Bleeding after Menopause: Is It Normal?

Bleeding after Menopause: Is It Normal?

Are you bleeding after menopause? 

See your doctor and rule out any serious health condition. Even if you are spotting, it is best to consult with your gynaecologist.

Menopause means you do not get periods continuously for one year, and it is an end to menstruation. Thereafter, you become post-menopause. If you suddenly bleed or spot, it could be due to noncancerous or cancerous reasons. 

Read on to know the causes, diagnosis and treatment for bleeding after menopause.

Causes of Bleeding after Menopause

Postmenopausal bleeding can be caused by noncancerous conditions, such as vaginal atrophy, uterine fibroids, or polyps. It can also be caused by cancerous ailments, such as cervical cancer or endometrial cancer.

Let us learn more about these causes.

Vaginal atrophy – thinning of vaginal tissue is called vaginal atrophy. Post-menopause, the low levels of oestrogen can make your vaginal walls dry, thin and inflamed. This may result in bleeding. Normal levels of oestrogen in your body keep your vaginal walls healthy and moist. 

Endometrial atrophy – thinning of the uterine lining is called endometrial atrophy. When endometrium tissue that lines your uterus becomes thin, you may bleed after menopause.

The endometrium tissue changes in response to oestrogen and progesterone hormones. Oestrogen helps the endometrium lining grow, thicken and prepare the uterus for pregnancy. 

Endometrial hyperplasia – thickening of the uterine lining is called endometrial hyperplasia. After menopause, if your body has high levels of oestrogens and low levels of progesterone hormones, the endometrium tissues become thick and can bleed. 

Endometritis – inflammation of the endometrium, the inner lining of the uterus is called endometritis. This condition may lead to vaginal bleeding, lower abdominal pain, fever or vaginal discharge.

Uterine fibroids – also known as leiomyomas, uterine fibroids are small tumours that grow in the uterus wall. Though these are noncancerous tumours, they can result in significant pain, bleeding, spotting, cramps, abdominal swelling and other uncomfortable symptoms.   

Uterine polyps – polyps are noncancerous tissue growths attached to your uterus or cervical walls or on your cervix. These polyps may result in bleeding, spotting or bleeding after sex.

Cervical cancer – bleeding after menopause could also be due to cervical cancer. Though a rare cause, cervical cancer grows slowly and may result in bleeding. You may also experience pain during intercourse and abnormal vaginal discharge due to cervical cancer.  

Endometrial cancer – cancer of endometrium tissue in the uterus is called endometrial cancer. This condition may cause pelvic pain, abnormal bleeding, weight loss and feeling a mass (tumour). According to, around 10% of women who experience bleeding after menopause suffer from endometrial cancer. 

Uterine sarcoma – it is a disease where cancerous cells grow in the uterus muscles and/or in other tissues that support the uterus. Signs of this cancerous disease include bleeding, pain in the abdomen, mass in the vagina, abdomen fullness and frequent urination.

Diagnosis of Bleeding after Menopause

You doctor will review your medical history and perform a physical exam to understand the cause of bleeding. You may be asked to get some of the following tests done to make a diagnosis:

Ultrasound: you may have to undergo a transvaginal ultrasound to capture any undesirable growths developing on your endometrium. The ultrasound images also help the doctor know the thickness of the endometrium tissues. For this test, a small probe is placed into your vagina to send sound waves that create an image to examination.

Sonohysterography: this test is recommended to measure the size of polyps in your uterus. For this test, a saltwater solution is put inside your uterus to create an ultrasound image.

Endometrial biopsy: your gynaecologist may ask you to get an endometrial biopsy done. This test looks for unusual growths, infections or development of cancerous cells. For this test, a thin tube is used to take a sample of the endometrium tissues in your uterus.  

Dilation and curettage: this test is done to open and examine your cervix. For this test, a thin tool is used to scrape a sample of your uterus lining. The sample is sent to a lab to check the thickness of uterine lining, polyps, or cancer. General or local anaesthesia is used for this test. 

Hysteroscopy: this test is done to examine your uterus from inside. For this test, a thin tube with a camera on one end is put inside the uterus after administering local or general anaesthesia.   

Sexually Transmitted Diseases (STDs): you may also experience spotting and bleeding after menopause due to STDs, such as gonorrhoea and chlamydia.  

Treatment for Bleeding after Menopause

After investigating your problem and establishing the cause of bleeding after menopause, your gynaecologist may discuss the different solutions with you and suggest the best treatment for bleeding after menopause.

  • Estrogen therapy: oestrogen or estrogen therapy is suggested to treat endometrial atrophy and vaginal atrophy. The low-dose oestrogen pills, creams, rings or tablets are used to treat the condition. The low levels of oestrogen present in these forms alleviate the problem and improve vaginal health.  
  • Progestin therapy: progestin therapy is a lab-made treatment for treating endometrial hyperplasia (thickening of the uterine lining). Progestin therapy acts as a progesterone hormone to treat the condition. It is used in the form of a pill, cream, intrauterine device or shot.
  • Dilation and curettage: In this surgery, your gynaecologist opens your cervix after administering local or general anaesthesia to remove polyps from your uterine lining.  
  • Hysteroscopy: in the hysteroscopy, polyps or thickened parts are removed from your uterine lining. Local or general anaesthesia is used to insert a hysteroscope into your vagina and use tiny surgical tools through the tube to remove the polyps.
  • Hysterectomy: the hysterectomy is the surgery where your uterus is removed either in part of full depending on the seriousness of the endometrial or cervical cancer. Hysterectomy is also performed in cases of the precancerous form of endometrial hyperplasia. In some women, your ovaries, fallopian tubes or adjacent lymph nodes are also removed.
  • Radiation therapy or chemotherapy: these therapies are recommended based on the type of cancer and the stage of cancer.  
  • STD Medications: you may be prescribed certain drugs to treat STDs that may also treat uterine and cervical infections.

Bleeding after menopause may be a one-time harmless experience, but, it may cause a lot of confusion in postmenopausal women. So, it is best to visit a doctor and get all the recommended tests done. Rule out all any underlying medical condition and enjoy a healthy life. 

Start taking care of your health on priority and life a healthy life. Eat nutritious food, be physically active, develop a hobby and take dietary supplements. You can take Femarelle Unstoppable, a dietary supplement full of calcium, vitamins D & B, flaxseeds and soy products that improve your vaginal health, reduce vaginal dryness and improve your libido.