Postmenopausal bleeding is any vaginal bleeding that occurs after a person has gone 12 months or more without a menstrual period. It can result from a range of causes—many benign but some that require further investigation. If you experience very heavy bleeding, severe pain, fainting, or fever with bleeding, seek urgent medical care.
By definition, postmenopausal bleeding occurs after at least 12 consecutive months without menstruation. Any amount or pattern of bleeding after this interval should be evaluated rather than ignored. The finding is a symptom, not a diagnosis, and needs clinical assessment to determine the underlying reason.
Several conditions can cause bleeding after menopause. Common causes include thinning of the uterine lining (endometrial atrophy), uterine polyps, effects of hormone therapy, and local infections. Certain medications (for example, some anticoagulants) can increase bleeding. Less commonly, bleeding may be caused by endometrial hyperplasia or cancers of the reproductive tract, which is why assessment is important.
Initial evaluation typically includes a medical history and pelvic examination. Common diagnostic tests are transvaginal ultrasound to assess endometrial thickness, endometrial biopsy to sample the uterine lining, cervical screening where due, and hysteroscopy if direct visual assessment is needed. Primary care or family physicians can arrange initial assessment and referrals; most evaluations are coordinated by gynecology specialists.
Seek emergency services if bleeding is so heavy that sanitary products are saturated quickly, or if bleeding is accompanied by fainting, severe abdominal pain, or a high fever. For non-urgent bleeding, schedule a prompt outpatient appointment so appropriate tests can be arranged.
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