Postmenopausal Bleeding

🌸 Postmenopausal Bleeding: What Every Woman Should Know

Once your periods have stopped for 12 months, you are considered postmenopausal. At this stage, any bleeding — spotting, staining, or full-flow bleeding — is NOT normal.

It may not always indicate a serious issue, but it should always be checked by a gynaecologist. Postmenopausal bleeding (PMB) is quite common, and in most cases, the cause is not dangerous — but early evaluation is essential.

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🌼 Why Does Postmenopausal Bleeding Happen?

There are several possible reasons:

• Vaginal or endometrial thinning (most common, due to low estrogen)
• Vaginal dryness or tiny tears
• Benign polyps
• Side effects of HRT or other medications
• Infections
• Endometrial hyperplasia (thickening of the uterus lining)
• Cancer (less common but must be ruled out)

Most causes are treatable once diagnosed correctly.

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🌷 What Should You Do if You Notice Bleeding?

Do not ignore it and do not assume it is normal.

Visit your gynaecologist for a proper evaluation.

Typical tests may include:

• Pelvic examination
• Ultrasound / Transvaginal Sonography (TVS)
• Pap smear (if due)
• Endometrial thickness measurement
• Blood tests
• Endometrial biopsy (if needed)
• Hysteroscopy: A thin scope is inserted into the uterus to view the lining and take a biopsy in the same sitting. This is the best method for diagnosis.

The treatment depends on the underlying cause.

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❓ Frequently Asked Questions About Postmenopausal Bleeding

1. Is any bleeding after menopause normal?

No. Once 12 months have passed without a period, any bleeding should be evaluated.

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2. Does postmenopausal bleeding always mean cancer?

No — absolutely not.

The most common causes are dryness, thinning of tissues, or benign polyps. Cancer is less common, but must be ruled out — that’s why evaluation is important.

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3. What can cause bleeding years after menopause?

• Vaginal dryness
• Polyps
• Endometrial thinning or thickening
• Hormone therapy
• Certain medications
• Less commonly, cancers of the uterus, vagina, or cervix

Your doctor will identify the exact cause.

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4. Will an ultrasound alone be enough?

Sometimes yes — especially if the endometrial thickness is normal. If it is thickened or irregular, a hysteroscopy with biopsy is recommended.

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5. Is the biopsy painful?

Most women tolerate it well. It may cause mild cramping for a few minutes but it is quick and safe.

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6. Can dryness alone cause bleeding?

Yes. After menopause, vaginal tissues become thin and dry, leading to small cracks or bleeding — especially after intercourse.

This is easily treatable with local estrogen gels or moisturisers.

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7. Should I stop my HRT if I get bleeding?

Do not stop HRT on your own. Bleeding can happen due to many harmless reasons. Your doctor will assess whether the dose or regimen needs adjustment.

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8. How soon should I see my doctor?

Not an emergency, but do not delay. Ideally, visit within a week.

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9. What if the bleeding was very light and only once?

Even a single episode of spotting needs evaluation. Most times it turns out to be minor, but it’s important to check.

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10. Can postmenopausal bleeding be prevented?

Not always — but regular check-ups, managing dryness, and controlling chronic conditions (like diabetes or obesity) can reduce the risk.

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🌸 Final Takeaway

Postmenopausal bleeding is common but not normal. The causes are usually simple and treatable — but timely evaluation is key to staying safe and stress-free.

📍 Source: Dr. Shweta Mehta – DNB, Obstetrics & Gynaecology | United Multispeciality Hospital, Kandivali West, Mumbai.