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Bleeding after Menopause

After years of regular cyclic bleeding, many women find a degree of relief when menopause comes and they no longer need to be bothered with the monthly ritual. At the present time we generally recommend natural hormone replacement therapy for the many benefits that it offers, including control of the estrogen withdrawal symptoms of hot flashes, night sweats, significant vaginal dryness and even decreasing cognition. The hormones are given, however, in a continuous and steady fashion to avoid the cycling that can cause issues with monthly withdrawal bleeding.


Though the menopausal transition may last up to a year, with irregular bleeding seen as the ovaries begin to lose their hormonal responsiveness, after this time of change no further bleeding should be seen. Unfortunately, bleeding sometimes occurs and can be a justifiable source of concern.


The causes of bleeding after menopause are usually benign, and can include anatomical issues such as uterine fibroids, polyps inside the uterus or on the cervix, or even vaginal trauma from tight or dry menopausal tissues. It may also be encouraged temporarily from a net imbalance of the helpful combination hormone therapy. But it may also result from an inappropriate overgrowth of the inside lining of the uterus, such as an endometrial hyperplasia or even a uterine cancer. In fact, this is the way that most uterine cancers declare themselves. Therefore, any bleeding seen after menopause must be taken seriously and thoroughly evaluated.


In order to reliably determine the cause of postmenopausal bleeding, a thorough history is taken and an examination is done, and a diagnostic ultrasound is ordered as well. The ultrasound will be able to measure the thickness of the uterine lining, and unless the lining is quite thin, the inside of the uterus will be inspected with lighted tube called a hysteroscope placed in the uterus (in the office with local anesthesia) and a biopsy of the lining tissue will be obtained. The biopsy will reliably confirm the state of the uterine lining.


Thankfully the cause is usually identified as a benign process such as endometrial polyps that can then be acted upon, but if a more serious issue is uncovered, it turns out that the bleeding is commonly an early warning sign, and safe and effective therapy can quickly and successfully be accomplished. Please do not hesitate to the let providers of Premier Ob/Gyn know if you have any worrisome bleeding concerns at any time of life! 


Premier OB-Gyn is accepting new patients in both our Maitland, FL and Oviedo, FL locations. We would be happy to see you! Please call 321-397-1212 or visit to book your appointment!


John van Wert, MD, FACOG Dr. John van Wert is a leading board-certified OB/GYN, serving patients in and around the Greater Metro Orlando for over 30 years. He provides services such as bioidentical hormone replacement, menopause management, vaginal surgery and rejuvenation, and robotic hysterectomies in addition to standard gynecology services. Dr. van Wert obtained his undergraduate degree at Duke University in North Carolina, his medical degree from Vanderbilt University Medical School in Tennessee and residency at the University of Florida in Gainesville. Dr. van Wert excels in gynecologic surgery, especially laparoscopic surgery and robotic hysterectomies. He has been named as one of Central Florida’s “Top Doctors” multiple times. Dr. van Wert is a long-standing board certified member of The American Board of Obstetrics and Gynecology and is also a member of the American Academy of Cosmetic Surgery and the American Association of Cosmetic Gynecologists.

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