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Why Women May Have Vaginal Bleeding After Menopause

Once you’ve reached menopause, you’ll no longer have menstrual periods. So, although not uncommon, if you have vaginal bleeding after menopause, it’s critical to talk to your health care provider. “A lot of different medical conditions can cause this bleeding, and most of them can be treated easily,” said Dawn Martin-Herring, MD, an OBGYN with Banner – University Medicine North in Tucson.

What can cause postmenopausal bleeding?

Bleeding after menopause can come from the skin outside the vagina, cervix or uterus. Sometimes it can stem from the bladder or rectum but appear to be vaginal. Most commonly, however, postmenopausal bleeding starts in the uterus and typically is caused by:

In the first three years of menopause, about 5 to 10% will experience vaginal bleeding. Women are less likely to experience bleeding more than three years into menopause.

“It’s common for people to worry about cancer, but the majority of women do not have cancer,” Dr. Martin-Herring said. But it’s important to see your health care provider for a physical exam, diagnosis and treatment. And keep in mind that it’s still possible to get cervical cancer after menopause.

Many women also have irregular bleeding before they reach menopause. Hormonal changes that start in your late 30s can sometimes cause irregular or abnormal bleeding. Even if you haven’t reached menopause—defined as one year without a period—talk to your health care provider if you have concerns about vaginal bleeding.

“Never assume that if you have had a recent pelvic examination, you do not need to be seen for bleeding in menopause. We cannot see everything on a pelvic examination, nor can we feel the ovaries well. New symptoms are worth a visit to your provider to determine whether you need additional testing or physical examination,” Dr. Martin-Herring said.

How can my doctor diagnose postmenopausal bleeding?

Your doctor will want to examine your vagina and the skin outside your vagina. You’ll likely have a transvaginal ultrasound of the pelvis, where an ultrasound wand is placed inside the vagina to get a close look at the ovaries and uterus.

After an ultrasound, your doctor may recommend an endometrial biopsy (biopsy of the uterine lining), or a procedure that uses a tiny camera to look inside the uterus to see if anything looks abnormal. If so, a biopsy can be taken from that area.

Treatment for postmenopausal bleeding

“Depending on the cause of bleeding, the most common treatments will be hormone replacement therapy (HRT), antibiotics or surgery,” Dr. Martin-Herring said.

In menopause, your vaginal skin is thinner and can bleed more easily. That can be treated with vaginal estrogen. Changes in your natural bacteria can cause infection, which can be treated with antibiotics.

Bleeding that comes from the uterus can be treated with progesterone hormone therapy or surgery to remove polyps inside the uterus or remove the uterus entirely (called a hysterectomy).

The bottom line

It’s not uncommon for women to experience vaginal bleeding or spotting after menopause, especially in the first three years. If you've experienced postmenopausal bleeding, talk to your health care provider so you can uncover the cause and get treated. If you’d like to connect with an OBGYN, reach out to Banner Health.

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