Bleeding after menopause is not considered a normal part of the menopause transition and should be evaluated. Postmenopausal bleeding can range from a small amount of spotting to heavier bleeding. Many causes are benign, but evaluation is important because bleeding can also be a sign of endometrial precancer or cancer.
What Counts as Postmenopausal Bleeding?
Menopause is confirmed after 12 consecutive months without a menstrual period when there is no other explanation. Any vaginal bleeding or spotting after that point is considered postmenopausal bleeding.
Common Causes
- Thinning of the vaginal or uterine lining related to low estrogen
- Genitourinary syndrome of menopause (GSM)
- Endometrial or cervical polyps
- Endometrial hyperplasia
- Medication effects, including some hormone therapies and anticoagulants
- Infection or cervical conditions
- Endometrial or other gynecologic cancer
Why Evaluation Matters
ACOG emphasizes prompt evaluation of postmenopausal bleeding because endometrial cancer commonly presents with bleeding. Most women with postmenopausal bleeding do not have cancer, but the symptom should not be attributed to hormones or vaginal dryness without an appropriate workup.
How Postmenopausal Bleeding Is Evaluated
Evaluation may include a medical history, medication review and pelvic examination. Depending on the clinical situation, clinicians may use transvaginal ultrasound, endometrial tissue sampling, hysteroscopy or other testing.
ACOG updated its guidance in 2026 to support a more comprehensive initial approach for most patients with postmenopausal bleeding, emphasizing both imaging and endometrial tissue evaluation when appropriate.
What If the Bleeding Happens While Using Hormone Therapy?
Bleeding patterns depend on the hormone regimen, how recently therapy was started, whether a uterus is present and other factors. Unexpected, persistent or recurrent bleeding while using hormone therapy still deserves medical assessment.
Could Vaginal Atrophy Cause Bleeding?
Yes. Low estrogen can make vulvovaginal tissue thinner and more fragile, which can contribute to bleeding, especially after sexual activity. But because more serious causes can present the same way, bleeding after menopause should still be evaluated. Learn more about genitourinary syndrome of menopause and vaginal atrophy.
When to Seek Care
Contact a clinician promptly for any bleeding after menopause. Seek urgent evaluation for heavy bleeding, dizziness, fainting, severe pelvic pain or other concerning symptoms.
Related Menopause Care
For broader menopause symptoms, see our menopause treatment in Los Angeles page. If you are still having irregular periods and have not yet reached 12 months without a period, our perimenopause and perimenopause vs menopause guides may be more relevant.
