What to Know About Vaginal Bleeding after Menopause

If you’ve gone for more than a year without a period, you have officially reached menopause.

Welcome! No more menstrual cup, period pants, or pad supply.

But what if it appears as if your period’s making a comeback? Is this cause for concern?

First things first — if you experience vaginal bleeding after menopause, it’s a good idea to make an appointment with your doctor.

While bleeding after menopause can be harmless, it’s important to check that there’s not something more serious going on.

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What’s happening in my body during menopause?

Women usually reach menopause by the age of around 51, after a period (!) called perimenopause.

During perimenopause, you will probably find your periods become irregular, heavier, or lighter. Or all three.

Menopause occurs when you’ve gone a year without a period.

This means your ovaries have stopped releasing eggs and making most of their estrogen.

Perimenopause and menopause come with all sorts of fun and games like hot flashes, sleep problems, and vaginal and urinary tract changes.

Postmenopause is the time after menopause.

During this time, you find many of those uncomfortable symptoms ease (and, if not, your doctor might be able to recommend some treatments to help you out.)

Plus, the inconvenience of having a period goes away.

But what happens if you find yourself on a random Tuesday pad run?

Can bleeding after menopause be harmless?

The great news is yes, for the most part, vaginal bleeding after menopause is usually harmless.

Cancer’s one of the big worries here — but it’s far from the most common reason.

A 2018 study by the National Cancer Institute found that overall only 9% of vaginal bleeding after menopause was linked to endometrial cancer.

9% is the average, which ranges from as low as 5% in North America to 13% in Western Europe.

So if you do experience some vaginal bleeding after menopause, there is no need to panic.

But while it may not be anything serious, it is worth checking out and keeping an eye on.

The best thing to do is consult with a doctor or gynae as soon as you can.

What is the most common reason for bleeding after menopause

Here’s a rundown of the reasons you may have what seems like a period after reaching menopause.

1. Endometrial atrophy

Endometrial atrophy is the thinning of the tissue lining the uterus.

Low levels of estrogen can cause the uterine lining (endometrium) to become too thin, which can cause abnormal bleeding.

2. Vaginal atrophy

Vaginal atrophy is the thinning and drying of the vaginal walls.

If you find that you’re bleeding after sex, it could be the thinner and more sensitive tissue of the vagina or vulva reacting to the friction.

A possible solution to this is topical estrogen cream prescribed by your doctor.

Lubrication during sex can also really help.

3. Uterine polyps

These are benign (noncancerous) growths in the uterus or cervix.

In many cases, they can be harmless.

But if they are causing you to bleed, you may need surgery to remove them.

4. Uterine fibroids

Like polyps, these are noncancerous growths that develop from uterine muscle tissue.

Luckily, they are less common after menopause.

And if they do happen, there are a number of treatments that can help, including hormonal therapies and surgery.

5. Endometritis

Endometritis is an infection of the uterine lining.

It can be caused by some sexually transmitted diseases (STDs), like chlamydia and gonorrhea.

In most cases, uterine infections aren’t life-threatening and can often be treated with antibiotics.

6. Endometrial hyperplasia

Too much estrogen and too little progesterone can cause an excessive overgrowth of the cells in your uterine lining.

While this is not cancer in and of itself, it does raise the risk of developing it.

Endometrial hyperplasia can be treated with progestin therapy, which will cause the endometrium to shed.

Your doctor will probably recommend regular biopsies to keep an eye on the situation in case it returns.

7. Medications

Hormone therapy, blood thinners, and some medications used to treat mental health conditions may cause vaginal bleeding after menopause.

8. Pelvic trauma

Any sort of injury to your pelvic area may result in bleeding.

9. Bleeding from the urinary tract or rectum

The bleeding may actually be coming from a neighboring source.

A UTI can cause blood in your pee — and unfortunately, these can be more common at this stage of your life.

And a number of different conditions can also cause rectal bleeding.

It’s a good idea to get to the source as soon as possible so that you can get the right treatment.

10. Certain cancers

This might sound pretty scary, we know.

But the great news is that if it’s caught in the early stages before it has spread outside the womb, uterine cancer has a 95% survival rate.

What cancers cause post-menopausal bleeding?

There are a few cancers that can cause post-menopausal bleeding.

Most common are cervical, uterine, and ovarian cancers.

You may experience this symptom as light spotting that is pinkish or brown.

But heavy bleeding after menopause is also a sign.

Risk factors for cervical cancer include HPV, long-term oral contraceptive use, smoking, a weakened immune system, family history, and a lack of access to medical care.

What can I expect at my doctor’s visit?

To diagnose what’s going on, your doctor will likely chat through your medical history, including when you went through menopause.

They may then decide to do a physical exam and possibly a pelvic ultrasound to check for growths and the thickness of your endometrium.

During this procedure, a probe is inserted into your vagina and sound waves are used to create a picture for the doctor to assess what’s happening inside your womb.

They may then decide to do a uterine biopsy.

Here, they insert a thin tube through the vagina and cervix to take a small sample of the endometrium to test for infection or cancerous cells.

This often happens in the doctor’s office and, in terms of discomfort, is almost like a pap smear.

Another procedure you may expect is a hysteroscopy, where a tiny camera is inserted into the uterus to take a look at the inside.

A D&C (dilation and curettage) may then be done where they take a sample of your cervical canal and uterine lining.

This procedure usually requires an anesthetic and is done either in hospital or an outpatient center.

If cancerous cells are detected, your doctor may recommend a hysterectomy, in which part or all of your uterus is removed.

Some chemotherapy, radiation, or hormone therapy may be needed, but that depends on the type and stage of cancer detected.

But let us reassure you about some things.

While this may all sound terrifying, vaginal bleeding can be your body’s way of communicating important information.

Unlike other kinds of cancer where the first signs are harder to detect, vaginal bleeding usually happens early on in uterine cancer.

This means doctors can intervene quickly to get you the treatment you need.

So if you do experience vaginal bleeding after menopause, be sure to call your doctor.

It may not be anything serious, but it’s always worth checking out.

And if you need to check in with other women who are where you’re at, join the Peanut menopause community.

We’re having the conversation.