Bleeding after menopause
Any bleeding after menopause should be checked, even a single episode of spotting. Most of the time the cause is not serious, but this is the most important bleeding symptom not to ignore.
Menopause means 12 months in a row without a period. Bleeding after that point, including pink or brown spotting, is postmenopausal bleeding.
Why it needs attention
Postmenopausal bleeding is the most common early sign of endometrial cancer. About 9 in 10 people with endometrial cancer have bleeding as an early symptom. Most people with postmenopausal bleeding do not have cancer; roughly 1 in 10 do. Because this cancer is usually found early when bleeding is checked promptly, prompt evaluation matters.
Common causes
- Thinning of the vaginal or uterine lining after menopause (atrophy)
- Endometrial or cervical polyps
- Menopausal hormone therapy
- Endometrial hyperplasia or cancer
- Medications such as tamoxifen
What evaluation usually involves
The first step is usually a transvaginal ultrasound to measure the thickness of the uterine lining, or an endometrial biopsy. A thin lining, 4 mm or less, makes cancer unlikely. A thicker lining, a lining that cannot be seen clearly, or bleeding that continues leads to a biopsy or hysteroscopy.
If you take hormone therapy
Some bleeding is expected in the first months of certain regimens. Bleeding that is heavy, persists beyond the first several months, or starts after a period of none should still be evaluated.
We can order your ultrasound quickly and arrange a biopsy if you need one. Book a visit.
Sources
- American College of Obstetricians and Gynecologists. Committee Opinion No. 734: The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol. 2018;131(5):e124–e129.
- American College of Obstetricians and Gynecologists; Society of Gynecologic Oncology. Committee Opinion No. 631: Endometrial intraepithelial neoplasia. Obstet Gynecol. 2015;125(5):1272–1278.