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Postmenopausal Bleeding: Causes, Diagnosis, and Treatment

Postmenopausal Bleeding Causes, Diagnosis, and Treatment

Introduction

Any vaginal bleeding after menopause can be frightening for a woman. Once periods have completely stopped, bleeding is not considered normal and should never be ignored. While many causes of postmenopausal bleeding are benign, in some cases it can be an early warning sign of serious conditions like uterine or cervical cancer. Timely evaluation ensures reassurance when the cause is harmless—and life-saving treatment when it is not.

What is postmenopausal bleeding?

Postmenopausal bleeding (PMB) refers to any vaginal bleeding occurring 12 months or more after a woman’s last menstrual period. It can range from light spotting to heavy bleeding or blood-stained discharge.

In my clinical experience, even minimal spotting after menopause deserves proper evaluation.

Postmenopausal bleeding can occur due to a variety of reasons, many of which are treatable.

Common causes include:

  • Thinning of vaginal lining (atrophic vaginitis):
    Low estrogen causes fragile vaginal tissues with delicate blood vessels that bleed easily due to friction or pressure.

  • Endometrial hyperplasia:
    Thickening of the uterine lining, which may cause bleeding even after menopause.

  • Endometrial or cervical polyps:
    Benign growths in 95–99% of cases, but still require evaluation.

  • Uterine fibroids:
    Degeneration of fibroids can sometimes cause bleeding after menopause.

  • Uterine prolapse:
    Advanced prolapse may cause ulcers on the cervix or vaginal walls, leading to bleeding.

  • Infections

  • Cancer:
    Cancer of the cervix or uterus must always be ruled out.

  • Hormone replacement therapy (HRT)

  • Injury or trauma

  • Bleeding from urine or stool, which may be mistaken for vaginal bleeding

Dr. Dimple Doshi’s Tip:
Most causes are benign, but menopause-related bleeding is never “normal” and should not be ignored.

You should consult a gynecologist immediately if you notice:

  • Any spotting or bleeding after menopause
  • Heavy or prolonged bleeding
  • Blood-stained white discharge
  • Bleeding associated with pelvic pain
  • Pain during intercourse
  • Unexplained weight loss

Early consultation helps rule out cancer and avoids unnecessary anxiety.

A step-by-step evaluation is essential to identify the cause.

Diagnostic methods include:

  • Pelvic examination:
    Helps diagnose conditions like senile vaginitis by direct inspection.

  • Transvaginal ultrasound:
    Measures endometrial thickness and detects polyps or fibroids.

  • Endometrial biopsy:
    A small sample of uterine tissue is taken for laboratory examination.

  • Hysteroscopy:
    A minimally invasive procedure using a camera to directly visualize the uterine cavity.

    • Can be combined with Dilation and Curettage (D&C)

    • Office hysteroscopy allows evaluation without admission or anesthesia in selected cases

    • OPD-based endometrial sampling saves time and avoids hospitalization

In my practice, hysteroscopy gives the most accurate diagnosis with minimal discomfort.

Treatment depends entirely on the underlying cause.

  • Thinning of vaginal tissues:
    Local estrogen creams or newer non-hormonal creams like Iseren may provide relief.

  • Endometrial hyperplasia:
    Requires hysteroscopy and D&C for diagnosis and treatment.

  • Polyps:
    Best removed under hysteroscopic guidance for precision and minimal invasion.

  • Fibroids:
    May require hysterectomy depending on size, symptoms, and suspicion.

  • Infections:
    Treated with appropriate antibiotics.

  • Uterine or cervical cancer:
    Requires early intervention—surgery, chemotherapy, radiotherapy, or a combination.

  • Uterine prolapse:
    Surgical correction such as hysterectomy with vaginal repair may be needed.

  • Hormonal imbalance:
    Progesterone therapy may be advised in selected cases.

While postmenopausal bleeding itself cannot always be prevented, general health measures help reduce risks:

  • Maintain a healthy weight
  • Avoid smoking
  • Limit alcohol intake
  • Attend regular gynecological check-ups

Q1. Is postmenopausal bleeding always cancer?

Ans. No. Most cases are benign, but cancer must always be ruled out.

Q2. Is light spotting after menopause normal?

Ans. No. Even a single episode should be evaluated.

Q3. Can infections cause bleeding after menopause?

Ans. Yes, vaginal or uterine infections can cause bleeding.

Q4. Is hysteroscopy painful?

Ans. No. It is minimally invasive and usually very well tolerated.

Q5. Can treatment be done on the same day as diagnosis?

Ans. Yes, in many cases diagnosis and treatment can be done together.

Conclusion

Postmenopausal bleeding is a warning sign that should never be ignored. While many causes are simple and treatable, early evaluation is essential to rule out serious conditions like cancer. With timely diagnosis and appropriate treatment, outcomes are excellent.

At Vardaan Hospital, Goregaon West, Mumbai, I focus on early diagnosis, minimally invasive evaluation, and personalized treatment so women can move forward with confidence and peace of mind.
Your health after menopause matters just as much as before—never hesitate to seek care.

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