What are the causes of postmenopausal bleeding?
Bleeding after menopause isn’t usually caused by something serious. But it’s important to have it checked by your doctor, as it can sometimes be a sign of problems with your womb lining (endometrium) – including cancer.
Here are the most common causes of bleeding after menopause.
Changes to your vaginal tissue
After the menopause, you have lower levels of the hormone estrogen – which can cause your vagina to become thinner, drier and sore (inflamed). This can sometimes lead to light bleeding after sex, because your tissues tear more easily.
- this change in your vaginal tissues is known medically as ‘vaginal atrophy’ or ‘atrophic vaginitis’
- it’s the most common cause of bleeding after menopause
- it can also cause vaginal itching and discharge, and pain during sex, and make you make likely to get urinary tract infections (UTIs)
- you may start to notice these symptoms in the years leading up to menopause, or only get them several years after your last period
Read more about menopause and vaginal dryness.
Polyps are small growths that can happen in the entrance to your womb (cervix) or womb lining (endometrium). They’re more common as you get older, and during and after the menopause.
They can cause vaginal bleeding because they irritate and rub against the tissue around them, which can expose tiny blood vessels that then bleed.
They’re a bit like skin tags, and they’re usually not harmful (benign).
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) is a treatment that can reduce or prevent menopause symptoms – such as vaginal dryness, hot flushes and mood swings – by restoring your hormone levels.
If you want to try it, your doctor will advise on the best type of HRT for you. Depending on the type you use, you may be expected to have a ‘withdrawal bleed’ – like a period – each month.
You may also find you get some unexpected bleeding with HRT, especially when you first start taking it.
But if this doesn’t settle down within the first 3 months, or if you notice new, irregular or heavy bleeding when you’re on HRT, see your doctor.
Thickening of the womb lining
A thickened womb lining – known as ‘endometrial hyperplasia’ – can happen when you have too much estrogen and not enough progesterone. It usually happens after the menopause, but it can also happen in the perimenopause.
A thickened womb lining often causes unusual vaginal bleeding, such as very heavy periods during the perimenopause or bleeding after the menopause.
It can also be caused by obesity, and is more common if you have polycystic ovary syndrome (PCOS).
Some medications can also cause it, including HRT and certain breast cancer medications, such as tamoxifen.
Fibroids are growths of muscle that can happen in the wall of your womb. They’re common, particularly after the age of 40.
Sometimes, a fibroid can bulge into the lining of your womb and cause bleeding.
Less common causes of bleeding after the menopause
Less commonly, PMB can be caused by cancers of the endometrium, cervix, vagina or, very rarely, ovaries.
About 1 in 10 people with postmenopausal bleeding have cancerous cells in their womb lining (which means 9 in 10 don’t).
Risk factors for endometrial cancer include increasing age, taking estrogen-only HRT, going through the menopause late, PCOS, high blood pressure and infertility.
Medications that thin your blood (anticoagulants) are another possible cause of vaginal bleeding after the menopause.