Causes and Risk Factors of Light Spotting After Menopause

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Menopause marks the end of menstrual bleeding. A person has reached menopause when they have not had a menstrual period for 12 months. When bleeding does occur 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.

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

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Common Causes

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.

Treating Vaginal and Vulvar Atrophy

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

  • Moisturizers
  • Lubricants
  • Hormonal therapy to restore levels of estrogen
  • Laser therapy

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.

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 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%.

Endometrial Hyperplasia

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

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.

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.

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.

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.

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.

Postmenopausal bleeding can be caused by:

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.

14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Newell S, Overton C. Postmenopausal bleeding should be referred urgently. Practitioner. 2012;256(1749):13-5.

  2. Lev-Sagie A. Vulvar and vaginal atrophy: physiology, clinical presentation, and treatment considerations. Clin Obstet Gynecol. 2015;58(3):476-491. doi:10.1097/GRF.0000000000000126

  3. Naumova I, Castelo-Branco C. Current treatment options for postmenopausal vaginal atrophy. Int J Womens Health. 2018;10:387-395. doi:10.2147/IJWH.S158913

  4. Huang C, Hong MK, Ding DC. Endometrial adenomyoma polyp caused postmenopausal bleeding mimicking uterine malignancy. Gynecol Minim Invasive Ther. 2017;6(3):129-131. doi:10.1016/j.gmit.2016.08.006

  5. Wethington SL, Herzog TJ, Burke WM, Sun X, Lerner JP, Lewin SN, Wright JD. Risk and predictors of malignancy in women with endometrial polyps. Ann Surg Oncol. 2011;18(13):3819-3823. doi:10.1245/s10434-011-1815-z

  6. Armstrong AJ, Hurd WW, Elguero S, Barker NM, Zanotti KM. Diagnosis and management of endometrial hyperplasia. J Minim Invasive Gynecol. 2012;19(5):562-571. doi:10.1016/j.jmig.2012.05.009

  7. Turnbull HL, Akrivos N, Simpson P, Duncan TJ, Nieto JJ, Burbos N. Investigating vaginal bleeding in postmenopausal women found to have an endometrial thickness of equal to or greater than 10 mm on ultrasonography. Arch Gynecol Obstet. 2017;295(2):445-450. doi:10.1007/s00404-016-4249-9

  8. National Cancer Institute. Closer look at postmenopausal bleeding and endometrial cancer.

  9. Mercer VJ, Naseemuddin A, Webb A. Monckeberg's arteriosclerosis: a case report of chronic endometritis presenting as postmenopausal bleeding. Menopause. 2021;29(2):247-249. doi:10.1097/GME.0000000000001902

  10. Brekelmans MP, Scheres LJ, Bleker SM, et al. Abnormal vaginal bleeding in women with venous thromboembolism treated with apixaban or warfarin. Thromb Haemost. 2017;117(4):809-815. doi:10.1160/TH16-11-0874

  11. Tarney CM, Han J. Postcoital bleeding: a review on etiology, diagnosis, and management. Obstet Gynecol Int. 2014;192087. doi:10.1155/2014/192087

  12. Clarke MA, Long BJ, Del Mar Morillo A, Arbyn M, Bakkum-Gamez JN, Wentzensen N. Association of endometrial cancer risk with postmenopausal bleeding in women: A systematic review and meta-analysis. JAMA Intern Med. 2018;178(9):1210-1222. doi:10.1001/jamainternmed.2018.2820

  13. Bukhari, N. Qazi, W. Jahan, S. Asmet, S. Akhter, N. Jabeen, R. Risk factors associated with postmenopausal bleeding and endometrial carcinoma. Prof Med Journ. 2021;28(2):208-213. doi:10.29309/TPMJ/2021.28.02.3447

  14. Harvard Health Publishing. Bleeding after menopause: get it checked out.

By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.