Period After Menopause: What’s Happening?

Once a woman has gone through menopause (i.e., has had their last menstrual period), any bleeding is not considered normal. During this stage, women do not have periods, and any other bleeding that may occur should be discussed with your doctor.

What Is the Menopause and What Is Menopause Age?

Menopause is when a woman’s menstrual cycle stops permanently. Once in this stage, a woman can no longer become pregnant. The time leading up to this event is called perimenopause. During perimenopause, periods grow infrequent.

Menopause is confirmed 12 months after your last period. Bleeding after this point is called postmenopausal bleeding (PMB), and it is considered abnormal bleeding. This stage usually occurs between the ages of 45 and 55.

Postmenopausal Bleeding

If you Google "postmenopausal bleeding," the search results are likely to make you nervous. But please don’t panic. There are many explanations for vaginal bleeding after menopause. And despite what Dr. Google says, it does not automatically mean you have cancer.

According to this study published by JAMA Internal Medicine, “postmenopausal bleeding occurs in approximately 90% of women with endometrial cancer; however, only 9% of women with postmenopausal bleeding were diagnosed with endometrial cancer.”

So, why the urgency to see a doctor? Well, endometrial cancer cannot be screened for, which means it can go undetected if symptoms are ignored. Because of that, even though postmenopausal bleeding may occur for a variety of reasons, understanding that it can allow for early detection of endometrial cancer means it’s always worth investigating.

Are You Really in Menopause? What Is Perimenopause?

One possible explanation of a post-menopausal period is that you’re still in perimenopause.

During perimenopause, your menstrual cycles and periods gradually come to an end. The average length of perimenopause is 4 years, and during that time, your period can become irregular, and there can also be irregular bleeding between periods.

Just as periods maybe start out irregularly when you go through the changes of puberty, so they become irregular as you go through the changes of perimenopause. From a hormonal standpoint, perimenopause is characterized by irregular estrogen and progesterone levels. 

Because of this gradual change, many individuals are unsure when perimenopause ends. In medical terms, menopause is confirmed 12 months after a woman's last period.

Symptoms of Perimenopause Periods

During perimenopause, some may notice changes to the menstrual period. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of hormone levels.

Many women may experience all of the following changes; others will just experience just some. If it reads like perimenopause is a bit of a rollercoaster ride, that’s not surprising - many feel that way!

• Less frequent or irregular periods: Because you start ovulating less as you age, your entire menstrual cycle may not run like clockwork anymore. This can mean less frequent and irregular periods, including skipped months.
• Spotting or lighter periods: Due to fluctuating hormones, you might experience very light periods or spotting between periods. It’s worth tracking your periods and any irregular bleeding in a journal or app.
• Longer periods or heavy bleeding: As periods become infrequent, sometimes the lining of the uterus has more time to become thicker. This means that when your uterus sheds its lining, there will be a longer and heavier period. 

Other symptoms include:

• Hot flashes
• Vaginal atrophy
• Accelerated skin aging
• Vaginal dryness
• Bone loss
• Mood swings
• Changes to your sex life (in desire or satisfaction)
• Cardiovascular disease and high blood pressure

Note: Even as your menstrual cycle becomes less regular, it is important to know that you’re still ovulating (even if it’s infrequent). If you want to avoid pregnancy, use birth control.

Post-Menopausal Bleeding: What Could Cause It?

If you haven’t had a period for one year and you experience bleeding, there are a few different explanations.

While we strongly urge you to see a doctor to understand these symptoms, don’t panic. Not all explanations of vaginal bleeding after menopause are serious. But you will want to have the more serious explanations ruled out quickly.

Here are some of the most common explanations of vaginal bleeding after menopause:

Vaginal Atrophy (Thinning Tissue in the Vagina)

Vaginal or endometrial atrophy occurs in some women. The body produces less estrogen, leading 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.

Endometrial Atrophy or Endometrial Hyperplasia

The endometrium is the tissue that lines your uterus. Fluctuating or irregular hormone levels can affect this tissue in two possible ways:

1. Thinning of the Endometrium (Endometrial Atrophy): According to the American College of Obstetricians and Gynaecologists, low estrogen levels can cause the tissue of the endometrium (or uterine lining) to thin, which can result in some bleeding.
2. Thickening of the Endometrium (Endometrial Hyperplasia): The uterine lining becomes thickened, most often due to increased estrogen and decreased progesterone. Endometrial hyperplasia can sometimes lead to endometrial cancer (also referred to as uterine cancer), though it may be prevented if detected early (source). Early indicators include unusual bleeding. Progestin is often used to treat endometrial hyperplasia.

Both the thinning and thickening of the endometrium can result in bleeding after menopause.

Polyps

Polyps are usually benign, noncancerous growths in the uterus, cervical canal, or on your cervix. While they are not usually harmful, they can grow quite large, which can cause discomfort. Women with polyps can experience bleeding, and because they can occur at any age, they may result in perimenopausal bleeding and bleeding after menopause.

Your doctor will advise whether you should seek to remove endometrial polyps. In general, they will seek to use the least invasive treatment before opting for surgical interventions.

Infection

Sexually Transmitted Diseases (STIs) and other infections like Pelvic Inflammatory Disease (PID) can all be explanations of spotting at any age, including perimenopausal bleeding and bleeding after menopause. 

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-round women's health, strenuous exercise can cause some bleeding (or perhaps brown spotting) in postmenopausal women. 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 is a form of hormone therapy used to treat symptoms associated with female menopause, including:

• Hot flashes
• Vaginal atrophy
• Accelerated skin aging
• Vaginal dryness
• Bone loss

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 spotting.

If you are on any medications you think might cause spotting, discuss this side effect with your doctor. She will help you determine if there’s any additional risk.

Endometrial Cancer, Cervical Cancer or Uterine Cancer

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

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

Seeing your doctor promptly will increase the chances that any cancer will be found early, which increases the chances of successful treatment. To determine if abnormal cells or cancerous cells are present, your doctor may take a normal biopsy to take a small sample of tissue. If positive, further tests will determine the extent (stage) of cancer.

Treatments for cervical or uterine cancer can vary (see the Mayo Clinic) but may include surgery, such as hysterectomy (removal of the uterus and cervix) or trachelectomy (removal of the cervix.)

Seeking Medical Advice for Vaginal Bleeding After Menopause: What to Expect…

In general, any bleeding post-menopause is worth a trip to your health care provider for some health information. Even if the spotting is minor, it’s worth eliminating the (slight) risk that it could be an early indicator of cancer. 

But don’t take this caution as a reason to panic. Odds are, there’s another explanation for your bleeding. And your health care provider may be able to help you address the symptoms.

Written by Jane Flanagan — Updated on March 25, 2022

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.