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 to become dry, thin and fragile. This is known as atrophy and can lead to 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 of the lining with bleeding, similar to a menstrual cycle. Tamoxifen (Soltamox, Nolvadex) is a 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. Between 1 percent and 14 percent of women with bleeding after menopause have endometrial cancer, according to a review published in the February 2012 issue of "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 small growths located 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. Cervical or vaginal infections, as well as injuries, are other less frequent causes.
Seeking Medical Attention
Menopause occurs when a woman hasn't had a period for 1 year. Any spotting or bleeding after menopause is abnormal and should be evaluated by a doctor.
Reviewed by Mary D. Daley, MD
- 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