We just don’t talk about menopause nearly enough, and we’re thinking it’s time that changes. So, first topic of conversation: postmenopausal bleeding, or bleeding after menopause. Is it a thing? What causes it? And… Can periods restart after menopause?
When should you worry and when should you go with the, um, flow? 🩸
Why am I bleeding after menopause?
Menopause is defined as the time 12 months after you have your last period. (We give it a year’s grace because some spotting is pretty common in that timeframe. It’s sort of more of a whimper than a bang situation.) So bleeding after menopause technically means bleeding after that 12 month period after your last period.
And, yes, it can happen.
Is bleeding after menopause serious?
In most cases, postmenopausal bleeding is not a cause for serious concern. For example, it might be caused by thinning or thickening of the uterus lining, or atrophic vaginitis. We’ll explain these in more detail later. But bleeding after menopause should always be checked out, 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.
To find out what’s going on, your doctor may perform:
A pipelle test 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 where your doctor looks inside your uterus with a tool called a hysteroscope. Yup, this one is also inserted vaginally.
A D&C (which stands for Dilation and Curette) where your doctor takes a sample of your uterus lining while you are under anesthetic.
An ultrasound where they move what is called a transducer over your belly on the outside to see what’s happening on the inside.
What is the most common cause of postmenopausal bleeding?
Vaginal bleeding after menopause can happen for several reasons. Most of them are easily treatable. Here are the more common causes:
- 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, itching, stinging. It can also mean that you suffer from more frequent urinary tract infections. Sex may be painful and accompanied by spotting.
Your doctor may offer you hormone therapy to up your estrogen levels. This may come in the form of creams, gels, and skin patches, or a ring that you insert into your vagina.
Thinning or thickening of the uterus lining—both of which have to do with hormones:
Thinning of the uterus lining (AKA endometrial atrophy) 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 (AKA endometrial hyperplasia) 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.
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 them is much higher after menopause. If this is what is causing your bleeding, you will likely have to have surgery. If they’re really small, you can probably have the procedure done under local anesthetic. If not, you may have to have a general aesthetic which could put you out of action for a bit.
So, bottom line: chances are your postmenopausal bleeding is caused by something easily treatable. But it’s always worth checking it out.