Bleeding after menopause: what does it mean?

Medically reviewed by Rosanna Sutherby, PharmD on March 25, 2021. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


Menopause marks the end of a woman’s menstrual cycles, meaning that you shouldn’t have a period anymore. However, some women still experience bleeding after menopause.

Taking an at-home postmenopause test can help you to better understand your menopausal state. If you find that you are in postmenopause, read on to learn more about whether it’s normal to bleed after going through menopause, what can cause postmenopausal bleeding, and how doctors can treat vaginal bleeding after menopause.

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What is menopause?

Doctors say that a woman has gone through menopause after she hasn’t had a menstrual period in 12 months. The years approaching menopause are known as perimenopause, or the menopausal transition. For most women, this transition occurs between the ages of 45 and 55, and it can last seven to 14 years. This early stage can also cause changes in hormone levels, which is why it’s important to check your health with a perimenopause test if symptoms arise during this stage.

During the menopausal transition, you may notice changes in your monthly cycle and symptoms like hot flashes. Abnormal perimenopausal bleeding, including spotting between periods and irregular bleeding, is also common. However, once you begin to experience postmenopause symptoms, all uterine bleeding and period-related symptoms should stop.

Related: What is postmenopause?

Is it normal to bleed years after menopause?

The short answer to this question is no. Postmenopausal women shouldn’t experience bleeding because menopause is the end of a woman’s menstrual cycle. While some women do experience postmenopausal vaginal bleeding, this type of bleeding isn’t normal. As a result, you should visit your doctor if you’re still bleeding as a postmenopausal woman.

What is the most common cause of postmenopausal bleeding?

According to an analysis published in JAMA Internal Medicine, abnormal vaginal bleeding after menopause is typically caused by a noncancerous condition. Some of the most common examples include vaginal atrophy (atrophic vaginitis), endometrial atrophy, uterine fibroids, and endometrial polyps.

  • Vaginal and endometrial atrophy: As estrogen hormone levels decrease, the uterine lining (endometrium) and vaginal tissue typically become thinner. This is known as atrophy, and it can cause postmenopausal bleeding.
  • Uterine polyps and fibroids: Polyps and fibroids are noncancerous growths that grow in the uterus. These similar but distinct growths can both cause abnormal bleeding after menopause.

While these conditions are all common causes of postmenopausal bleeding, they aren’t the only ones.

What other conditions can cause bleeding after menopause?

Some other conditions can cause abnormal uterine bleeding after menopause.

  • Endometrial hyperplasia, or the overgrowth of the cells lining the uterus
  • Infection of the uterine lining
  • Injury or trauma to the pelvic area
  • Certain medications, including hormone therapy and tamoxifen
  • Endometrial cancer, or uterine cancer
  • Cervical cancer

In most cases of postmenopausal bleeding, the cause is harmless. However, medical experts still recommend visiting your doctor to rule out more serious causes of abnormal bleeding, such as endometrial carcinoma.

Is bleeding after menopause always cancer?

While cancer isn’t the only or even the most common cause of postmenopausal bleeding, it’s still important to see your doctor if you have bleeding after menopause. More than 90% of women who have endometrial cancer experience abnormal vaginal bleeding and early diagnosis greatly increases the likelihood of successfully treating cancer.

How do doctors diagnose bleeding after menopause?

To find the cause of abnormal vaginal bleeding, your doctor will perform a physical exam and ask about your family and health history. He or she may also order a transvaginal ultrasound or an endometrial biopsy.

Transvaginal ultrasonography allows your doctor to assess your uterine cavity and endometrial thickness. He or she can also examine your fallopian tubes and ovaries. During this procedure, your doctor or an ultrasound technician will place an instrument into the vagina to examine the uterine cavity and endometrial lining. This instrument will emit sound waves that bounce off the pelvic organs. These sound waves get sent to a nearby computer and create a picture called a sonogram.

Endometrial biopsy, or endometrial sampling, involves removing a small piece of the endometrial lining. After taking the sample, the doctor will send it to the lab. There, the scientists will look for anything abnormal, including signs of infection or cancer.

What treatments are available to help with postmenopausal bleeding?

The treatments for bleeding after menopause vary depending on what’s causing the issue, which is why it’s so important to get the right diagnosis.

  • Doctors can remove polyps using a minimally invasive procedure called hysteroscopy.
  • Medications and hormone replacement therapy can treat vaginal and endometrial atrophy.
  • Progesterone hormone therapy is an effective treatment for endometrial hyperplasia.
  • Dilation and curettage (D&C) can also help with endometrial hyperplasia by removing the excess tissue from inside the uterus.

If cancer is responsible for the abnormal bleeding, your doctor can treat it with a hysterectomy. This surgical procedure involves removing the uterus. In some cases, your doctor may also recommend removing the cervix, fallopian tubes, and ovaries as part of the hysterectomy.

Related: The benefits of progesterone after menopause

Learn more about your postmenopausal health with the Everlywell at-home Postmenopause Test. This postmenopause test can help you to understand if your postmenopausal bleeding is caused by imbalanced hormone levels by allowing you to easily check your estradiol and progesterone levels from the comfort of home.

References

1. What Is Menopause?. National Institute of Aging. URL. Accessed March 25, 2021.

2. Bleeding after menopause: Is it normal?. Mayo Clinic. URL. Accessed March 25, 2021.

3. Bleeding after menopause: Get it checked out. Harvard Medical School. URL. Accessed March 25, 2021.

4. Postmenopausal bleeding: Don’t worry — but do call your doctor. Harvard Medical School. URL. Accessed March 25, 2021.

5. Abnormal uterine bleeding in peri- and postmenopausal women. Harvard Medical School. URL. Accessed March 25, 2021.

6. Study Provides Closer Look at Postmenopausal Bleeding and Endometrial Cancer. National Cancer Institute. URL. Accessed March 25, 2021.

7. The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. American College of Obstetricians and Gynecologists. URL. Accessed March 25, 2021.

8. Perimenopausal Bleeding and Bleeding After Menopause. American College of Obstetricians and Gynecologists. URL. Accessed March 25, 2021.

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