Postmenopausal Bleeding: Causes, Diagnosis, and Treatment
Introduction
Any vaginal bleeding after menopause can be worrying—and rightly so. Once your periods have completely stopped, bleeding is no longer considered normal. While postmenopausal bleeding is not always due to a serious illness, it should never be ignored. Early evaluation helps us rule out dangerous causes like cancer and, in many cases, identify simple and treatable conditions.
What is postmenopausal bleeding?
Postmenopausal bleeding (PMB) means any vaginal bleeding occurring 12 months or more after your last natural menstrual period. This may appear as light spotting, blood-stained discharge, or heavy bleeding. Regardless of the amount, every episode needs medical assessment.
In my clinical experience, even a single episode of spotting after menopause deserves attention.
What causes postmenopausal bleeding?
Postmenopausal bleeding can occur due to several reasons, ranging from harmless to serious.
Common causes include:
Endometrial atrophy:
Thinning of the uterine lining due to low estrogen levels, making blood vessels fragile.Vaginal atrophy:
Thinning and dryness of vaginal tissues, often leading to bleeding after friction.Endometrial polyps:
Small growths inside the uterus, usually benign but capable of causing bleeding.Endometrial hyperplasia:
Thickening of the uterine lining, which may sometimes progress to cancer if untreated.Fibroids:
Non-cancerous uterine growths that may degenerate and bleed after menopause.Infections:
Involving the cervix, uterus, or urinary tract.Hormone therapy:
Hormone replacement therapy or certain medications may trigger bleeding.Cancer:
Cancer of the uterus, cervix, or ovaries must always be ruled out.
Other less common causes:
Sexual trauma
Bleeding from the urinary tract or rectum, which may be mistaken for vaginal bleeding
Dr. Dimple Doshi’s Tip:
Most causes of postmenopausal bleeding are benign, but cancer must always be excluded first.
How is postmenopausal bleeding diagnosed?
Finding the exact cause requires a structured evaluation by your gynecologist.
Diagnostic steps may include:
Pelvic examination:
To assess vaginal and cervical health and detect obvious abnormalities.Transvaginal ultrasound:
Measures endometrial thickness and detects polyps or fibroids.Endometrial biopsy:
A small sample of uterine lining is taken to rule out cancer or hyperplasia.Hysteroscopy:
A minimally invasive procedure using a thin camera to directly visualize the uterine cavity. This allows precise diagnosis and, in many cases, treatment at the same time.
In my practice, hysteroscopy provides the most accurate diagnosis with minimal discomfort.
What are the treatment options for postmenopausal bleeding?
Treatment depends entirely on the underlying cause:
Endometrial or vaginal atrophy:
Local estrogen therapy or non-hormonal vaginal creams may be advised.Polyps:
Surgical removal, best done under hysteroscopic guidance.Endometrial hyperplasia:
Progesterone therapy or surgical management, depending on severity.Infections:
Treated with appropriate antibiotics.Fibroids:
May require surgery if symptomatic or suspicious.Cancer:
Managed with surgery, chemotherapy, radiotherapy, or a combination, depending on the stage.
When should you see a doctor?
You should consult a gynecologist immediately if you experience:
- Any spotting or bleeding after menopause
- Blood-stained white discharge
- Heavy or recurrent bleeding
- Bleeding associated with pelvic pain or pain during intercourse
Early evaluation ensures timely treatment and peace of mind.
Conclusion
Postmenopausal bleeding is a symptom that should never be ignored. While many causes are simple and treatable, early diagnosis is crucial to rule out serious conditions like cancer. With prompt evaluation and appropriate treatment, outcomes are usually excellent.
At Vardaan Hospital, Goregaon West, Mumbai, I focus on early detection, minimally invasive evaluation, and personalized care for women after menopause. If you notice any bleeding—even once—please seek medical advice. Your health and well-being always come first.
