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Postmenopausal Bleeding

If you've completed menopause -- meaning you've gone without a period for more than 1 year -- you shouldn't have any menstrual bleeding. Even a little spotting is not normal after menopause.

If you have postmenopausal bleeding, make an appointment to see your doctor as soon as possible. It could be caused by a number of health problems, some of which are serious.

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Here are the most common causes of postmenopausal bleeding.

Causes of Postmenopausal Bleeding

Polyps: These are growths, usually noncancerous, that can develop in the uterus, on the cervix, or inside the cervical canal. They might cause bleeding.

Endometrial atrophy (thinning of the endometrium): The endometrium, the tissue that lines the uterus, can become very thin after menopause because of lower estrogen levels. This may cause unexpected bleeding.

Endometrial hyperplasia: In this condition, the lining of the uterus becomes thick, and bleeding may occur as a result. Obesity may be the cause of the problem. Some people with endometrial hyperplasia may have abnormal cells that can lead to endometrial cancer (cancer of the uterine lining).

Endometrial cancer (uterine cancer): Bleeding after menopause can be a sign of endometrial cancer.

Other causes: Hormone therapy, infection of the uterus or cervix, use of certain medications such as blood thinners, and other types of cancer can cause postmenopausal bleeding.

Figuring Out the Cause of Postmenopausal Bleeding

Your doctor can determine the cause of your bleeding by taking your medical history and doing a physical exam and a few tests. Tests may include:

Transvaginal ultrasound: During this test, an imaging device is inserted inside the vagina, so your doctor can view the pelvic organs and look for anything unusual.

Endometrial biopsy: A thin tube is inserted into your uterus, and a tiny sample of the uterine lining is removed. It's sent to a lab to look for anything unusual.

Saline-infused sonogram: Saline is placed in the uterus through the cervix with a small, thin tube. The doctor looks by ultrasound to see if there are any masses within the uterine lining. It's often done along with an endometrial biopsy.

Hysteroscopy: During this test, your doctor uses an instrument with a light and small camera to examine the inside of the uterus and look for problems.

D&C (dilation and curettage): This test allows your doctor to remove tissue from the uterus lining, so it can be sent to a lab for analysis.

Ultrasound and biopsy can be performed in your doctor's office. Hysteroscopy and D&C are usually done in a hospital or outpatient surgical center.

How Is Postmenopausal Bleeding Treated?

Treatment depends on what's causing the bleeding. 

If polyps are to blame, surgery may be needed to remove them. 

Endometrial atrophy can be treated with medication alone. 

Endometrial hyperplasia may be treated with medication, such as progestin or progesterone therapy, or surgery to remove thickened areas of the endometrium. If you have endometrial hyperplasia, you'll need to get checked by your doctor on a regular basis.

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