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    Bleeding after menopause: Why it happens and what to do about it

    By NCVC Staff | Published on Sep 23, 2023

    Menopause is a natural process in a woman’s life when her reproductive hormones decline, leading to the cessation of her menstrual cycle. However, it is not uncommon for women to experience postmenopausal bleeding, which can occur a year or more after their last menstrual period. This can be a cause for concern, but understanding why it happens and seeking appropriate medical attention is crucial.

    Causes of Postmenopausal Bleeding

    Postmenopausal bleeding can be a symptom of underlying conditions that require medical attention. The following are common causes of bleeding or spotting after menopause:

    1. Endometrial Atrophy

    During menopause, the production of hormones such as estrogen and progesterone decreases. This hormonal change can lead to thinning of the uterine lining, triggering bleeding. It is especially common when a woman’s body stops producing estrogen, which plays a significant role in sexual and reproductive development.

    Always consult with a doctor if you notice bleeding post-menopause.

    2. Vaginal Atrophy

    Vaginal atrophy is a condition characterized by the thinning of vaginal tissue. After menopause, low levels of estrogen cause the vaginal walls to become thin, dry, and inflamed, which may result in bleeding.

    3. Endometrial Hyperplasia

    Endometrial hyperplasia is a condition where the lining of the uterus becomes too thick due to an imbalance of estrogen and progesterone. This imbalance can cause the endometrium to become thicker and potentially lead to bleeding. If left untreated, the cells in the endometrium can become abnormal and increase the risk of developing cancer.

    4. Endometrial Polyps

    Endometrial polyps are non-cancerous growths that develop on the lining of the uterus. Some polyps can also grow inside the cervical canal, causing pain. These polyps can cause unusual or heavy bleeding.

    Endometrial polyps impact fertility, but removing polyps is always a choice.

    5. Uterine Fibroids

    Uterine fibroids, or leiomyomas, are benign tumors that can develop during the reproductive years or after menopause. These fibroids form in the walls of the uterus and may not cause symptoms, but they can result in pain and bleeding.

    Treatment for Postmenopausal Bleeding

    The treatment for postmenopausal bleeding varies depending on the underlying cause. Here are some common procedures and medications used to address postmenopausal bleeding:

    • Antibiotics: In cases where an infection in the cervix or uterus is causing the bleeding, antibiotics can be prescribed.

    • Estrogen Therapy: For bleeding due to vaginal dryness, estrogen therapy can help treat vaginal and endometrial atrophy. Estrogen can be taken in the form of pills, vaginal creams, vaginal rings, or vaginal tablets.

    • Progestin: Progestin, a synthetic form of progesterone, is often used to treat endometrial hyperplasia. It triggers the shedding of the uterine lining. Progestin can be taken as a pill, cream, or intrauterine device (IUD).

    • Hysteroscopy: This procedure involves the use of a hysteroscope, a thin illuminated tube, to remove polyps or other abnormal growths that are causing bleeding. It can also be used to remove thicker areas of the uterine lining caused by endometrial hyperplasia. Dilation and curettage (D&C) is another treatment option that involves removing polyps or thicker portions of the uterine lining using a thin instrument.


    Menopause is a significant transition in a woman’s life, marking the end of her reproductive years. Whether you experience light spotting or heavier bleeding after menopause, it is important to take it seriously and consult a doctor for further guidance. Postmenopausal bleeding can be a sign of underlying health problems, and early detection and appropriate treatment are essential for your well-being.

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