Postmenopausal Bleeding: 7 Causes of Spotting After Menopause

You’ve reached the menopause milestone — a whole year with no period.

Perimenopause may be in your rearview, but the changes in your body can still take a little time to get used to.

But what about vaginal bleeding after menopause? Can periods restart after menopause?

Short answer: No.

There are times when postmenopausal bleeding is harmless and may even make sense in certain circumstances (hello, friction 🌶).

Still, it’s by no means the norm and definitely not something to play down as just another postmenopause symptom.

Vaginal bleeding at any unexpected time of your life should always be flagged, especially when periods are no longer part of your calendar. 🚩

Here’s what you need to know about spotting after menopause.

In this article: 📝

What is postmenopausal bleeding?

Basically, any vaginal bleeding after menopause (AKA 12 straight months without a period) is considered postmenopausal bleeding.

So, whether your periods stopped 15 months ago or 15 years ago, it’s postmenopausal bleeding.

And it’s worth stressing: Vaginal bleeding is not seen as ‘normal’ for anyone postmenopause.

As for what it is exactly, many would (rightly) assume that it’s linked directly to the uterus, but it can actually arise from the cervix, vagina, fallopian tubes, vulva, and perineum.

About 4% to 11% of postmenopausal women report vaginal bleeding.

But in all cases, it needs to be flagged and explored.

What does postmenopausal bleeding look like?

Postmenopausal bleeding can be anything from a light spotting of brown or pink discharge to some slight bleeding after sex or a heavy flow of fresh red blood (much like a period).

No matter if you’re lightly spotting or reaching for the period pants once more, vaginal bleeding after menopause is not normal.

The best step is to seek advice from your doctor or ob-gyn ASAP to get the all-clear.

Your doctor may refer to postmenopausal bleeding ICD 10, which is the International Classification of Diseases, regarding further testing or investigations they recommend.

Even if it is something serious, the sooner you get a diagnosis, the better.

What is the most common cause of postmenopausal bleeding?

Vaginal bleeding after menopause can be alarming, and while we’re eager to offer relief, there’s not one main cause.

Vaginal dryness (vaginal atrophy) is often top of the list, but really there’s a range of causes of postmenopausal bleeding.

And while not all are serious, they do require a check-in with your doctor.

The most common causes of postmenopausal bleeding are:

1. Vaginal atrophy

Vulvovaginal atrophy is the thinning of the vaginal walls caused by low hormone levels after menopause.

The lining of the vaginal walls can become dry and inflamed, especially after sex.

2. Endometrial atrophy

This is the thinning of the uterine lining, again, caused by very low hormone levels.

3. Polyps

These are non-cancerous tissue growths that can form anywhere in your cervix, uterus, or cervical canal.

One study found that of 481 women with Endometrial polyps, 51.1 % experienced postmenopausal bleeding.

4. Endometrial hyperplasia

This is the thickening of your uterine lining caused by an imbalance of hormones, specifically too much estrogen and not enough progesterone.

Cells in the uterine lining can become abnormal and can sometimes lead to cancer.

5. Cancer

Postmenopausal bleeding is the most common symptom of certain types of cancers, including endometrial, uterine, cervical, and vaginal cancers.

Although serious, only around 9% of postmenopausal women who sought medical advice for vaginal bleeding were diagnosed with cancer.

So, don’t assume the worst just yet—better to focus on booking that check-up first.

6. HRT treatment

Spotting can be a common side effect of hormone replacement therapy, which can also be a common cause of endometrial hyperplasia.

Breakthrough bleeding is a common issue for women taking HRT. So much so that many opt for alternative natural treatments.

Your health practitioner will be able to go over some of these options with you.

7. Sexually transmitted disease (STD)

Sometimes, postmenopausal spotting could point to an STD like chlamydia and gonorrhea.

If you’re also experiencing abnormal discharge that smells foul and looks green or yellow, alongside pain when you pee or have sex, it’s time to check in with your doctor.

Can stress cause spotting after menopause?

There are anecdotal suggestions that severe and prolonged stress caused by trauma, grief, or illness can trigger spotting after menopause.

However, there’s just not enough evidence for it to be included as a common medical cause.

Is bleeding during menopause normal?

Bleeding during the perimenopausal phase—before your periods completely stop—can absolutely happen.

And it tends to be irregular in timing, length, and heaviness.

In this context, it’s simply your body’s way of adjusting to your reducing hormone levels.

But there is an endpoint—that significant milestone of menopause.

For many women, from here on, menopause symptoms will ease off nicely, but for others, those vasomotor symptoms like hot flashes and night sweats can last for another two years. 🥵

Some even ten years.

The point is, there is no golden standard of postmenopause, no normal experience to compare yours to.

What is certain, though, is vaginal bleeding should not be part of this chapter, and it doesn’t have to be.

Reach out to your healthcare provider and start the conversation.

Best believe many in the Peanut menopause community or having it, too.

Join us. ❤️