Any unexplained vaginal bleeding can feel worrying, including postmenopausal bleeding. The good news is that many causes can be easily dealt with. Less commonly, there can be serious reasons for bleeding after menopause, so always get checked by a doctor. Here’s the lowdown.
Menopause is the time in your life when your periods stop. Before stopping altogether, they usually become less regular over a few months or years (though they can also stop suddenly) – this time is known as perimenopause.
“Once you’ve been through menopause, you can wave goodbye to periods,” says Dr Ann Nainan, family doctor and Healthily expert. “But sometimes, you may still get bleeding or ‘spotting’ (light bleeding).”
“The first thing that’s important is to understand when you’re actually ‘postmenopausal’,” says Dr Ann.
“You may think you’re having a period after menopause, but you may actually still be in the perimenopause – during this time, irregular bleeding is common, and you may go for several months without having a period. So the bleeding may be a normal part of your transition towards menopause.”
Here’s what you need to know:
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.
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.
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) 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.
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 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.
Always see your doctor or ob-gyn if you notice any vaginal bleeding after the menopause. They can rule out serious causes, and help you figure out what’s going on.
You should also see a doctor if you notice:
You should call an ambulance or go to the emergency room if you have:
The treatment for PMB depends on what’s causing it.
“Don’t just put up with this – there are things you can do to prevent annoying bleeding and discomfort, and enjoy sex again,” says Dr Ann.
The options include vaginal moisturizers, special lubricants you can use during sex, estrogen you use in your vagina, and HRT.
Read more about [treatments for vaginal dryness](/self-care/menopause-vaginal-dryness-symptoms-causes-and-treatment/#Treatments your doctor can prescribe for vaginal dryness).
Polyps don’t always need treatment, especially if they’re small, and they sometimes go away on their own.
If they do need treating, they’re usually removed with surgery. Depending on their size and location, they may be removed at a day clinic using a local anesthetic or at a hospital under general anesthetic.
If you think HRT is causing postmenopausal bleeding, speak to your doctor. It may settle down once you’ve been using HRT for a while, or you may be offered a different type of HRT. Your doctor will discuss the options with you.
Some people stop taking HRT because of bleeding problems. But it’s important to discuss the pros and cons with your doctor – and rule out other causes.
You’ll probably have an ultrasound scan to measure the thickness of your lining and check for other causes of bleeding, such as polyps or ovarian cysts.
You may also have an endometrial biopsy – a simple procedure where tissue is removed and examined under a microscope.
Treatment depends on the results of the biopsy, but isn’t always needed. If necessary, it can usually be treated with progesterone-like hormone medication, or surgery to thin it.
If you’re taking tamoxifen and have bleeding or spotting after menopause, your doctor may advise a hysteroscopy, to check your womb for polyps or thickening. If thickening is found, your doctor will advise on whether you should still take tamoxifen, and if any treatment is needed.
If fibroids are only causing minor symptoms, you may not need any treatment. They also often shrink after the menopause, so any symptoms may ease or go away.
If you need treatment, options include hormonal or non-hormonal medication, surgery to remove them, or ‘ablation’ – a procedure that removes the lining of your womb.
Read more about fibroid treatment.
“Vaginal dryness can mean some women feel worried about any kind of internal examination or procedure after the menopause – but try not to worry,” says Dr Ann. “Your ob-gyn is used to doing these, and will be able to suggest ways to make you more comfortable. Don’t let worries put you off having these procedures, as they can be really important. Tell your ob-gyn if you’re concerned, so they can reassure you and take extra care.”
"Don’t let worries put you off having these procedures, as they can be really important. Tell your ob-gyn if you’re concerned, so they can reassure you and take extra care."
Dr Ann Nainan
Clinical content reviewer, MBBS, DFSRH, MRCGP
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.