Bleeding After Menopause

Bleeding after menopause can be worrying. Most of the time the cause is not serious, but it always needs to be checked. We start the evaluation by telehealth, order the right imaging, and help you reach gynecology when a biopsy is needed.

Become a Patient

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Understanding Postmenopausal Bleeding

Postmenopausal bleeding is any vaginal bleeding that happens 12 months or more after your last menstrual period. That includes light spotting, pink or brown discharge, and a single episode that stops on its own. Because periods have ended, bleeding is not expected, and every episode should be checked, even a small one. Irregular bleeding is common during perimenopause, before periods have stopped for a full year, but heavy, prolonged or very frequent bleeding then deserves a look too.

Most causes are not cancer. Common causes include thinning and dryness of the vaginal and uterine lining from lower estrogen, polyps in the uterus or cervix, and bleeding related to hormone therapy. Other causes include thickening of the uterine lining (endometrial hyperplasia), infections, fibroids and some medicines, such as blood thinners. Bleeding can also come from the urinary tract or the rectum and be mistaken for vaginal bleeding. Endometrial cancer, a cancer of the lining of the uterus, is less common, but bleeding is its most common early sign, which is why it must always be ruled out.

Care matters because endometrial cancer found early, when bleeding is often the only sign, is very treatable. The evaluation usually starts with a transvaginal ultrasound to measure the thickness of the uterine lining, and often includes a referral to gynecology for an endometrial biopsy, a short office procedure that samples the lining. We start by telehealth for patients physically located in Utah at the time of the visit, order imaging at a local imaging center, and help you arrange the exam and referral.

Signs & Symptoms of Postmenopausal Bleeding

Spotting. Even a small amount of blood on underwear or toilet paper counts.
Pink or brown discharge. Discharge tinged with blood should be checked.
Bleeding like a period. What feels like a period returning after a year without one.
Bleeding after sex. Bleeding during or after intercourse, which can come from dry tissue or the cervix.
Bleeding on hormone therapy. Bleeding that is heavy, persistent or unexpected for your regimen.
Watery or unusual discharge. A new watery or bad-smelling discharge can come with some causes.
Pelvic pressure or cramping. Cramping or pressure along with bleeding.
Dryness and irritation. Vaginal dryness, itching or burning often travel with bleeding from thin tissue.

What to Expect

Any bleeding 12 months or more after your last period is checked, even spotting
A video visit to review the bleeding, your health history, medicines and hormone therapy
A transvaginal ultrasound at a local imaging center to measure the uterine lining
Referral to gynecology for an endometrial biopsy when needed, and help arranging a pelvic exam
Labs at a local lab, such as a blood count, when bleeding has been heavy or ongoing
Treatment for the cause once it is found, and follow-up so nothing is missed

How We Evaluate Postmenopausal Bleeding

Assessment

We talk by video about when the bleeding started, how much there has been, whether it follows sex, and whether you take hormone therapy, tamoxifen, blood thinners or other medicines. We review risk factors such as excess weight, diabetes, estrogen taken without progesterone, and family history. We may order a blood count at a local lab if bleeding has been heavy.

Imaging and Referral

Most evaluations include a transvaginal ultrasound at a local imaging center to measure the thickness of the uterine lining. Often the next step is an endometrial biopsy, a short procedure done by gynecology, and we help you arrange that referral. A pelvic exam, which needs an in-person visit, checks the cervix, vagina and vulva. Our in-person clinic is being planned in Cache County, Utah. Until it opens, we help you arrange the exam nearby.

Treatment and Follow-Up

Treatment depends on the cause. Once more serious causes have been ruled out, vaginal moisturizers or low-dose vaginal estrogen can help thin, dry tissue. Polyps are usually removed by gynecology, and hormone therapy may be adjusted. We track your results, make sure every step is completed, and ask you to tell us right away if bleeding returns.

Benefits

Taken Seriously

Any bleeding after menopause is checked, even a single spot, and your concern is never brushed off.

A Clear Path

You will know which tests you need, why, and what comes next, and we help arrange each step.

Experience in Women's Health

Brooke Tuttle, FNP-C, is a board-certified family nurse practitioner who has practiced family medicine since 2017. Before that, she spent 11 years as a registered nurse in labor and delivery, postpartum and the well-baby nursery.

Coordinated Care

We keep track of imaging, referrals and results so the evaluation is completed.

Your Care Journey

First Visit

We review your bleeding and history by video, order a transvaginal ultrasound at a local imaging center, and order labs if needed.

The Next Few Weeks

We review the ultrasound with you. If a biopsy or exam is needed, we help you arrange a gynecology visit.

After Your Results

Results guide treatment, whether that is care for thin tissue, removal of a polyp, a change in hormone therapy, or further specialist care.

Long-Term Care

We keep up with your health care after menopause and want to hear right away if bleeding ever returns.

Warning Signs That Need Emergency Care

Heavy bleeding. Soaking through a pad every hour for two hours or more is an emergency. Call 911 or go to the nearest emergency room.

Dizziness, fainting or a racing heart. These can mean you have lost a lot of blood. Call 911 or go to the nearest emergency room.

Large clots. Passing large clots, especially with heavy flow, needs emergency care.

Bleeding with severe pain or fever. Go to the nearest emergency room.

Bleeding while taking a blood thinner. Heavy bleeding on a blood thinner needs emergency care, and any new bleeding should be reported promptly.

Any bleeding at all. Even spotting after menopause needs a prompt visit, so reach out rather than waiting to see whether it happens again.

Bleeding that returns. Bleeding that comes back after a normal evaluation should be checked again.

If you are unsure whether bleeding is an emergency, it is safer to be seen.

What to Expect From the Evaluation

Transvaginal ultrasound. A small probe placed in the vagina gives a clear picture of the uterus and measures the thickness of its lining. A thin lining is reassuring, while a thicker lining or bleeding that continues usually leads to a biopsy.

Endometrial biopsy. A thin, flexible tube passed through the cervix collects a small sample of the uterine lining, usually in a gynecology office. It can cause cramping for a short time.

Pelvic exam. An in-person exam checks the vulva, vagina and cervix for sources of bleeding, and a Pap test may be done if one is due.

Other tests. Some people need a hysteroscopy, which looks inside the uterus with a small camera, or a procedure to remove a polyp. Gynecology guides these steps.

Most Causes Are Not Cancer

Thin, dry tissue from lower estrogen is the most common cause of bleeding after menopause, and polyps and hormone therapy are other common causes. Even so, endometrial cancer must be ruled out each time, because bleeding is its most common early sign and it is very treatable when found early. Waiting to see whether bleeding happens again is not recommended.

Common Questions About Postmenopausal Bleeding

Does a small amount of spotting need to be checked?

Yes. Any bleeding 12 months or more after your last period should be checked, including light spotting, pink or brown discharge, or a single episode that stops on its own. Most causes are not serious, but the only way to know is to look.

Is bleeding after menopause a sign of cancer?

Usually not. Most bleeding after menopause comes from thin, dry tissue, polyps or hormone therapy. Endometrial cancer is less common, but bleeding is often its first sign, so it must always be ruled out. When it is found early, it is very treatable.

I take hormone therapy. Is bleeding normal?

Some light, irregular bleeding is common in the first months of some hormone therapy regimens, and cyclic regimens cause expected monthly bleeding. Bleeding that is heavy, continues past the first several months, or starts after a stretch without any should be checked. Tell us about any bleeding and we will help you decide what it needs.

Can the evaluation be done by telehealth?

The first step can. By video we review your bleeding, history and medicines and order a transvaginal ultrasound at a local imaging center. The ultrasound, a pelvic exam and a biopsy all happen in person, and we will help you arrange each one, including a referral to gynecology when a biopsy is needed.

What is an endometrial biopsy?

It is a short procedure in which a thin, flexible tube collects a small sample of the lining of the uterus. It is usually done in a gynecology office and can cause cramping for a short time. The sample is checked under a microscope for precancer or cancer.

Does insurance cover the evaluation?

Sagebrooke Family Medicine is an insurance-based practice, and we are in the process of joining insurance plans. What you pay depends on your plan, including any copay, deductible or coinsurance. Contact the practice to check whether your plan is accepted, and check with your insurer about coverage for ultrasound and other imaging, labs and specialist referrals.

Get Postmenopausal Bleeding Checked

Any bleeding after menopause deserves a look. Request a telehealth visit and we will start the evaluation and help you arrange each next step. For heavy bleeding or dizziness, call 911.