Is Bleeding After Menopause Normal?

After 12 months without a period, a woman has officially reached menopause. From then on, any vaginal bleeding isn’t normal, and it’s something you shouldn’t ignore.

“Bleeding after menopause is not a normal symptom that you should experience after you stop having periods,” said Kellie Rath, MD, OhioHealth gynecologic oncologist. “It's important to let your healthcare provider know that you're experiencing that so you can come in for an evaluation and we can figure out what the cause may be.

After menopause, women should pay attention to any unexpected bleeding or abnormal discharge. Clear or white discharge is typical, but anything dark yellow, brown, pink or containing blood clots can signal a problem.

“Even just a wisp of pink would not be a normal symptom,” Dr. Rath said. “So if you do experience that, give your doctor, your nurse practitioner, your APP, your OBGYN a call.”

Hearing the words “postmenopausal bleeding” can be scary, but Dr. Rath said that while cancer is one possible cause, it’s not the only one.

“Polyps or benign growths of the uterus can happen, benign growths of the cervix could happen,” she said. “Even thinning of the vaginal tissue or the vulvar tissue could cause that bleeding. Sometimes we find out that the bleeding isn't even vaginal. Maybe it's coming from the bladder or coming from the colon.”

Because there are many potential explanations, seeking care quickly is important.

An evaluation typically begins with a physical exam, followed by imaging such as an ultrasound to look at the uterus, cervix, ovaries and uterine lining. In many cases, a biopsy, or small sample of tissue, may be taken to help identify the cause.

Dr. Rath also noted that irregular bleeding during perimenopause, the transition period before menopause, is common but still worth monitoring.

“If (your cycle) is getting heavier, you're getting irregular spotting, if it's painful, those are all things to be concerned about,” she said. “And we may want to do an evaluation, an ultrasound, an exam, a biopsy to be sure we know what's causing that irregular bleeding, making sure it's part of that normal perimenopausal transition.”

To hear more from Dr. Rath about various topics in gynecologic and cancer care, be sure to follow her on LinkedIn.