Bleeding after the menopause

Category: Women's Health · All women's health symptoms

What it can feel like

Bleeding after the menopause means any vaginal bleeding occurring a year or more after your last period. It should never be dismissed as 'one last period' — it always needs prompt investigation, because while the commonest causes are benign thinning of the tissues, it is the classic early symptom of womb cancer, which is highly curable at that stage.

Possible causes

A symptom can have many causes, and most are not serious. The lists below group conditions this symptom can be associated with — common causes first. They are possibilities to discuss with a clinician, not a diagnosis.

Common causes

Postmenopausal bleeding can be associated with thinning and fragility of the vaginal and womb lining (atrophy — the commonest cause), polyps of the cervix or womb lining, and hormone replacement therapy effects, particularly when doses change.

Other possible causes

Bleeding after the menopause can also be associated with precancerous thickening of the womb lining and womb (endometrial) cancer, and occasionally with cervical or ovarian pathology.

Red flags — when to seek help promptly

Any vaginal bleeding more than a year after your last period — arrange prompt assessment
Bleeding after the menopause that is heavy or comes with pelvic pain
Bleeding in a woman taking tamoxifen
Bleeding after the menopause with weight loss or a pelvic mass

What a clinician may do

Assessment is usually on an urgent pathway: pelvic examination, a transvaginal ultrasound to measure the womb lining, and where the lining is thickened or bleeding persists, a camera look inside the womb (hysteroscopy) with a lining sample (biopsy). Thin linings with a normal examination are often reassuring but bleeding that recurs is re-investigated.

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Frequently asked questions

How soon is 'prompt' for postmenopausal bleeding?

It should be reported as soon as noticed and is typically investigated within two weeks on cancer pathways. Do not wait for a second episode: a single bleed, even spotting, is enough to trigger the pathway.

Why does the ultrasound measure the lining?

After the menopause the womb lining should be thin. A thin lining on scan makes cancer very unlikely and focuses attention on atrophy or polyps; a thickened lining needs a sample. The measurement triages who needs the camera test first.

Related symptoms — Women's Health

Bleeding after sex Bleeding between periods Breast lump Breast pain Heavy periods Hot flushes

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Please note: This page is educational information about a symptom. A symptom alone cannot diagnose any condition, and the causes listed here are possibilities, not a diagnosis. If you are worried about a symptom — especially one that is new, severe, getting worse or not going away — please see your own clinician, who can examine you and arrange tests. In an emergency, call your local emergency number.