Postmenopausal Bleeding

What is postmenopausal bleeding?

Postmenopausal bleeding is bleeding that occurs after menopause. Menopause is a stage in a woman’s life (around age 51) when reproductive hormones drop and her monthly menstrual periods stop. Vaginal bleeding that occurs more than a year after a woman’s last period isn’t normal. The bleeding can be light (spotting) or heavy.

Postmenopausal bleeding is usually due to benign (noncancerous) gynecological conditions such as endometrial polyps. But for about 10% of women, bleeding after menopause is a sign of uterine cancer (endometrial cancer). Uterine cancer is the most common type of reproductive cancer (more common than ovarian or cervical cancers.) Talk to your healthcare provider if you experience any bleeding after menopause.

Who is more likely to have postmenopausal bleeding?

Anyone can have vaginal bleeding, especially during perimenopause. Perimenopause, the time leading up to menopause, usually occurs between ages 40 and 50. It’s the phase when a woman’s hormone levels and periods start to change.

How common is postmenopausal bleeding?

Postmenopausal bleeding occurs in about 10% of women over 55.

What causes postmenopausal bleeding?

The most common causes of bleeding or spotting after menopause include:

• Endometrial or vaginal atrophy (lining of the uterus or vagina becomes thin and dry).
• Hormone replacement therapy (HRT) (estrogen and progesterone supplements that decrease some menopausal symptoms).
• Uterine cancer or endometrial cancer (cancer in the lining of the uterus).
• Endometrial hyperplasia (the lining of the uterus gets too thick and can contain abnormal cells).
• Uterine polyps (growths in the uterus).

Other causes can include:

• Cervical cancer (cancer in the cervix).
• Cervicitis or endometritis (infection or inflammation in the cervix or uterus).
• Bleeding from other areas, nearby, in the bladder or rectum or bleeding from the skin of the vulva (outside near the vagina).

How do you know the cause of postmenopausal bleeding?

• Identifying the cause of the bleeding can include the following:
• Exam by your provider of the vagina and cervix.
• Pap smear to check the cervical cells.
• Ultrasound, usually using a vaginal approach, which may include the use of saline to make it easier to see any uterine polyps.
• Biopsy of the endometrium or uterus. In this procedure, your healthcare provider gently slides a small, straw-like tube into the uterus to collect cells to see if they are abnormal. This is done in the office and can cause come cramping.

How is postmenopausal bleeding treated?

Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments.

Medications include:

• Antibiotics can treat most infections of the cervix or uterus.
• Estrogen may help bleeding due to vaginal dryness. You can apply estrogen directly to your vagina as a cream, ring or insertable tablet. Systemic estrogen therapy may come as a pill or patch. When estrogen therapy is systemic, it means the hormone travels throughout the body.
• Progestin is a synthetic form of the hormone progesterone. It can treat endometrial hyperplasia by triggering the uterus to shed its lining. You may receive progestin as a pill, shot, cream or intrauterine device (IUD).

Surgeries include:

• Hysteroscopy is a procedure to examine your cervix and uterus with a camera. Your healthcare provider inserts a hysteroscope (thin, lighted tube) into your vagina to remove polyps or other abnormal growths that may be causing bleeding. This can be done in the office for diagnosis. To remove any growths, hysteroscopy is often done in the operating room under general anesthesia.
• Dilation and curettage (D&C) is a procedure to sample the lining and contents of the uterus. Your healthcare provider may perform a D&C with a hysteroscopy. A D&C can treat some types of endometrial hyperplasia.
• Hysterectomy is a surgery to remove your uterus and cervix. You may need a hysterectomy if you have uterine cancer. Your healthcare provider can tell you about the different approaches to uterus removal. Some procedures are minimally invasive, so they use very small cuts (incisions).

When should I contact my doctor?

Contact your healthcare provider if you experience vaginal bleeding:

• More than a year after your last menstrual period.
• More than a year after starting hormone replacement therapy (HRT).

A note from Cleveland Clinic

It’s normal to have irregular vaginal bleeding in the years leading up to menopause. But if you have bleeding more than a year after your last menstrual period, it’s time to see your healthcare provider. It could be the result of a simple infection or benign growths. But in rare cases, bleeding could be a sign of uterine cancer.