Post-Menopausal Bleeding

iStock 000006048423SmallBleeding after menopause (ie one year of no periods because of decline in ovarian function) is always abnormal. Often the cause is benign but cancer must be ruled out.

Here are some of the conditions that can cause post-menopausal bleeding.


Polyps usually are noncancerous growths that develop from tissue similar to the endometrium, the tissue that lines the inside of the uterus. They either attach to the uterine wall or develop on the endometrial surface. They may cause irregular or heavy bleeding.

Polyps also can grow on the cervix or inside the cervical canal. These polyps may cause bleeding after sex.

multiple endometrial polypsThinning of the Endometrium

After menopause, the endometrium may become very thin as a result of low estrogen levels. This condition is called endometrial atrophy. As the lining thins, you may have abnormal bleeding.

Endometrial Hyperplasia

In this condition, the lining of the uterus thickens, due to excess estrogen relative to progesterone. Endometrial hyperplasia can cause irregular or heavy bleeding. In some cases of endometrial hyperplasia, the cells of the lining become abnormal. This condition, called atypical hyperplasia, can lead to cancer of the uterus.

Endometrial hyperplasia most often is caused by excess estrogen without enough progesterone. Diagnosis and treatment of endometrial hyperplasia allows for prevention of the most common form of endometrial cancer.

Endometrial Cancer

In the United States, endometrial cancer is the most common type of cancer of the female reproductive system. Listed are some risk factors for endometrial cancer:

  • Advancing age
  • Early puberty or late menopause
  • Never having been pregnant
  • Irregular periods
  • History of infertility
  • Long-term use of medications containing high doses of estrogen
  • Obesity
  • Polycystic ovary syndrome (PCOS)
  • Treatment with a drug called tamoxifen
  • Certain ovarian tumors
  • History of diabetes, high blood pressure, gallbladder disease, or thyroid disease
  • Personal history or family history of certain types of cancer (such as ovarian cancer or colon cancer)
  • Smoking

Endometrial cancer also can occur in the absence of any of these risk factors.

Bleeding is the most common sign of endometrial cancer in women after menopause. When diagnosed early, most cases of endometrial cancer can be treated successfully.

Other Causes

Other causes of bleeding after menopause include

  • hormone therapy
  • infection of the uterus or cervix
  • use of some medications
  • other types of cancer

Debra Ravasia, updated 2017