What’s postmenopausal bleeding?

Postmenopausal bleeding occurs in a woman’s vagina after she has undergone menopause. Once a woman has gone 12 months without a period, she’s considered to be in menopause.

In order to rule out serious medical problems, women with postmenopausal bleeding should always see a doctor.

What is vaginal bleeding?

Vaginal bleeding can have a variety of causes. These include normal menstrual cycles and postmenopausal bleeding. Other causes of vaginal bleeding include:

  • trauma or assault
  • cervical cancer
  • infections, including urinary tract infections

If you’re experiencing vaginal bleeding and are postmenopausal, your doctor will ask about the duration of the bleed, the amount of blood, any additional pain, or other symptoms that may be relevant.

Because abnormal vaginal bleeding can be a symptom of cervical, uterine, or endometrial cancer, you should get any abnormal bleeding evaluated by a doctor.

Bleeding can occur in postmenopausal women for several reasons. For example, women who take hormone replacement therapy may have vaginal bleeding for a few months after starting the hormones. It’s also possible for a woman who thought she was in menopause to begin ovulating. If this occurs, bleeding may also occur.

There are a variety of other conditions that can cause postmenopausal bleeding.

Some common causes include: polyps, endometrial hyperplasia, and endometrial atrophy.

Uterine polyps

Uterine polyps are noncancerous growths. Though benign, some polyps may eventually become cancerous. The only symptom most patients with polyps will experience is irregular bleeding.

Uterine polyps are particularly common in women who have gone through menopause. However, younger women can also get them.

Endometrial hyperplasia

Endometrial hyperplasia is the thickening of the endometrium. It is a potential cause for postmenopausal bleeding. It is often caused when there is an excess of estrogen without enough progesterone. It occurs frequently in women after menopause.

Long-term use of estrogen can lead to increased risk of endometrial hyperplasia. It can ultimately lead to cancer of the uterus if not treated.

Endometrial cancer

Endometrial cancer begins in the uterus. The endometrium is a layer of the uterus. In addition to abnormal bleeding, patients may experience pelvic pain.

This condition is often detected early. It causes abnormal bleeding, which is easily noticed. The uterus can be removed to treat the cancer in many cases. About 10 percent of women who have postmenopausal bleeding have endometrial cancer.

Endometrial atrophy

This condition results in the endometrial lining becoming too thin. It can occur in postmenopausal women. As the lining thins, bleeding may occur.

Cervical cancer

Bleeding after menopause is often harmless. However, it can also be a rare sign of cervical cancer. Cervical cancer tends to progress slowly. Doctors can sometimes identify these cells during a regular exam.

Annual visits to the gynecologist can help with early detection and even prevention of cervical cancer. This can be done by monitoring for abnormal Pap smears.

Other symptoms of cervical cancer can include pain during sex or abnormal vaginal discharge, including in women who are postmenopausal.

Many women who experience postmenopausal bleeding may not have other symptoms. But symptoms may be present. This can depend on the cause of bleeding.

Many symptoms that occur during menopause, like hot flashes, often begin to decrease during the postmenopausal time period. There are, however, other symptoms that postmenopausal women may experience.

Symptoms postmenopausal women may experience include:

  • vaginal dryness
  • decreased libido
  • insomnia
  • stress incontinence
  • increased urinary tract infections
  • weight gain

A doctor may conduct a physical exam and a medical history analysis. They may also conduct a Pap smear as part of a pelvic exam. This can screen for cervical cancer.

Doctors may use other procedures to view the inside of the vagina and the uterus.

Transvaginal ultrasound

This procedure allows doctors to view the ovaries, uterus, and cervix. In this procedure, a technician inserts a probe into the vagina, or asks the patient to insert it herself.


This procedure shows endometrial tissue. A doctor inserts a fiber optic scope into the vagina and cervix. The doctor then pumps carbon dioxide gas through the scope. This helps to expand the uterus and makes the uterus easier to see.

Treatment depends on the cause of the bleeding, on whether bleeding is heavy, and if additional symptoms are present. In some cases, bleeding may require no treatment. In other situations where cancer has been ruled out, treatment may include the following:

  • Estrogen creams: Your doctor may prescribe estrogen cream if your bleeding is due to thinning and atrophy of your vaginal tissues.
  • Polyp removal: Polyp removal is a surgical procedure.
  • Progestin: Progestin is a hormone replacement therapy. Your doctor may recommend it if your endometrial tissue is overgrown. Progestin can decrease the overgrowth of tissue and reduce bleeding.
  • Hysterectomy: Bleeding that cannot be treated in less invasive ways may require a hysterectomy. During a hysterectomy, your doctor will remove the patient’s uterus. The procedure may be done laparoscopically or through conventional abdominal surgery.

If bleeding is due to cancer, treatment will depend on the type of cancer and its stage. Common treatment for endometrial or cervical cancer includes surgery, chemotherapy, and radiation therapy.

Postmenopausal bleeding may be benign or could be a result of a more serious condition like cancer. Although you may not be able to prevent abnormal vaginal bleeding, you can seek help quickly to get a diagnosis and treatment plan in place, no matter what the cause. When cancers are diagnosed early, the chances of survival are higher. To prevent abnormal postmenopausal bleeding, the best strategy is to reduce your risk factors for the conditions that could cause it.

What you can do

  • Treat endometrial atrophy early in order to prevent it from progressing into cancer.
  • Visit your gynecologist for regular screenings. This can help detect conditions before they become more problematic or result in postmenopausal bleeding
  • Maintain a healthy weight, following a healthy diet and exercising regularly. This alone can prevent a variety of complications and conditions throughout the entire body.
  • If your doctor recommends it, consider hormone replacement therapy. This may help prevent endometrial cancer. There are cons, however, which you should discuss with your doctor.
Was this helpful?

Postmenopausal bleeding is often successfully treated. If your bleeding is due to cancer, the outlook depends on the type of cancer and stage at which it was diagnosed. The five-year survival rate is about 82 percent.

Regardless of the cause of the bleeding, maintain a healthy lifestyle and continue to make regular visits to your gynecologist. They can help detect any other conditions early on, including cancer.