Bleeding after menopause

What it is

Postmenopausal bleeding is any bleeding from the vagina after someone has gone 12 months without a period.¹ It always needs checking by a doctor, even if it's light, happened only once, is spotting or brown discharge, or you're not sure it's blood.^1,2

Myth: A little spotting after menopause is nothing to worry about.

It's easy to brush off, especially if it's light or doesn't come back. Most of the time it isn't serious, but because it can be a sign of cancer, every episode should be checked.¹

Common causes

thinning and inflammation of the vaginal lining or the uterine lining, from lower estrogen¹
polyps in the uterus or on the cervix, usually not cancer¹
a thickened uterine lining, called endometrial hyperplasia, which can come from hormone therapy, high estrogen levels or being overweight¹

Less often, it's caused by cancer of the uterus or ovaries.¹ Unusual bleeding can be an early sign of endometrial cancer, which mostly affects people in their mid-60s after menopause. It's usually found early, when treatment works best.³

Tests

a speculum exam and a check of the pelvis and belly¹
a vaginal ultrasound to look at the uterine lining¹
sometimes a hysteroscopy, a thin camera passed through the cervix, which can also take a small tissue sample (a biopsy)¹

On hormone therapy

If you're taking hormone therapy, talk to a doctor if irregular or heavier bleeding or spotting continues after 6 months on it.²

Recap

Any bleeding after 12 months without a period needs checking, even if it's light, brown or happened once.
Common causes are thinning of the vaginal or uterine lining, polyps and a thickened lining.
It can be an early sign of uterine cancer, which mostly affects people in their mid-60s.
Tests include a vaginal ultrasound, and sometimes a hysteroscopy and biopsy.

Words to know 4

endometrial cancer	Cancer of the lining of the uterus. Most cases are after menopause.
endometrial hyperplasia	A thickened lining of the uterus, which can come before cancer.
hysteroscopy	A procedure that uses a thin camera passed through the cervix to look inside the uterus.
postmenopausal bleeding	Any bleeding from the vagina after 12 months without a period.