after a long bleed-free stretch. It's usually the hormones, but it still needs checking. HRT side effects
Don't wait and see
It's tempting to hope a bit of spotting will go away on its own, especially if it's light and doesn't happen again. Please call anyway. A quick evaluation usually brings reassurance, and in the uncommon cases where something is found, finding it early makes all the difference.
Keep reading
Postmenopausal bleeding questions
Is bleeding after menopause always serious?
No. Most of the time the cause is harmless, most often thin, dry vaginal or uterine tissue, or a polyp. But because a small share of cases are caused by uterine cancer or precancerous changes, any bleeding after menopause should be checked promptly.
How common is cancer as a cause of postmenopausal bleeding?
In a large review of studies, about 9 in 100 women with postmenopausal bleeding were found to have endometrial cancer, which means the large majority were not. When it is found this way, it's usually at an early, highly treatable stage.
Is spotting on hormone therapy normal?
Some irregular spotting is common in the first three to six months of continuous combined hormone therapy, and a monthly bleed is expected on cyclic regimens. Bleeding that is heavy, persists beyond about six months, or starts after a long bleed-free stretch should be checked.
What tests are done for bleeding after menopause?
It's evaluated by a gynecologist, and we arrange the referral promptly. The evaluation usually starts with a pelvic exam and a transvaginal ultrasound to measure the thickness of the uterine lining, and may include a small sample of the lining (endometrial biopsy) or a hysteroscopy.
How soon should I be seen?
Call us within a few days of noticing any bleeding after you've gone a year without a period, and we'll arrange a prompt gynecology evaluation. Seek urgent care for heavy bleeding, dizziness or fainting.
- Clarke MA, et al. Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis. JAMA Intern Med 2018;178(9):1210–1222.
- The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society. Menopause 2020;27(9):976–992.
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767–794.
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