Bleeding after menopause: why even light spotting should be checked

English version

What is postmenopausal bleeding?

Menopause is generally confirmed after 12 consecutive months without a menstrual period, when there is no other medical explanation. Any vaginal bleeding after that—including light spotting or pink or brown discharge—is known as postmenopausal bleeding.

It is often caused by a non-cancerous condition. However, it should always be assessed, even when the amount is very small or it happens once.

What can cause bleeding after menopause?

• Thinning and dryness of the vaginal lining due to lower oestrogen.
• Thinning of the uterine lining.
• Vaginal or cervical inflammation.
• Cervical or uterine polyps.
• Thickening of the uterine lining, called endometrial hyperplasia.
• Bleeding associated with hormone replacement therapy.
• Certain medicines, including blood-thinning medicines.
• Less commonly, cancer affecting the cervix, uterus, vagina or ovaries.

Vaginal dryness may cause bleeding after sex, but repeated bleeding should not be assumed to be caused only by dryness.

What if you take hormone replacement therapy?

Some bleeding can occur after starting or changing certain forms of hormone replacement therapy. The expected pattern depends on the treatment and how long it has been used. Do not stop prescribed hormones without advice. Contact the prescribing doctor if bleeding is heavy, continues, begins after a period without bleeding or concerns you.

What assessment may be required?

A doctor will ask about the timing and amount, whether bleeding followed sex, your last natural period, medicines, hormone use, other symptoms and cervical-screening history. Depending on the findings, assessment may include:

• Examination of the vagina and cervix.
• Transvaginal ultrasound.
• Cervical screening when due or clinically indicated.
• Hysteroscopy to examine the inside of the uterus.
• An endometrial biopsy—a sample of the uterine lining.

Not every woman requires every test. A normal cervical-screening result does not assess all causes arising from the uterine lining.

When should you arrange a consultation?

• Any bleeding or spotting after 12 months without a period.
• Pink, red or brown vaginal discharge after menopause.
• Bleeding after sexual intercourse, even if it happened only once.
• Repeated or increasing bleeding.
• Bleeding with pelvic discomfort, pressure or unexplained discharge.
• Unexpected bleeding while using hormone therapy or tamoxifen.

These symptoms do not mean that cancer is present. They mean that the source of the bleeding should be identified.