If you have gone 12 months without a period because of the menopause, any bleeding after that — even light spotting, or a pink or brown discharge — is called postmenopausal bleeding. Most of the time the cause turns out to be harmless. But because it can occasionally be the first sign of cancer of the womb lining, every episode of bleeding after menopause should be checked promptly — even if it happens only once.1 Found early, the serious causes are far easier to treat.

What can cause bleeding after menopause?

There are several possible causes, and most are not serious:

  • Thinning of the vaginal or womb lining (atrophy) — the most common cause, due to lower oestrogen levels after menopause.
  • Polyps — small, usually non-cancerous growths on the cervix or in the womb.
  • A thickened womb lining (endometrial hyperplasia) — which needs treatment, as it can sometimes progress if left alone. You can read more in our guide to endometrial hyperplasia.
  • Hormone replacement therapy (HRT) — some types can cause bleeding, especially in the first months.
  • Blood-thinning medicines — these can make bleeding more likely.
  • Womb (endometrial) cancer — less common, but this is the reason all bleeding must be checked.1

What happens when you come in

Getting checked is straightforward, and most women need only two simple steps:

  1. A chat and an examination. Your doctor will ask about your bleeding, your health, and any medicines (including HRT), then do a gentle pelvic examination.
  2. A transvaginal ultrasound scan. This is the first-line test: a slim ultrasound probe is placed in the vagina to look at the womb and measure the thickness of its lining. It takes a few minutes and is done by the gynaecologist at the clinic.

For women who are not on HRT, a lining thickness of 4 mm or less is reassuring. If the lining measures more than 4 mm, or the scan shows anything else that needs a closer look, further tests are arranged.2 (If you are on HRT, the thresholds are a little different, and your doctor will interpret the scan with that in mind.)

Further tests, where needed, may include:

  • An endometrial biopsy — a very thin tube takes a small sample of the womb lining. It takes less than a minute and is done in the clinic.
  • A hysteroscopy — a slim telescope-camera looks inside the womb, and a sample can be taken at the same time.

Please don't put off coming in — assessment is quick, and in most women it simply provides reassurance.

How is it treated?

Treatment depends entirely on the cause:

  • Vaginal atrophy is usually eased with local oestrogen (a small pessary or cream), along with vaginal moisturisers and lubricants.
  • Polyps can be removed with a simple procedure.
  • A thickened lining (hyperplasia) is usually treated with progestogen hormone tablets, or a hormone coil (LNG-IUS) as an alternative — and monitored with follow-up samples.3
  • HRT-related bleeding may settle with a change in your HRT type or dose.
  • If cancer is found, it is usually caught early in women who report bleeding promptly — and early treatment gives the best outcomes.1

The takeaway

Bleeding after menopause is usually caused by something minor — but you cannot know that without a check. One episode is enough of a reason to come in. A quick scan gives answers, and in most cases, peace of mind. If you have noticed any bleeding after menopause, please contact us at Sugabi Clinic without delay.

References

  1. NHS. Postmenopausal bleeding [Internet]. London: NHS; [cited 2026 Jul 21]. Available from: https://www.nhs.uk/symptoms/post-menopausal-bleeding/
  2. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 734: The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol. 2018;131(5):e124–e129. Available from: https://doi.org/10.1097/AOG.0000000000002633
  3. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral (NG12) [Internet]. London: NICE; 2015 [updated 2025; cited 2026 Jul 21]. Available from: https://www.nice.org.uk/guidance/ng12