Light spotting after menopause can be caused by a few different things, including non-cancerous polyps, vaginal dryness, or excess growth of the tissue that lines the uterus. Because it can also be a symptom of endometrial cancer, spotting after menopause should always be evaluated by a healthcare provider.

This article discusses the causes and risk factors associated with bleeding after menopause.  

Common Causes

When bleeding occurs after menopause, it’s referred to as postmenopausal bleeding. It is relatively rare; only about 10% of people who have reached menopause experience postmenopausal bleeding.

There are several common causes for spotting or light bleeding after menopause.

Vaginal and Vulvar Atrophy

Vaginal and vulvar atrophy occurs when the vaginal walls or the vulva (outer part of the female genitals) begin to thin and become dry and inflamed. When this happens, a person may experience irritation or soreness in the area.

It is caused by a decrease in the female reproductive hormone estrogen. Although it can happen at any age, it is most common following menopause. It affects as many as 50% of women who have reached that stage of reproductive health.

Vaginal and vulvar atrophy can cause bleeding, although spotting is most common during sexual intercourse because of the increase in irritation to the area.

Polyps

Polyps are growths that can develop from any tissue in the body. Typically, polyps are noncancerous, however, they do have the potential to morph into cancerous growths if left untreated.

Treating Vaginal and Vulvar Atrophy

Typically, treatment involves relieving irritation and restoring moisture to the area. Some options include:

The various types of polyps that can develop and cause vaginal bleeding after menopause include:

  • Endometrial polyps (growths attached to the inner wall of the uterus that extend into the uterine cavity)
  • Cervical polyps (growths in the cervical canal, the lower part of the uterus)

Endometrial Hyperplasia

Endometrial hyperplasia is a condition characterized by the thick growth of endometrial tissue that lines the uterus.

Endometrial Polyps and Cancer Risk

Although it’s possible for endometrial polyps to develop into cancer, the risk associated with postmenopausal endometrial polyps is low, at 1.3%.

After a person reaches menopause, they may decide to undergo certain types of therapies that increase their levels of estrogen to cope with symptoms. However, this extra estrogen can actually bring on endometrial hyperplasia.

This excessive and thick growth of endometrial tissue can lead to vaginal bleeding following menopause because the tissue has to be shed.

Endometrial Cancer

Endometrial cancer is a type of cancer that forms within the endometrial tissue. According to the National Cancer Institute, roughly 9% of menopausal people were diagnosed with endometrial cancer after experiencing vaginal bleeding.

Why Does Estrogen Cause Endometrial Hyperplasia?

Estrogen is the reproductive hormone that causes the cells of the uterine lining to grow. When there is too much growth because of excessive estrogen, endometrial hyperplasia can result.

Rare Causes of Postmenopausal Spotting

There are many other causes of spotting after menopause. Some are easily treatable, while others may require more extensive treatment.

It’s worth noting that although the connection between vaginal bleeding and endometrial cancer is clear, most people who have postmenopausal bleeding do not go on to develop the disease.

Postmenopausal bleeding can be caused by:

  • Cervical cancer
  • Ovarian cancer
  • Endometritis, which is an infection of the endometrial lining
  • Trauma or injury to the vagina
  • Estrogen replacement therapy
  • Certain medications, such as blood thinners
  • Certain sexually transmitted infections (STIs) that cause bleeding to occur following sexual intercourse

Genetics

Genetics does not play a role in whether a person will experience postmenopausal bleeding. However, some women may be more susceptible to developing endometrial cancer, which can go hand in hand with vaginal bleeding in a small number of cases.

Most people who have postmenopausal vaginal bleeding will not develop endometrial cancer. So, genetic susceptibility to endometrial cancer is not a good risk marker for the development of postmenopausal bleeding.

Risk Factors

The risk factors associated with postmenopausal vaginal bleeding are not well-known because there are many different underlying causes for why it occurs. According to research, the most common risk factor was having either diabetes or hypertension.

Summary

Postmenopausal bleeding is not normal and should be discussed with a healthcare provider. Some causes include polyps, vaginal and vulvar atrophy, endometrial hyperplasia, estrogen replacement therapy, and cancer. Although many of these aren’t serious, others, like cancer, can be life-threatening if not caught early and treated appropriately.

The most common risk factors for postmenopausal bleeding are preexisting conditions such as diabetes and hypertension. Genetics doesn’t typically determine whether you will experience spotting after you have entered menopause.

A Word From Verywell

Spotting after menopause can be alarming, because you probably assume vaginal bleeding is behind you. While you shouldn’t worry about it too much, you do need to have it evaluated by a healthcare provider since it can be serious. A provider can identify the cause and determine treatment options to address the bleeding.

Frequently Asked Questions

  • What are common causes of bleeding after menopause?
  • Common causes of bleeding after menopause include vaginal or vulvar atrophy, polyps, and uterine fibroids (tissue growth). In most cases these are noncancerous conditions, but some may have the potential to become cancerous after time. If found early, they can be successfully cured.
  • When should I be concerned about spotting after menopause?
  • All spotting after menopause is unusual and warrants a healthcare evaluation. Even if you don’t have a serious health issue, the bleeding needs to be addressed.

Common causes of bleeding after menopause include vaginal or vulvar atrophy, polyps, and uterine fibroids (tissue growth). In most cases these are noncancerous conditions, but some may have the potential to become cancerous after time. If found early, they can be successfully cured.

All spotting after menopause is unusual and warrants a healthcare evaluation. Even if you don’t have a serious health issue, the bleeding needs to be addressed.