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Causes

The most common causes of bleeding or spotting after menopause include:

● Endometrial or vaginal atrophy (lining of the uterus or vagina becomes thin and dry).
● Hormone Replacement Therapy (HRT) (estrogen and progesterone supplements that decrease some menopausal symptoms).
● Uterine cancer or endometrial cancer (cancer in the lining of the uterus).
● Endometrial hyperplasia (the lining of the uterus gets too thick and can contain abnormal cells).
● Uterine polyps (growths in the uterus).

Other causes can include:

● Cervical cancer (cancer in the cervix).
● Cervicitis or endometritis (infection or inflammation in the cervix or uterus).
● Bleeding from other areas, nearby, in the bladder or rectum, or bleeding from the skin of the vulva (outside near the vagina).

Risk Factor

Anyone can have vaginal bleeding, especially during perimenopause. Perimenopause, the time leading up to menopause, usually occurs between ages 40 and 50. It’s the phase when a woman’s hormone levels and periods start to change.
 

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Diagnosis

● Identifying the cause of the bleeding can include the following:
● Exam by your provider of the vagina and cervix.
● Pap smear to check the cervical cells.
● Ultrasound, which usually using a vaginal approach, which may include the use of saline to make it easier to see any uterine polyps.
● Biopsy of the endometrium or uterus. In this procedure, your healthcare provider gently slides a small, straw-like tube into the uterus to collect cells to see if they are abnormal. This is done in the office and can cause some cramping.

Treatment 

Treatment for postmenopausal bleeding depends on its cause. Medication and surgery are the most common treatments.

Medications include:

● Antibiotics can treat most infections of the cervix or uterus.
● Estrogen may help bleeding due to vaginal dryness. You can apply estrogen directly to your vagina as a cream, ring, or insertable tablet. Systemic estrogen therapy may come as a pill or patch. When estrogen therapy is systemic, it means the hormone travels throughout the body.
● Progestin is a synthetic form of the hormone progesterone. It can treat endometrial hyperplasia by triggering the uterus to shed its lining. You may receive progestin as a pill, shot, cream, or intrauterine device (IUD).

Surgeries include:

● Hysteroscopy is a procedure to examine your cervix and uterus with a camera. Your healthcare provider inserts a hysteroscope (thin, lighted tube) into your vagina to remove polyps or other abnormal growths that may be causing bleeding. This can be done in the office for diagnosis. To remove any growths, hysteroscopy is often done in the operating room under general anesthesia.
● Dilatation & Curettage (D&C) is a procedure to sample the lining and contents of the uterus. Your healthcare provider may perform a D&C with a hysteroscopy. A D&C can treat some types of endometrial hyperplasia.
● A hysterectomy is surgery to remove your uterus and cervix. You may need a hysterectomy if you have uterine cancer. Your healthcare provider can tell you about the different approaches to uterus removal. Some procedures are minimally invasive, so they use very small cuts (incisions).

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