Going through menopause can be a complex and sometimes overwhelming experience. And if you notice unexpected spotting after menopause, it can be downright frightening. Many women experience some form of postmenopausal bleeding, which can range from light spotting to a heavier flow.

While spotting after menopause can sometimes be caused by minor women’s health issues, it can also be a symptom of a more serious condition. Keep reading to learn the most common causes of postmenopausal spotting, how to differentiate between light spotting and heavy bleeding, and when to seek medical attention.

Your gynecologist plays a crucial role in monitoring your health after menopause. If you have any postmenopausal bleeding, TopLine MD Alliance encourages you to seek medical care to identify the cause and get timely treatment. Let’s explore why.

Common causes of spotting after menopause

Women are considered postmenopausal after going 12 consecutive months without a menstrual cycle. Any bleeding after menopause should be evaluated by a healthcare provider – even if it only happens once.

Two of the most common causes of postmenopausal spotting include:

  • Hormonal changes – The hormonal changes that occur during menopause can cause the vaginal and vulvar tissues to thing, making them more prone to bleeding.
  • Vaginal atrophy – The vaginal lining naturally becomes thinner and drier with age, increasing the likelihood of irritation and bleeding

More serious causes of spotting after menopause include:

  • Polyps –Non-cancerous (benign) growths that may develop in the uterus or on the cervix, potentially causing vaginal bleeding.
  • Fibroids – Another type of benign growth that may develop in the uterus, ranging in size from a small pea to a large melon.
  • Endometrial hyperplasia – A condition where the uterine lining becomes abnormally thick or contains abnormal cells, which could lead to cancer.
  • Cancer – About 90% of women diagnosed with uterine cancer experience vaginal bleeding as an early symptom. Endometrial, cervical, and ovarian cancer can also cause vaginal bleeding.
  • Injury or trauma –Bleeding may result from irritation or injury to the vagina or nearby structures, such as the bladder or rectum.

Other risk factors for spotting after menopause

Women may be at an increased risk of postmenopausal bleeding if they take hormone replacement therapy (HRT) or have a history of:

  • Polyps
  • Fibroids
  • Thyroid disease
  • Polycystic ovary syndrome (PCOS)
  • Diabetes
  • Breast cancer
  • Colon cancer
  • Obesity
  • Smoking
  • Pelvic trauma or injury

Distinguishing between light spotting and heavy bleeding

“Light spotting” after menopause refers to a small amount of blood or pinkish-gray or brown discharge. This minimal blood is often only noticeable when wiping with toilet paper or as a minor stain.

“Heavy bleeding” after menopause is comparable to a menstrual period, with a steady flow of blood that soaks through a pad or tampon and requires frequent changes.

When to seek care for spotting after menopause

Any bleeding after menopause is not considered normal. Even light spotting can be a sign of an underlying condition, so it’s always best to consult a gynecologist.

If you experience any postmenopausal bleeding, consult with a TopLine MD Alliance affiliated gynecologist as soon as possible.

Diagnostic tests for postmenopausal bleeding

To determine the cause of the bleeding, your gynecologist may ask about your medical history and perform one or more of the following tests:

  • Pelvic exam – evaluates the vagina and cervix for abnormalities
  • Pap smear – checks for irregular or precancerous cells on the cervix
  • Pelvic ultrasound – views the organs within the pelvic cavity (cervix, uterus, fallopian tubes, and ovaries)
  • Endometrial biopsy – collects cells from the uterine lining for further testing

Treatment options for spotting after menopause

Treatment depends on the underlying cause of the bleeding. Your gynecologist may recommend medications or, in some cases, a surgical procedure.

Medications include:

  • Antibiotics – used to treat infection
  • Estrogen – helps manage vaginal atrophy, available as a pill, patch, cream, ring, or insertable tablet applied directly to the vagina
  • Progestin – used to treat endometrial hyperplasia, available as a pill, shot, cream, or intrauterine device (IUD)

Surgical treatments include:

  • Hysteroscopy – The gynecologist inserts a thin, lighted scope into the vagina to see the inside of the uterus.
  • Dilation and curettage (D&C) – abnormal uterine tissue and can be performed at the same time as a hysteroscopy.
  • Hysterectomy – Surgical removal of the uterus and cervix, typically reserved for severe conditions.

If postmenopausal bleeding is caused by cancer, a TopLine MD Alliance affiliated gynecologist can provide a referral to a gynecologic oncologist for specialized care.

Preparing for your appointment

TopLine MD Alliance affiliated gynecologists are committed to providing top-quality care through every stage of menopause. If you are experiencing bleeding, your gynecologist can likely still see you – but it’s best to call ahead to confirm.

Before your appointment, consider the following:

  • If using a pad or tampon, bring an extra one with you.
  • Avoid sexual activity for a short period before your visit, as it may interfere with test results.
  • Refrain from douching or using vaginal medications unless instructed otherwise by your provider.

Early evaluation of postmenopausal bleeding can lead to better outcomes and peace of mind. Contact your TopLine MD Alliance affiliated gynecologist to schedule an appointment today.

About TopLine MD Alliance

The TopLine MD Alliance was created by physicians who came together to make healthcare experiences better for patients. We help patients navigate the healthcare system, connecting them with top-of-the-line healthcare providers, practices, diagnostic centers, and imaging centers we trust.

Visit us online to find a TopLine MD Alliance affiliated gynecologist or other provider near you.

The TopLine MD Alliance is an association of independent physicians and medical practice groups who are committed to providing a higher standard of healthcare services. The members of the TopLine MD Alliance have no legal or financial relationship with one another. The TopLine MD Alliance brand has no formal corporate, financial or legal ties to any of the affiliated physicians or practice groups.