Why am I Bleeding After Menopause?

Of all the silver linings of menopause, not having to deal with the mood swings, bloating, cramps, and blood that come with your period may be the biggest. So, when suddenly they all start up again, it can be a shock — and a reason to see your gynecologist, stat.

“Women’s bodies give us warning signs,” says Carolyn DeLucia, MD, FACOG, a board-certified OBGYN in private practice in New York City and Hillsborough, New Jersey. By definition, menopause is the cessation of monthly menses for the entirety of one year, so any vaginal bleeding after that point is considered abnormal and should be communicated to your doctor. Although there are many reasons a woman can experience post-menopausal bleeding, the most serious concern is cancer of the cervix or endometrium. “Very often it’s not cancer, but that needs to be ruled out,” says Dr. DeLucia.

As adamant as Dr. DeLucia is that a woman seek out care from her gynecologist if she’s bleeding after menopause, she also notes that the culprit may not be dangerous — for example, shrinking uterine fibroids or one last spontaneous period. “Yes, it can happen. I call it the last hurrah,” she says.

Bleeding can also be linked to hormone replacement therapy says Kourtney Sims, MD, a board-certified gynecologist in Houston, TX, who is also Phenology’s chief medical advisor. “The bleeding is in relation to the progesterone in hormone replacement therapy. Some women [in menopause] will need to do combined therapy of estrogen and progesterone rather than estrogen alone and they can have bleeding in response. Typically, the bleeding is for a short period of time, less than 6 months, and lasts less than 7 days a cycle. But again, you must never assume because there could be things like malignancies,” says Dr. Kourtney.