Spotting or bleeding after menopause can be surprising and concerning, especially if your last period was many years ago. The most common causes of spotting after menopause include thinning of the reproductive tract tissues and hormone therapy. In some cases, spotting can signal cancer in the lining of the uterus or cervical cancer. Other possible causes of spotting include fibroids and small growths in the uterus or cervix, known as polyps. Any spotting after menopause should not be ignored, so see your doctor right away if you have this symptom.
Most Common Cause
A lack of estrogen is the most common cause of postmenopausal spotting in women not taking hormone therapy. Estrogen production drops to a low level after menopause, causing the tissues of both the vagina and uterus can become dry, thin and fragile. This is known as atrophy, which can cause bleeding. The bleeding usually comes from the lining of the uterus, known as the endometrium. In some cases, however, severe dryness causes small cracks and tears in the vagina that can also bleed.
Hormone replacement therapy, taken to reduce menopausal symptoms such as hot flashes and night sweats, can cause spotting or bleeding. Hormone therapy can stimulate the lining of the uterus and cause shedding and bleeding similar to a menstrual cycle. Tamoxifen (Soltamox, Nolvadex) is a specific type of hormone therapy taken to reduce the risk of breast cancer recurrence. This medication stimulates the lining of the uterus in some women, causing spotting or bleeding.
Endometrial cancer, or cancer of the uterine lining, is the most common gynecologic cancer in the United States. This type of cancer is the reason that between 1 percent and 14 percent of women have bleeding after menopause, according to a review published in the February 2012 "Journal of Ultrasound in Medicine." Abnormal thickening of the uterine lining can also cause bleeding or spotting. This thickening is not cancerous but may progress to endometrial cancer over time if left untreated.
Less Common Causes
Uterine fibroids or polyps may also contribute to spotting. Polyps are abnormal growths inside the uterus or on the cervix, the opening of the uterus. Uterine fibroids are noncancerous uterine tumors that can contribute to heavy, painful periods before menopause and spotting or bleeding after menopause. Another possible cause of spotting after menopause is cervical cancer, which is less common than endometrial cancer. Other less common causes of spotting can include cervical or vaginal infections as well as injuries.
Seek Medical Attention
Any woman who hasn't had a period for at least 1 year is considered to be in menopause. When in menopause, spotting or bleeding is abnormal and should be evaluated by a doctor.
- Journal of Family Practice: Postmenopausal Bleeding: First Steps in the Workup
- Journal of Ultrasound in Medicine: Sonography in Postmenopausal Bleeding
- Obstetrics and Gynecology: ACOG Practice Bulletin No. 149: Endometrial Cancer
- American Family Physician: Endometrial Cancer
- Obstetrics and Gynecology: ACOG Practice Bulletin No 141: Management of Menopausal Symptoms
- Obstetrics and Gynecology: ACOG Practice Bulletin No 126: Management of Gynecologic Issues in Women With Breast Cancer
- Obstetrics and Gynecology: ACOG Committee Opinion No 440: The Role of Transvaginal Ultrasonography in the Evaluation of Postmenopausal Bleeding
- Canadian Family Physician: Approach to Diagnosis and Management of Abnormal Uterine Bleeding