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Bleeding After Menopause — Why It Always Needs Checking
Also described as postmenopausal bleeding, bleeding after periods stopped.
Any bleeding more than twelve months after the last period needs assessment, however light or brief. Most causes are benign — thinning of the lining, polyps, or hormone therapy — but this is also the main presenting symptom of endometrial cancer, which is highly curable when found early.
🚨 Get emergency care if you have
- •Any vaginal bleeding after menopause, including spotting
- •Bleeding with pelvic pain or a mass
- •Blood-stained or offensive discharge
- •Bleeding with unexplained weight loss
- •Recurrent bleeding after a previously normal assessment
What causes bleeding after menopause?
Endometrial atrophy
Thinning of the lining after oestrogen falls. The commonest and entirely benign cause.
Endometrial polyp
A benign growth causing intermittent spotting, removed at hysteroscopy.
Endometrial hyperplasia
Thickened lining that can progress, so it is treated and monitored.
Endometrial cancer
Presents this way in most cases, and is curable at an early stage. The reason no bleeding is ignored.
Hormone therapy or vaginal atrophy
Bleeding related to HRT, or fragile vaginal tissues causing spotting after intercourse.
How it is investigated
- ✓Transvaginal ultrasound to measure endometrial thickness
- ✓Hysteroscopy with endometrial biopsy
- ✓Pap smear and cervical examination
- ✓Haemoglobin where bleeding has been recurrent
Not every patient needs every test. The consultation decides which of these apply to you.
Frequently asked questions
It was only spotting once. Does that still need checking?▼
Yes. The amount does not indicate the cause, and a single episode of spotting can be the first sign of an endometrial cancer that is entirely curable at that stage. An ultrasound and, where indicated, a biopsy give a clear answer quickly.
What if I am on hormone replacement therapy?▼
Some regimens cause expected bleeding, particularly in the first months. Unscheduled bleeding, or bleeding that starts after a settled period on HRT, is still investigated rather than assumed to be the treatment.
This page is general health information, not a diagnosis or a substitute for a consultation. Symptoms overlap between harmless and serious conditions, and only an examination can tell them apart. If you are worried, see a doctor.
Plan your first visit
Not sure which specialist to see? Tell our care team the reason for your visit and we will help you choose.
- Bring previous prescriptions, relevant test reports or scan images, a medication list and photo ID.
- If you plan to use insurance, bring your policy details. OPD, tests and admission benefits depend on your individual plan and approval.
- Your first consultation determines which tests or treatments are needed; not everyone needs every test listed on this page.
Appointments are requests until confirmed. In a medical emergency, call 044 2025 2025 or go to the nearest emergency department.