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Is Postmenopausal Bleeding Usual?

Any unusual bleeding should always be checked, and particularly post menopause.


I am hearing from an increasing number of postmenopausal women with hormonal symptoms, among which are hot flushes.

However if there is also bleeding it can have a number of causes and always needs to be investigated,.

What’s the cause?

A number of conditions may lead to postmenopausal bleeding including these:

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 oestrogen 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 oestrogen 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): Oestrogen helps to keep this tissue healthy. After menopause, low oestrogen 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:

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

Helpful information: 

Several of these conditions can be helped by progesterone such as endometrial hyperplasia, but others do need additional oestrogen. Sometimes a combined cream with both hormones can be sufficient, but for atrophy you will usually require a separate oestrogen source prescribed by your doctor.