What Causes It?

A number of conditions may lead to postmenopausal bleeding:

Polyps: These tissue growths show up inside your uterus or cervical canal, or on your cervix. They’re usually not cancer, but they can cause spotting, heavy bleeding, or bleeding after sex.

Endometrial atrophy (thinning of the uterine lining): The endometrium is the tissue that lines your uterus. It responds to hormones like estrogen and progesterone. Low hormone levels after menopause can cause it to get too thin. This may trigger bleeding.

Endometrial hyperplasia (thickening of the uterine lining): After menopause, you may have too much estrogen and too little progesterone. As a result, the endometrium gets thicker and can bleed. Sometimes cells in the endometrium can become abnormal. This could lead to cancer, so get it treated as soon as possible.

Vaginal atrophy (thinning of vaginal tissue): Estrogen helps to keep this tissue healthy. After menopause, low estrogen levels can cause your vaginal walls to become thin, dry, and inflamed. That often leads to bleeding after sex.

Cancer: Bleeding is the most common symptom of endometrial or uterine cancer after menopause. It can also signal vaginal or cervical cancer.

Sexually transmitted diseases: Some, like chlamydia and gonorrhea, may cause spotting and bleeding after sex. Herpes sores can also bleed.

Medications: Bleeding is often a side effect of certain drugs, like hormone therapy, tamoxifen, and blood thinners.

How Is It Diagnosed?

To find the cause of your bleeding, the doctor will do a physical exam and review your medical history. You may need one or more of the following tests:

Transvaginal ultrasound: This image helps your doctor check for growths and look at the thickness of your endometrium. She’ll place a small probe into your vagina. It sends off sound waves to create a picture of the inside of your body.

D&C (dilation and curettage): During this procedure, the doctor opens your cervix. She uses a thin tool to scrape or suck a sample of the uterus lining. She sends this to a lab that will check for polyps, cancer, or a thickening of the uterine lining (endometrial hyperplasia).

Ultrasound and biopsy are usually done in your doctor’s office. Hysteroscopy and D&C require anesthesia on one part of or your whole body. You’ll either go to a hospital or an outpatient surgical center.

How Is It Treated?

That depends on what’s causing the bleeding.

Estrogen therapy: This hormone is used to treat vaginal and endometrial atrophy. Your doctor may prescribe it in of the following forms:

• Pills: You’ll take them by mouth.
• Vaginal cream: You’ll use an applicator to get it inside your body.
• Vaginal ring: You or your doctor can put it in place. It releases a steady dose of estrogen for about 3 months.
• Vaginal tablet: You’ll insert it using an applicator. You may need to do it daily, or a few times a week.

Progestin therapy: This lab-made version of progesterone is used to treat endometrial hyperplasia. Your doctor may prescribe it in a pill or shot, a vaginal cream, or intrauterine device.

Hysteroscopy: This procedure can remove polyps. Doctors also use it to remove thickened parts of the uterine lining caused by endometrial hyperplasia. She’ll insert a hysteroscope into your vagina and pass tiny surgical tools through the tube.

Medications: Your doctor can prescribe drugs like antibiotics for sexually transmitted diseases. They can also treat cervical or uterine infections.

Is Bleeding During Perimenopause Normal?

The years before menopause are called perimenopause. During this time, your hormones shift. Your period may be heavier or lighter than usual. You may also have spotting. That’s normal. But if your bleeding is heavy or lasts longer than usual, talk to your doctor. You should also get checked out if you bleed after sex or more often than every 3 weeks.