9 Common Causes of Light Spotting After Menopause

This article was medically reviewed by Dr. Navya Mysore and updated on March 8, 2024

When you experience a menstrual cycle, spotting is not usually considered unusual or an automatic cause for concern. If it’s accompanied by other symptoms or happening on a regular basis, it’s definitely worth seeking medical advice. But for many, it’s a regular part of their cycle.  

After menopause, the perception of any bleeding changes dramatically. Any vaginal bleeding after menopause is considered abnormal vaginal bleeding and should be investigated.

Postmenopausal Bleeding: A High-Level Overview

During perimenopause (the stage before menopause), your menstrual cycle gradually comes to an end. The average length of perimenopause is 3-5 years, and during that time, your menstrual period can become irregular, and there can be irregular bleeding between periods.

Just as periods start out irregularly when you go through the changes of puberty, so they become irregular as you go through the changes of perimenopause.

Because of this gradual change, many individuals are unsure when perimenopause ends, and menopause begins. In medical terms, menopause is confirmed 12 months after your last menstrual period. 

Bleeding after this point is called postmenopausal bleeding (PMB), and it is considered abnormal bleeding.

Don’t Freak Out. But *Do* See a Doctor…

If you Google "vaginal bleeding after menopause" or “causes of light spotting after menopause,” the search results are likely to send you into a panic. 

Please don’t panic! There are many explanations for spotting after menopause. So, why the urgency to see a doctor?  

One serious reason for menopausal bleeding is endometrial cancer, which cannot be screened for and means it can go undetected if symptoms are ignored.

So, even though postmenopausal bleeding can occur for a variety of reasons—not just cancer—understanding that it can allow for early detection of endometrial cancer means it’s always worth investigating.

Causes of Vaginal Bleeding Postmenopause

As mentioned, there can be a number of reasons for postmenopausal bleeding and while we urge you to work with your doctor to determine the underlying cause of postmenopausal bleeding, it might be helpful to know some of the most common explanations:

You’re Still in Perimenopause

One obvious reason you might experience spotting after menopause is that you’re not yet actually in menopause. The perimenopause stage lasts, on average, 3-5 years. But for some women, this stage may last only a few months or continue for up to 10 years.

"During perimenopause, the ovaries begin to make less estrogen. Some months, the ovaries may release an egg. Other months, they do not release an egg. In your 40s, your menstrual periods may be shorter or longer, and the days between may increase or decrease.

Your bleeding may change too—it may be heavier or lighter. You also may skip periods," according to the American College of Obstetricians and Gynecologists. 

Considering periods become irregular at this stage, it can be easy to mistake the stage you’re in for menopause. It’s worth tracking your periods and irregular bleeding after menopause so you and your doctor can understand what stage you’re in.

If you’ve gone 12 months since your last period, you’re considered to be in menopause.

Vaginal Atrophy (Thinning Tissue in the Vagina)

Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying, and inflammation of the vaginal walls.

According to the Mayo Clinic, “Because the condition causes both vaginal and urinary symptoms, doctors use the term ‘genitourinary syndrome of menopause (GSM)’ to describe vaginal atrophy and its accompanying symptoms.” You may also notice brown spotting or other bleeding relating to the dryness caused by the reduction in estrogen.

Symptoms of GSM

 In addition to bleeding, symptoms of GSM include:

• Vaginal dryness, burning, and itching
• A burning sensation when urinating
• Frequent urinary tract infections (UTIs)
• Urinary incontinence (shop incontinence underwear)
• Decreased vaginal lubrication during sex and increased discomfort during sex

Ever wonder about nighttime incontinence? We've got you covered.

Endometrial Atrophy or Endometrial Hyperplasia

The endometrium is the tissue that makes up the uterine lining. Fluctuating or irregular hormone levels during menopause can affect the tissue of the uterus in 2 possible ways:

1. Thinning of the endometrium (atrophy): Low estrogen levels can cause the tissue of the endometrium (or lining of the uterus) to thin, which can result in some abnormal uterine bleeding.
2. Thickening of the endometrium (endometrial hyperplasia): When the uterine lining becomes thickened, most often due to increased estrogen and decreased levels of the hormone progesterone, it is called endometrial hyperplasia which can result in abnormal uterine bleeding.

Polyps

Polyps are usually benign, noncancerous growths in the uterus (a.k.a. endometrial polyps), cervical canal, or on your cervix. While polyps are not usually harmful, but they often bleed and cause spotting between your cycle or after menopause.

Many people aren’t even aware they have them, so it’s always good to have this checked out by a medical professional.

Infection

Sexually transmitted infections (STIs) can be the reason for spotting or light bleeding. 

Most infections are treatable. But infections can become more serious if ignored, so it’s worth getting routinely tested for STIs.

Strenuous Exercise

While exercise is essential for good all-around health, strenuous exercise after menopause can trigger bleeding (or perhaps brown discharge). This usually happens while you are close to transitioning into menopause from perimenopause.

Generally, this is not something to be concerned about. But if it happens for the first time, it’s good to seek reassurance from your doctor.

Hormone Replacement Therapy (HRT)

Hormone replacement therapy (such as estrogen and progesterone therapy) therapy) is a form of hormone therapy used to treat symptoms associated with perimenopause and menopause, including:

• Hot flashes
• Vaginal atrophy
• Skin and hair changes
• Vaginal dryness
• Joint pain
• Low libido 
• Bone loss

These symptoms are related to decreased levels of estrogen and progesterone that occur during menopause. HRT medications are available in different formulations, including oral tablets, patches, vaginal suppositories, and creams. 

Side effects of HRT medications include unusual bleeding, though this is considered a less common side effect. More information about HRT can be found at the Mayo Clinic.

Other Medications

In addition to HRT, a side effect of other medications can include unusual bleeding. For example, blood thinners may cause unusual postmenopausal bleeding.

If you are on any medications and have post menopausal bleeding be sure to share your complete medication list with your healthcare provider so they can review your medications to see if this is a possible medication risk.

Cervical or Uterine Cancer

According to the Dana-Farber Cancer Institute, spotting in postmenopausal women can, in some cases, be an early sign of cervical or uterine cancer and should always be investigated further.

“Any postmenopausal bleeding should warrant a visit to a gynecologist,” says Ursula Matulonis, MD, chief of the Division of Gynecologic Oncology at Dana-Farber Cancer Institute.

"If the bleeding is related to cancer, a conversation with your doctor can lead to an earlier diagnosis and better prognosis," according to the institute. "Even if the bleeding is not related to cancer, talking with your doctor can help him or her determine the cause and the best treatment for you."

Time to See a Doctor? What to Expect…

In general, any bleeding post menopause is worth a trip to your health care provider. Even if the spotting is minor, it’s worth eliminating the risk that it could be an early indicator of cancer, such as endometrial cancer. 

Rule Out Endometrial Cancer

It’s worth noting that age is a factor too. According to the American Cancer Society, endometrial cancer most often affects postmenopausal women—60 is the average age at diagnosis.

So, what can you expect when you see your doctor or healthcare provider?

To diagnose and treat any cause of abnormal perimenopausal bleeding or bleeding after menopause, your doctor will likely:

• Review your personal and family health history
• Perform a physical exam including a pelvic exam, which may include the following tests:
• Endometrial biopsy
• Pelvic ultrasound

Treatment of Postmenopausal Bleeding

Your treatment could include hormone therapy, which could be administered through pills, creams, or patches. 

Or it could involve other procedures (including surgery), like:

• Hysteroscopy: During hysteroscopy, instruments inserted through the hysteroscope (a device your doctor uses to see inside your uterus) can be used to remove polyps in your uterus. 
• D&C (dilation and curettage): A surgery in which your cervix is opened (or dilated). Your doctor will then use a surgical instrument called a curette to remove excess tissue in the uterus.
• Hysterectomy: This is a major surgery to remove the uterus. Your doctor or healthcare provider may also recommend the removal of your ovaries, fallopian tubes, cervix, or nearby lymph nodes at the same time as your uterus.

It’s important to understand that postmenopausal bleeding or spotting is never considered normal. You should see your healthcare provider if this is happening to you. However, please do not panic or jump to the worst possible conclusions. As we’ve seen, these symptoms can have many possible sources, and not all are serious causes.

Sources:

https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

https://www.healthline.com/health/womens-health/spotting-before-periods 

https://www.acog.org/womens-health/faqs/perimenopausal-bleeding-and-bleeding-after-menopause

https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 

https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372 

https://blog.dana-farber.org/insight/2018/11/spotting-periods-sign-cancer/ 

https://www.cancer.org/cancer/types/endometrial-cancer.html 

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We hope you found this post informative—but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. 

We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.