In the years leading up to menopause, your estrogen and progesterone levels start to drop. This can cause numerous changes to your vagina, cervix, and uterus.
You’ve officially reached menopause when you haven’t had a period in 12 months. Any spotting or bleeding after that is called postmenopausal bleeding, and it means that something isn’t right.
Continue reading to learn the causes of bleeding after menopause and when you should seek medical attention.
Although the vagina has less moisture after menopause, you might still have some discharge. This is perfectly normal.
A thinner vaginal lining is more easily irritated and more vulnerable to infection. One clue that you have an infection is a thick, yellow-white discharge.
Fresh blood looks bright red, but older blood turns brown or black. If you notice spots of brown or black in your underwear, it’s most likely blood. The discharge may be lighter in color if you also have yellow or white discharge due to infection.
A variety of things might cause brown spotting after menopause.
Vaginal bleeding can be a side effect of hormone replacement therapy (HRT). Continuous low-dose HRT can cause light bleeding or spotting for several months after you start taking it. Cyclic HRT can cause bleeding similar to that of a period.
The reason this happens is that HRT can lead to thickening of the uterine lining, known as endometrial hyperplasia. Endometrial hyperplasia can cause spotting or heavy bleeding. It’s usually the result of too much estrogen and not enough progesterone.
Some women with endometrial hyperplasia develop abnormal cells, which is called atypical hyperplasia. It’s a condition that can lead to uterine cancer. Abnormal bleeding is the most obvious sign of endometrial cancer. Early diagnosis and treatment can prevent this type of cancer from developing.
Vaginal and uterine tissue thinning
Decreasing levels of hormones can cause thinning of the vaginal lining (vaginal atrophy) or uterus (endometrial atrophy).
Vaginal atrophy causes the vagina to be less flexible, drier, and less acidic. The vaginal area can also become inflamed, a condition known as atrophic vaginitis. In addition to discharge, this can cause:
Polyps are noncancerous growths in the cervix or uterus. Polyps that are attached to the cervix may cause bleeding following intercourse.
Cancer of the cervix or uterus
Bleeding is the most common symptom of uterine cancer. Other symptoms include painful urination, pelvic pain, and pain during intercourse.
Bleeding after menopause isn’t normal, so it’s best to have it checked out. An exception might be if you’re on HRT and have been advised that it’s a potential side effect. Still, if spotting and bleeding are heavier and longer lasting than you expected, see your doctor.
Vaginal spotting or bleeding will likely turn out to be benign. But it’s important to check for serious problems or conditions that can be prevented with early treatment.
Depending on other symptoms or known health conditions you have, your doctor may:
- ask about your medical history and current medications
- do a physical examination, including a pelvic exam
- take a swab to check for infections
- perform a Pap test to check for cervical cancer cells.
- take a blood sample
- do a pelvic ultrasound or hysteroscopy to get images of your cervix, uterus, and ovaries
- take a tissue sample, also known as a biopsy, to check for cancerous cells
- perform a dilation and curettage (D & C) to scrape the inner walls of your uterus so that tissue samples can be checked for cancer
Some of these tests can be done right away in your doctor’s office. Others may be scheduled as an outpatient procedure at a later date.
Spotting can be treated, but it depends on the cause.
There are a number of treatments for thickening of the endometrium. For mild thickening, your doctor may take a wait-and-see approach. If your bleeding is due to HRT, you may have to adjust your treatment or stop it altogether. Otherwise, treatment options include:
- hormones in the form of oral tablets or intrauterine system implant
- hysteroscopy or D & C to remove the thickening
- surgery to remove the cervix, uterus, and ovaries, which is called a total hysterectomy
Endometrial hyperplasia raises your risk of endometrial cancer, so it’s important to monitor your condition.
Atrophic vaginitis or endometrium
Estrogen therapy is the usual treatment for atrophic vaginitis or endometrium. It’s available in many forms such as:
- skin patches
Another option is to use a soft, flexible vaginal ring, which slowly releases the hormone.
If you have a mild case, it may not require treatment at all.
Polyps are usually surgically removed. Cervical polyps can sometimes be removed in a doctor’s office. Using small forceps, your doctor can twist the polyp off and cauterize the area.
Endometrial cancer usually requires a hysterectomy and removal of nearby lymph nodes. Additional treatment may include chemotherapy and radiation therapy. When caught early, it’s highly curable.
Menopause is different for every woman. You can’t prevent most of the problems associated with spotting. But there are some things you can do to get an early diagnosis and treat them before they get worse, including:
- Getting a yearly checkup. If you’re at high risk for cervical or uterine cancer, ask your doctor how often you should get a Pap smear and pelvic exam.
- Reporting unusual discharge, spotting, or bleeding to your doctor right away, especially if accompanied by pain or other symptoms.
- Telling your doctor if intercourse is uncomfortable or painful.
It’s worth consulting with your doctor for any brown, black, or red spotting after menopause.
Once you find the cause, they can recommend the best way to treat it. In most cases, treatment will resolve the problem.
Spotting can be troublesome at any age, and so can other vaginal irritations. To make life a little easier, follow these tips:
- Wear a light menstrual pad every day to protect your clothing. It will help you avoid getting caught off guard in public or staining your favorite clothes.
- Wear breathable cotton underwear or underwear with a cotton crotch.
- Avoid clothing that is tight in the crotch.
- Avoid harsh or fragranced soaps and menstrual products that can irritate your thinning vaginal tissues.
- Don’t douche. It can cause irritation and spread bacteria.
- Avoid strong laundry detergents.