Postmenopausal Bleeding: What You Need to Know

Menopause is defined as going 12 months in a row without a period. The average age for menopause in the U.S. is 52, although it can happen between ages 45 and 55.

During perimenopause, the years leading up to menopause, periods can become irregular. It’s not uncommon for periods to stop for several months and then return. However, if bleeding resumes after a consecutive 12 months or more without a period, it is considered postmenopausal bleeding. All postmenopausal bleeding should be evaluated by your women’s health provider.

“If you notice bleeding a year or more after your last period, contact your ob-gyn,” says O’Hara K. Haley, MD, an ob-gyn at UPMC Magee-Womens in Central Pa.

Although most cases of postmenopausal bleeding are benign, sometimes bleeding can be a sign of a serious medical condition. While every woman should get regular pelvic exams, Dr. Haley stresses that postmenopausal bleeding is a reason to see your provider promptly.

Common causes of bleeding or spotting after menopause include:

• Thinning of vaginal and uterine walls as hormones shift
• Benign polyps (non-cancerous growths) in your uterus
• Medications like blood thinners
• Inflammation, infection, or injury to your reproductive organs
• Thickening of uterine lining (“endometrial hyperplasia”)

In a small percentage of cases, Dr. Haley says, bleeding after menopause is a sign of endometrial or uterine cancer.

To determine the cause of postmenopausal bleeding, your provider will ask about your symptoms and medical history and will likely recommend a pelvic exam. After the exam, you might need additional diagnostic tests. Those tests may include:

• Hysteroscopy(a thin, lighted tube with a camera inserted into your uterus through your cervix)
• Transvaginal ultrasound (a small wand-like device inserted into your vagina that uses sound waves to generate images of your pelvic organs)
• Biopsy of your cervix or endometrium (the lining of your uterus)

Treatment for postmenopausal bleeding will depend on symptoms and diagnosis. If your bleeding is caused by endometrial polyps, your provider may recommend having the polyps removed. Antibiotics can be prescribed to treat infections, and lubricants or hormonal therapy can help thinning vaginal walls.

In cases where bleeding leads to a cancer diagnosis, your provider will refer you to a gynecologic oncologist, a specialist in cancers of the female reproductive organs. The board-certified gynecologic oncologists with UPMC Magee-Womens in Central Pa. work closely with ob-gyns to provide compassionate, comprehensive care for gynecologic cancer.

For more information about UPMC Magee-Womens providers in Central Pa., or to request an appointment, visit UPMC.com/MageeWomens.