If you have gone through menopause — defined as 12 consecutive months without a period — and then notice any vaginal bleeding, even the faintest spotting, this is something that must be evaluated by a doctor immediately. It is never normal, and it should never be dismissed.
This blog explains why postmenopausal bleeding matters, what it could indicate, and what to do next.
What Is Postmenopausal Bleeding?
Postmenopausal bleeding (PMB) is any vaginal bleeding that occurs after a woman has been through menopause. This includes:
- Fresh red bleeding
- Light pink spotting
- Brown or dark discharge (old blood)
All of these need evaluation — there is no safe type of postmenopausal bleeding.
How Common Is It?
Postmenopausal bleeding affects approximately 10% of postmenopausal women. The majority of cases (approximately 90%) have a non-cancerous cause. However, approximately 10% of women with PMB are found to have endometrial (uterine) cancer — which is why every case must be investigated.
Common Causes of Postmenopausal Bleeding
Non-Cancerous Causes (90% of cases)
- Endometrial atrophy — thinning of the uterine lining due to oestrogen deficiency; the most common cause
- Vaginal atrophy — thinning and dryness of the vaginal walls
- Endometrial or cervical polyps — benign growths inside the uterus or on the cervix
- Hormone replacement therapy (HRT) — breakthrough bleeding during HRT
- Uterine fibroids — though less common after menopause
- Infections — cervicitis or vaginitis
Cancerous Causes (approximately 10% of cases)
- Endometrial (uterine) cancer — the most important cause to rule out
- Cervical cancer
- Vaginal cancer
- Ovarian cancer (less commonly)
Risk Factors That Increase the Probability of Cancer
Certain factors make it more likely that PMB is caused by cancer:
- Obesity (BMI over 30)
- Diabetes or hypertension
- Never having been pregnant
- Late menopause (after age 55)
- Long-term use of oestrogen without progesterone
- Tamoxifen use for breast cancer
- Family history of uterine, ovarian, or colorectal cancer
- Recurrence of bleeding (rather than a single episode)
What Investigations Will a Doctor Order?
If you present with postmenopausal bleeding, your doctor will typically recommend:
- Transvaginal ultrasound (TVS) — to measure the thickness of the endometrium. A thickened endometrium (over 4 to 5 mm) requires further investigation.
- Endometrial biopsy — a sample of the uterine lining to check for cancer or pre-cancer cells
- Hysteroscopy — direct visualisation of the inside of the uterus using a small camera; allows targeted biopsy of suspicious areas
- Pap smear — to rule out cervical cancer
How Quickly Should You Be Seen?
Postmenopausal bleeding should be evaluated within 2 weeks of its occurrence. Do not wait to see if it happens again. Even a single episode warrants prompt investigation.
What Happens If Cancer Is Found?
If the investigations confirm uterine cancer, the good news is that most women with PMB who have cancer are diagnosed at an early stage — because they sought medical attention quickly. Stage I uterine cancer has a 5-year survival rate of approximately 95% with appropriate treatment.
Please Do Not Wait
Postmenopausal bleeding is your body’s warning signal. Heed it. Every day of delay is a day that could make a difference in your diagnosis and treatment outcome. Please see a specialist.
Dr. Monisha Gupta is a Gynecologic Oncologist at Fortis Hospital, Shalimar Bagh, New Delhi. If you or a loved one is experiencing postmenopausal bleeding, book a consultation today.
