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What Are the Causes of Postmenopausal Spotting?

by 
author image Kate Killoran
Katherine Killoran is a board certified OB/GYN practicing in Rockport, Maine. She graduated from Boston University School of Medicine in 1999 but really learned how to be healthy and well from her own breast cancer diagnosis. She blogs about healthy lifestyle habits on her website www.drkilloran.com.
What Are the Causes of Postmenopausal Spotting?
What Are the Causes of Postmenopausal Spotting? Photo Credit: Wavebreakmedia/iStock/GettyImages

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.

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Most Common Cause

Doctor with a senior female patient
Doctor with a senior female patient Photo Credit: Brand X Pictures/Stockbyte/Getty Images

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 Therapy

Close-up of woman emptying pills from a bottle onto hand
Close-up of woman emptying pills from a bottle onto hand Photo Credit: Wavebreakmedia Ltd/Wavebreak Media/Getty Images

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.

Uterine Cancer

Cancer patient lays in bed, and talks to her doctor
Cancer patient lays in bed, and talks to her doctor Photo Credit: KatarzynaBialasiewicz/iStock/Getty Images

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

Middle-aged woman rests outside on a park bench
Middle-aged woman rests outside on a park bench Photo Credit: Thomas Lammeyer/iStock/Getty Images

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

Senior woman and her doctor in a medical office
Senior woman and her doctor in a medical office Photo Credit: AlexRaths/iStock/Getty Images

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

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