Bleeding After Menopause: What Your Doctor Needs You to Know

We just don’t talk about menopause nearly enough, and it’s time that changes.

Especially around potential health issues like postmenopausal bleeding or bleeding after menopause.

Yes, the menopausal transition is taxing on the body, but it doesn’t mean every concerning condition gets an automatic medical pass.

Say it with us: Common doesn’t mean normal. And heavy postmenopausal bleeding most certainly should not be ignored.

While it might not be a one-size-fits-all situation, having the right information can empower you to take charge of your health and address any concerns ASAP.

So, let’s dive into what you need to know about bleeding after menopause, including when should you worry and when should you go with the, um, flow. 🩸

In this article: 📝

Why am I bleeding after menopause?

Menopause is defined as the time 12 months after you have your last period.

So, when we’re talking about postmenopausal bleeding, we mean any vaginal bleed that happens the year after your last period.

And that includes vaginal spotting or discharge that looks brown, pink, or even orange.

Sure, sometimes it could be down to the tissue of your vagina and vulva now being thinner—vaginal dryness is a very real part of the post-menopause chapter.

So, if you notice some spotting after sex, the friction could be the reason.

Still, it should be more of a whimper than a bang situation.

Once you’ve transitioned into postmenopause territory, any vaginal bleeding could be a sign of a health issue, including endometrial (uterine) cancer.

Just like any other discomforting or alarming sign, it’s important not to ignore it or delay discussing it with your healthcare provider.

All the better for you to be informed and proactive about the very real changes happening in your body.

What does bleeding after menopause mean?

In some cases, postmenopausal bleeding might not be a cause for serious concern.

It could just be down to the thinning or thickening of the uterus lining (atrophic vaginitis)—we’ll explain these in more detail below.

But the American College of Obstetricians and Gynecologists (ACOG) will be the first to tell you, vaginal bleeding years after menopause should always be checked out.

And it’s because there’s a small chance it can be caused by endometrial cancer.

Endometrial cancer only happens in about 9% of women who experience postmenopausal bleeding—but it’s definitely worth investigating.

The sooner you can detect it, the sooner you can prevent it from spreading.

And the more treatment options you will have available to you.

What tests are done for postmenopausal bleeding?

To find out what’s going on, your doctor may perform:

• A pipelle test: This is where they take a sample of the lining of your uterus. They do this by sticking a thin tube into your vagina and up into your uterus.
  
• A hysteroscopy: This is where your doctor looks inside your uterus with a tool called a hysteroscope. Yup, this one is also inserted vaginally.
  
• A D&C: This stands for Dilation and Curette. It’s where your doctor takes a sample of your uterus lining while you are under anesthetic.
  
• An ultrasound: Here, they move what is called a transducer over your belly on the outside to see what’s happening on the inside.

What causes vaginal bleeding after menopause?

Vaginal bleeding after menopause can happen for several reasons, and many of them are easily treatable.

Here are the more common causes:

1. Atrophic vaginitis

As your estrogen levels drop, your vagina responds by thinning, drying, and inflaming.

And yes, it can be as uncomfortable as it sounds—think burning, vaginal itching, and stinging.

It can also mean that you suffer from more frequent urinary tract infections.

In fact, the condition can ignite such a wide range of vaginal and urinary symptoms that doctors often use the term Genitourinary syndrome of menopause (GSM) to describe it.

Alongside changes to your vaginal discharge, frequent peeing, and lack of vaginal lubrication, sex can also be painful (accompanied by spotting).

In terms of treatment, your doctor may offer you hormone therapy (HRT) to up your estrogen levels.

This can come in the form of creams, gels, and skin patches, or a ring that you insert into your vagina.

2. Thinning or thickening of the uterus lining

These both have to do with hormones:

• Thinning of the uterus lining: Also called endometrial atrophy, this is when the tissue (called the endometrium) starts to thin as a response to low estrogen levels. The treatment is usually hormone therapy to up your estrogen levels.
  
• Thickening of the uterus lining: Also known as endometrial hyperplasia, it happens if you have excess estrogen. Sometimes abnormal cells grow. This can be a precursor to cancer, so definitely worth checking it out. Your doctor will likely prescribe hormone therapy to balance things out. In some cases, surgery might be necessary to get rid of some of that thickening.

3. Polyps

Polyps are small growths in the uterus or cervix.

You can also get them in your ear canal, but it’s not likely that this would be the cause of your postmenopausal vaginal bleeding.

The likelihood of getting cervical polyps is much higher after menopause.

If this is what is causing your bleeding, you will likely have to have surgery under a general anesthetic which could put you out of action for a bit.

But, if they’re really small, you can probably have the procedure done under local anesthetic.

Treatment for postmenopausal bleeding

Finding the right treatment for your postmenopausal bleeding is all about addressing the underlying cause.

So, if it’s atrophic vaginitis, topical estrogen can help strengthen the tissue, but for polyps, you might instead require a simple surgical procedure to resolve the bleeding.

As for more serious causes, like endometrial hyperplasia or endometrial cancer, a far more comprehensive approach is taken.

This could involve medication, procedures to remove the affected tissue, or more extensive surgery—it all depends on your overall health, medical history, and your specific diagnosis.

Can postmenopausal bleeding be OK?

Navigating the waves of change during postmenopause can certainly feel like uncharted territory.

And while vaginal bleeding after menopause can (and should) raise eyebrows, it might not always be a cause for alarm.

As potential causes, vaginal dryness and cervical polyps can be relatively straightforward to address.

Still, while some causes are less serious, any postmenopausal bleeding should be a signal to reach out to your healthcare provider—especially if it’s bleeding 2 years after menopause.

And no matter what treatment journey you embark on, keeping communication open with your doctor is essential.

Yes, self-advocacy is uncomfortable and difficult, but it’s worth it if it secures you personalized care.

All the more reason to get you informed, comfortable, and confident in making decisions about your health—that’s exactly what the Peanut community is here for. ❤️