What is bleeding after menopause?

Menopause is the time when you stop having periods. The average age of menopause is 51 years. You have reached menopause when you have not had a period for at least 12 months.

Some females report vaginal bleeding or spotting after menopause, usually in the first year after menopause. This is called 'postmenopausal bleeding'. It is common in the first 4 to 6 months of menopause hormone therapy (MHT), also known as hormone replacement therapy (HRT).

If you do not use MHT, any vaginal bleeding or spotting after menopause should be checked by a doctor.

What is perimenopause?

Perimenopause is the stage of life leading up to your last menstrual period. This stage can last several years.

During perimenopause, it is common to have irregular periods. If you are concerned about any vaginal bleeding, speak to your doctor.

What causes bleeding after menopause?

Some cancers can cause vaginal bleeding after menopause, such as:

• cervical cancer
• endometrial cancer
• ovarian cancer
• vaginal cancer

Other causes of vaginal bleeding after menopause include:

• thinning of the lining of your vagina (atrophic vaginitis)
• thickening of the lining of the uterus (endometrial hyperplasia)
• polyps (growths) on your cervix or uterus
• sexually transmitted infections (STIs)

Menopausal hormone therapy (MHT)

Menopausal hormone therapy, also called hormone replacement therapy (HRT), can sometimes cause vaginal bleeding. You should check with your doctor if you have bleeding while taking MHT.

When should I see my doctor?

Bleeding after menopause may be a sign of a serious condition that needs treatment. Always see your doctor if you have bleeding after menopause.

How is the cause of bleeding after menopause diagnosed?

Your doctor will ask about your symptoms and your health in general. They might ask you:

• how long you have had vaginal bleeding
• how often you have noticed the bleeding
• how heavy the bleeding is
• when the bleeding happens — for example, if you have bleeding after sex

Tell your doctor if you have had any other symptoms and whether you are taking menopausal hormone therapy (MHT).

Your doctor will ask to examine you. This may involve a vaginal examination and a check of your cervix using a medical device called a speculum. This is the same device used when you have a cervical screening test.

Tests

Your doctor may recommend some tests to find the cause of your bleeding, such as:

• an ultrasound scan, with the probe placed over your abdomen (tummy) or inserted into your vagina
• a swab of your vagina and cervix to test for infections
• a cervical screening test

Your doctor may refer you to a gynaecologist for further tests. These may include a:

• hysteroscopy — a procedure that uses a small camera to look inside your uterus
• biopsy of the lining of your uterus

How is bleeding after menopause treated?

Your treatment will depend on what is causing the bleeding.

Surgery

If your bleeding is caused by a cancer, you may be referred to a gynaecological oncologist. This is a specialist who treats cancers of the female reproductive system. They will usually recommend surgery, such as a hysterectomy, to remove the cancer.

Even if you don't have cancer, you may choose to have a hysterectomy to stop the bleeding if it is heavy or other treatments aren't working.

Bleeding caused by a polyp can be treated by removing the polyp.

Medicines

If your bleeding is caused by a thickened lining of your uterus, hormone treatment can help. This could be in the form of tablets or an intrauterine device (IUD).

If your bleeding is caused by a thinned vaginal lining, creams or medicines containing oestrogen can help. Speak with your doctor about treatments for bleeding after menopause.

If you are taking menopausal hormone therapy, your doctor may change the dose or type of your therapy to try to address the bleeding.

What are the complications of bleeding after menopause?

Complications of bleeding after menopause will depend on what is causing the bleeding. Some causes of bleeding after menopause can be serious, and can lead to complications, so it's important to see your doctor.

Heavy vaginal bleeding at this stage of life can lead to anaemia.

Can bleeding after menopause be prevented?

Most causes of vaginal bleeding after menopause cannot be prevented, but your doctor can advise you on the best treatment to manage it.

Resources and support

Jean Hailes for Women's Health and the Australasian Menopause Society have more information on women's health and menopause.

Cancer Council has more information on cancers affecting the female reproductive system.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

Languages other than English

Visit the Jean Hailes website to find information about menopause and other topics in several community languages.

Information for Aboriginal and/or Torres Strait Islander peoples

See this booklet about menopause for Aboriginal and/or Torres Strait Islander females.