At menopause, your periods finally stop. You may not be happy about all the changes menopause brings, but most women are glad to be done with the mess and inconvenience of periods. So, bleeding after menopause can be surprising and frustrating.

Any vaginal bleeding or spotting that occurs after menopause should prompt a doctor's visit. Many times, the cause of postmenopausal bleeding is not serious. But it can be an early warning sign of cancer.

What causes postmenopausal bleeding?
Postmenopausal bleeding is often caused by thinning of the tissues that line the uterus and vagina. After menopause, there is not enough estrogen to form an endometrium, the tissue that lines the uterus in preparation for a fertilized egg. When the top layer of endometrium thins, underlying tiny blood vessels are exposed, which can sometimes lead to bleeding. The vaginal lining can also become thin after going through menopause. This can lead to vaginal spotting, especially after intercourse.

Postmenopausal bleeding or spotting may also be caused by:

• Hormone therapy.
• Polyps, noncancerous growths usually made of tissue from the uterine lining.
• Endometrial hyperplasia, an overgrowth of tissue lining the uterus. Excess endometrial tissue can separate and cause bleeding.
• Endometrial (uterine) cancer. Bleeding is an early sign of this cancer. Treatment is often successful if it is caught early.
• Some medications or chronic health problems such as thyroid disease.

What are the signs of postmenopausal bleeding?
Postmenopausal bleeding can range from spotting to heavier bleeding, like a heavy period. Any blood from the vagina is not normal after you have gone through menopause.

How is it diagnosed?
To diagnose the cause of postmenopausal bleeding, your doctor will ask about your medical history, including when you had your last menstrual period. You will need to describe how much bleeding you have and how often. Bring a list of your medications. Your doctor will do a pelvic exam and may do the following tests:

• Endometrial biopsy. For this test, the doctor uses a thin tube (catheter) to take a small sample of uterine lining. The sample is examined under a microscope to check for cancer and other abnormalities.
• Vaginal or abdominal ultrasound. This test uses a device that emits sound waves to create a digital image of the uterus and other organs.
• Hysteroscopy. A thin, lighted device is inserted through the vagina to view the inside of the uterus.
• Dilation and curettage (D&C). In this procedure the doctor widens the cervix and removes tissue from the lining of the uterus to examine under a microscope.

How is it treated?
The proper treatment will depend on what is causing the bleeding. Treatment might include:

• Hormone therapy. If the endometrium is too thin or too thick, your doctor may prescribe hormones to stabilize the tissue so it no longer bleeds. Hormones can also be used to stop vaginal spotting. If you are already on hormone therapy and it is causing the bleeding, your doctor may adjust the dose.
• Removal of polyps. Polyps can be removed during a hysteroscopy or D&C.
• Hysterectomy. Surgery to remove the uterus may be needed to treat uterine cancer.

Related Articles How Your Menstrual Cycle Changes as You Approach Menopause Decision Focus: Hormone Therapy (HT) for Menopause Understanding a Cancer Pathology Report Testosterone for Low Libido After Menopause What Are the Symptoms of Uterine Cancer?

External Sources National Institute on Aging. Age page: menopause. . Accessed December 10, 2009 Lentz GM. Postmenopausal bleeding. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Katz: Comprehensive Gynecology, 5th ed. Philadelphia, PA: Mosby Elsevier; 2007. American Congress of Obstetricians and Gynecologists. Menopausal bleeding. . Accessed December 09, 2009 National Women's Health Information Center. Understanding menopause. . Accessed December 10, 2009

This article was reviewed and updated 08-01-2009.