Postmenopausal vaginal bleeding can raise a lot of concern for women. Indeed, once you reach menopause, the last thing you expect to see blood in your underwear. That ship should have sailed. Vaginal bleeding after menopause is not normal, but don’t panic. If you notice bleeding, even if it is just spotting, follow up with your doctor.
What causes vaginal bleeding after menopause?
It is important to familiarize yourself with what causes vaginal bleeding after menopause has been reached. Menopause is determined when a woman has gone 12 consecutive months without a period. If you have reached this point and have vaginal bleeding anytime after you have hit menopause, there are a few conditions that may be responsible.
Atrophy(or thinning) of the vaginal lining
Atrophy of the endometrial lining
Uterine or cervical polyps
Thickening of the uterine lining
Sexually transmitted infections
Certain medications including HRT
The cause for alarm lies in the potential that postmenopausal vaginal bleeding may from cancer in your reproductive tract. This is because postmenopausal vaginal bleeding is noted in women who have endometrial, uterine, and cervical cancers. However, most cases of vaginal bleeding after menopause are from non-cancerous sources like vaginal wall atrophy.
Given that postmenopausal vaginal bleeding is not normal, it is important to always see your doctor at any sign of bleeding. Even though the likelihood of cancer is low, bleeding may be your only indication that something is amiss in the early stages. Therefore, it is important to identify the cause of vaginal bleeding in order to treat the underlying issue and put your mind at ease.
So, what is the most common cause of postmenopausal bleeding?
The main culprit behind vaginal bleeding after menopause is usually atrophy of your vaginal or endometrial lining. Estrogen is responsible for keeping your tissues healthy in your uterus and vagina. When estrogen falls to low levels in postmenopausal women, it can cause thinning, dryness, and inflammation. This can lead to bleeding, especially if the skin is irritated by something such as intercourse.
Other common causes of postmenopausal bleeding include uterine or cervical polyps that are usually not cancerous. Endometrial hyperplasia, or thickening of the uterine wall, is also a common cause of vaginal bleeding and is usually the result of hormone replacement therapy (HRT).
How is postmenopausal vaginal bleeding diagnosed?
Your doctor will likely do a few different tests to identify the cause of your bleeding. These tests may include a vaginal ultrasound, a pelvic exam, and possibly a hysteroscopy. This is a procedure that allows your doctor to see inside your uterus with a small camera at the end of a scope.
Vaginal bleeding after menopause and hysterectomy
Many women have hysterectomy surgery for a variety of reasons. It is common to experience some bleeding after surgery, even if you are already menopausal. If you have a hysterectomy before you reach menopause, you should not bleed with cycles as you no longer have your uterus.
Bleeding is normal in the days and weeks following surgery and it should get lighter over time. However, it should stop by six weeks after surgery. If you continue to bleed or have bleeding any time after a hysterectomy, this is not normal and needs to be evaluated by a doctor.
To recap: Vaginal bleeding after menopause is not normal. While the likelihood of cancer is low, it is important to rule it out. Cancer is easier to treat in the early stages. Always see your doctor for postmenopausal bleeding even if:
It only happened one time
You are not even sure if it was blood
There was only a tiny amount of blood in your discharge (which may be pink, red, or brown)
You feel totally fine
Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.
Meet the Author
Perry Babe Julia ( RN, BSN, BA) is a registered nurse based in Colorado. Julia's nursing background in women’s health has ranged from neonatal and postpartum care to labor and delivery, to outpatient gynecological medicine for both adolescent and adult populations.
Much of her education and clinical experience are related to educating women on women’s health topics ranging from lifestyle improvements, disease management, and general health education.