Let’s explore why this happens, what the most common causes are, and what to expect during evaluation and treatment.

Endometrial Atrophy – As estrogen levels decline after menopause, the uterine lining (endometrium) can become thin and fragile, leading to occasional spotting or light bleeding.
Endometrial Hyperplasia – In some cases, the uterine lining may thicken due to excess estrogen, which can cause irregular bleeding. This condition can sometimes lead to endometrial cancer if left untreated.
Polyps – Benign growths in the uterus or cervix are a frequent cause of abnormal bleeding. They may require removal, especially if they cause symptoms.
Hormone Therapy – If you are using menopausal hormone therapy (MHT), some types—especially those containing both estrogen and progesterone—can cause breakthrough bleeding, particularly in the first few months of use or with a change in medication dosing.
Infections or Inflammation – Vaginal or endometrial infections, such as endometritis or cervicitis, can lead to abnormal bleeding and require treatment.
Endometrial or Cervical Cancer – While most cases of PMB are not due to cancer, it is crucial to rule out endometrial or cervical cancer, as early detection greatly improves outcomes.
Other Medical Conditions – Some blood disorders, thyroid conditions, and the use of blood thinners can also contribute to abnormal postmenopausal bleeding. Conditions like chronic endometritis (long-term inflammation of the uterine lining) can also be an underlying cause that should be investigated.

Don’t panic.
- While postmenopausal unscheduled bleeding (PMB) can be caused by serious conditions, many common and treatable issues can also be the cause.
Call your GYN/menopause healthcare professional.
- Letting us know is the first step in order to discuss this further and form a plan of action.

Any postmenopausal bleeding should be evaluated. We will help determine the appropriate next steps based on your symptoms and medical history.

Monitor your symptoms.
- Take note of how much you are bleeding, whether it’s light spotting or a heavier flow, and any associated symptoms like pain or discomfort.

This helps us determine the potential cause of the bleeding.
Initially, we will most likely ask you to monitor the bleeding for 1-2 weeks to see if it will subside on its own. Of course, if the bleeding is very heavy, painful, or intolerable, we will progress into a clinical work-up without taking a wait-and-watch approach.

You may need to have one or a combination of the following tests:

Pelvic Exam – To check for any visible abnormalities in the urethra, vagina, cervix, or uterus.
Transvaginal Ultrasound – This imaging test evaluates the thickness of the endometrial lining and detects polyps or fibroids.
Endometrial Biopsy – A small sample of tissue from the uterine lining is taken and examined under a microscope to check for abnormal or cancerous cells.
Hysteroscopy – A procedure that allows your gynecologist to look inside the uterus with a small camera to identify and possibly remove any growths.
Additional Lab Testing – Blood tests may be performed to check hormone levels, thyroid function, and clotting factors that could contribute to abnormal bleeding.

Endometrial Atrophy – Treated with vaginal estrogen therapy to restore tissue health and reduce fragility.
Endometrial Hyperplasia – Management depends on whether abnormal cells are present. Progestin therapy or a procedure such as a dilation and curettage (D&C) may be recommended.
Polyps – Removed through a minor surgical procedure if they are symptomatic or show concerning features.
Hormone Therapy-Related Bleeding – If MHT is causing irregular bleeding, your clinician may adjust the dosage or switch to a different regimen.
Infections or Inflammation – Treated with antibiotics or other appropriate medications.
Cancerous Conditions – If endometrial or cervical cancer is diagnosed, treatment may involve surgery, radiation, or chemotherapy, depending on the stage and type.
Other Medical Conditions – If blood disorders or thyroid issues are found to be contributing factors, treatment will be tailored accordingly, such as adjusting medications or supplementing with thyroid hormones if necessary.

Postmenopausal Bleeding—Why it happens and what to do

Testosterone…the not so “male hormone”