Bleeding after menopause is not always cancer, but it should be investigated promptly because early assessment can identify endometrial, cervical, vaginal or medication-related causes and exclude serious disease.
Possible causes
Common causes include thinning of vaginal or endometrial tissues, polyps, hormone therapy and infection. Endometrial or cervical cancer is less common but important to exclude. Bleeding from the urinary or bowel tract can sometimes be mistaken for vaginal bleeding.
Initial assessment
Clinicians review the timing, amount and recurrence of bleeding, medications such as anticoagulants or hormone therapy, cervical-screening history and risk factors. Pelvic examination helps identify vulval, vaginal or cervical sources.
Ultrasound, biopsy and hysteroscopy
Transvaginal ultrasound measures the endometrium and looks for focal lesions. Depending on the result and symptoms, endometrial biopsy or hysteroscopy may be advised. Persistent or recurrent bleeding can require further assessment even after an initially reassuring test.
After results
Treatment depends on the cause. Atrophic tissues may respond to local treatment, polyps can be removed, and abnormal pathology is referred promptly. A clear safety-net plan should explain what to do if bleeding recurs.
Questions worth discussing at your consultation
- Which tests are recommended first and why?
- Does my hormone therapy or medication affect interpretation?
- What happens if the first tests are normal but bleeding recurs?
- When should I expect pathology results?