Postmenopausal bleeding is any vaginal bleeding that happens 12 months or more after a woman's last period. It should always be checked by a doctor. Most cases are caused by harmless conditions like thinning of the vaginal or uterine lining, but it can also be the first sign of endometrial cancer, so prompt evaluation is important.
Common Causes
Non-cancerous causes
- Thinning of the vaginal lining (vaginal atrophy)
- Thinning of the uterine lining (endometrial atrophy)
- Endometrial or cervical polyps
- Hormone replacement therapy
- Infections
- Blood-thinning medicines
Pre-cancerous and cancerous causes
- Endometrial hyperplasia (thickening of the lining)
- Endometrial cancer
- Cervical cancer
- Rarely, ovarian or vaginal cancers
Why Should It Never Be Ignored?
Bleeding after menopause is the most common symptom of endometrial cancer. When checked early, many cancers are found at an early stage, when treatment is most successful.
How Is It Evaluated?
History and examination
Your doctor asks about bleeding pattern, medicines and health conditions, and examines the vagina and cervix.
Transvaginal ultrasound
Measures endometrial thickness. A thin lining usually suggests a benign cause.
Endometrial biopsy
A small sample of the lining is taken, often in the clinic.
Hysteroscopy
A thin camera looks inside the uterus to find polyps or abnormal areas and take biopsies.
Pap smear or HPV test
To check the cervix.
Who Is at Higher Risk of Cancer?
- Obesity
- Diabetes
- High blood pressure
- Estrogen-only hormone therapy
- Tamoxifen use
- Family history or Lynch syndrome
What Happens Next?
- Atrophy may be treated with vaginal moisturisers or local hormone creams
- Polyps can be removed during hysteroscopy
- Hyperplasia may be treated with hormones or surgery
- Cancer is usually treated with surgery and sometimes additional therapy
Key Takeaways
- Any bleeding after menopause needs checking.
- Most causes are not cancer.
- Endometrial cancer must be ruled out.
- Ultrasound and biopsy are key tests.
- Early evaluation leads to better outcomes.
Final Thoughts
It is easy to dismiss a small amount of bleeding, but it is your body's signal to get checked. Early evaluation brings either reassurance or early treatment. For assessment of postmenopausal bleeding, you can consult Dr. Varadharajan, a surgical oncologist in Chennai.
