- You shouldn't experience vaginal bleeding after menopause, or a year after your last period.
- Postmenopausal bleeding may be due to polpys, PCOS, medication side effects, infections, or cancer.
- Don't ignore postmenopausal bleeding — an OB-GYN can help find the cause and the right treatment.
Once you reach menopause, which typically happens between the ages of 45 and 55, you should no longer experience vaginal bleeding.
However, postmenopausal bleeding — when you bleed after going through menopause, or roughly a year after your last period — may be more common than you think.
Dr. Anna Barbieri, board-certified gynecologist at Mt. Sinai Medical Center and founder of Elektra Health, says 4%-11% of people with a uterus will likely experience postmenopausal bleeding in their lifetime.
This blood might range in color from a light pinkish-gray to dark red or even brown. Because postmenopausal bleeding may be a symptom of something more serious, experts recommend getting any vaginal bleeding after menopause checked out.
Below, you'll find nine possible causes of postmenopausal bleeding and what to do next.
1. Vulvar, vaginal, or endometrial atrophy
One of the most common sources of postmenopausal bleeding is vulvar or vaginal atrophy.
Vulvar atrophy, or vulvovaginal atrophy (VVA), refers to the thinning of the vulvovaginal tissue, which happens for about half of all people who go through menopause. Similarly, vaginal atrophy refers to the thinning of the vaginal walls, which can happen as estrogen levels in your body begin to decrease.
Endometrial atrophy, or thinning of the uterine wall, can also cause postmenopausal bleeding.
Atrophy can commonly cause light bleeding after sex or unusual discharge. Unusual discharge can look yellow or grayish in color with a watery or thinner consistency.
Other common symptoms include:
- Pain or discomfort during sex
- Vaginal dryness
- Genital itching
- Frequent urination
- Burning with urination
2. Polyps
Uterine polyps, also known as endometrial polyps, can form along the inner uterine wall, or endometrium, when the lining of your uterus produces too many cells. These growths can range widely in size, from smaller than a grain of rice to larger than a golf ball.
Cervical polyps, small, finger-shaped growths that develop on the cervix, can also cause post-menopausal bleeding.
Polyps can irritate the surrounding tissue, exposing blood vessels and leading to bleeding or spotting. Although they can cause irregular bleeding or spotting between periods, uterine polyps are more likely to develop after menopause.
Postmenopausal polyps typically don't involve noticeable symptoms other than bleeding.
3. Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome, or PCOS, is a hormonal disorder that doesn't have a clear cause.
The symptoms of PCOS and perimenopause can overlap, so it's fairly common to receive a PCOS diagnosis before reaching menopause if you experience irregular periods and weight gain, Barbieri says.
Your care team may recommend a pelvic exam, blood tests, or ultrasound to help determine whether your symptoms meet diagnostic criteria for PCOS.
Common symptoms of PCOS include:
- Unintentional weight gain
- Irregular bleeding or menstrual periods
- Excess facial or body hair
- Severe acne
4. Medications
Hormonal medications or treatments, like hormonal contraceptives, can cause irregular vaginal bleeding by altering hormones such as estrogen and progesterone.
Hormone therapy, which your doctor may prescribe to treat common symptoms of menopause, may also cause light to heavy bleeding for the same reason.
Other medications may infrequently cause vaginal bleeding due to their effect on blood clotting. These medications include:
- Anticoagulants
- Antiplatelets
- Tricyclic antidepressants
- Serotonin reuptake inhibitors (SSRIs)
- Antipsychotics
5. Bleeding from the urethra or bladder
You might notice blood on your underwear or in the toilet, but that doesn't automatically mean it came from your vagina.
Instead, it may have come from your urine, which could suggest a urinary tract infection (UTI), kidney stones, or a kidney infection.
Symptoms related to bleeding from the urethra or bladder include:
- Slight pink to reddish urine
- Pain or a burning sensation when urinating
- Urine that has a foul odor or smells like ammonia
- Fever
- Flank pain, which happens on one side of your body between your back and stomach
6. Bleeding originating from the GI tract
Blood in the toilet or on your underwear could also come from your gastrointestinal (GI) tract, which includes your anus, rectum, stomach, esophagus, and small and large intestines.
On its own, GI bleeding is often a sign of a more serious condition, including hemorrhoids, colonic polyps, peptic ulcers, ulcerative colitis, and even GI cancer.
Other symptoms you might notice include:
- Shortness of breath
- Blood in your vomit or stool
- Dizziness
- Paleness
- Exhaustion
- Little to no urination
- Rapid heartbeat
- Drop in blood pressure
7. Endometrial hyperplasia
Endometrial hyperplasia, a condition that causes thickening of the uterine lining, affects about 0.13% of people with a uterus.
This thickening typically happens as the result of too much estrogen and not enough progesterone in your body. It can cause heavy or atypical bleeding during perimenopause and after menopause.
The most common sign of endometrial hyperplasia is irregular bleeding, including:
- Short menstrual cycles
- Unusually long periods
- Heavier than normal periods
- Missed periods
Early treatment may reduce your risk of endometrial cancer.
8. Yeast infections
Postmenopausal yeast infections are fairly uncommon unless you're receiving estrogen therapy, as high estrogen levels can increase your risk, says Dr. Sam Rahman, board-certified OB-GYN and clinical assistant professor of OB-GYN at Northwestern Feinberg School of Medicine.
If you have a yeast infection, the blood may appear pinkish or light red, and it may involve more spotting than heavy bleeding.
Other symptoms include:
- Redness and swelling of the vulva
- Itching and irritation
- A burning sensation when urinating
- Pain or burning during sex
- Bleeding after sex
9. Uterine or endometrial cancer
Sometimes, postmenopausal bleeding may suggest uterine or endometrial cancer.
Since roughly 10% of those who experience postmenopausal bleeding develop cancer of the uterus, it's essential to get an evaluation whenever postmenopausal bleeding happens, Barbieri says.
Symptoms of endometrial cancer may include:
- Difficulty urinating
- Pain when urinating
- Pain during sex
- Bleeding or discharge unrelated to a menstrual period
- A mass in your pelvic region
Although uterine cancer doesn't always involve noticeable symptoms, you could experience:
- Pelvic pain
- Abnormal Pap test results
- Unusual vaginal spotting, bleeding, or discharge
What to do next
Because postmenopausal bleeding can have a variety of causes, it's important to talk with a healthcare professional if you experience any irregular bleeding.
In all cases of postmenopausal bleeding, an OB-GYN or other healthcare professional can perform an exam to narrow down the cause and rule out serious conditions. They can also offer guidance on treatment and next steps.
Some causes of postmenopausal may require monitoring or treatment, especially if they happen as a symptom of a more serious underlying concern. For example, your OB-GYN may recommend removing polyps as a precautionary measure, especially after menopause.
If you suspect your bleeding relates to a medication you're taking, mention this side effect to your prescribing doctor or clinician. They can offer more guidance on managing side effects or switching to an alternate medication, if necessary.
Insider's takeaway
Postmenopausal bleeding can have many possible causes, but it most often happens as a result of vaginal atrophy and uterine polyps. During menopause, it's very common to experience vaginal dryness and changes in hormone levels, which can contribute to these concerns and lead to bleeding.
Menopause is often considered taboo in many households and cultures, but talking with friends, loved ones, and doctors about menopause and the changes that come with it can help break down the stigma surrounding it.
After all, being more open about common menopause experiences can make it easier to recognize when your symptoms might pose a cause for concern.