Vaginal bleeding after menopause, also known as postmenopausal bleeding, is generally considered abnormal and should be evaluated by a healthcare professional. While it's not always a cause for alarm, it can sometimes indicate underlying health issues that need attention. Here are some possible reasons why bleeding may occur after menopause:

1. Hormonal changes: After menopause, a woman's levels of estrogen (or oestrogen) and progesterone decline significantly. However, hormonal fluctuations can occasionally cause the lining of the uterus (endometrium) to become thicker, leading to bleeding.
2. Endometrial atrophy: As women age, uterine lining can also become thinner and lose its supportive tissues due to decreased estrogen levels. This condition is known as endometrial atrophy and can cause bleeding after menopause.
3. Vaginal atrophy: As mentioned before, postmenopausal women often struggle with lower levels of estrogen. As the hormone begins to deplete, the vaginal walls begin to thin, causing vaginal dryness and inflammation. This can cause both severe pain after intercourse, and troublesome urinary symptoms as well. For this reason, doctors will often refer to vaginal atrophy as genetourinary syndrome of menopause (GSM). 
4. Endometrial hyperplasia: Sometimes, the uterine lining may become thicker instead of thinner, leading to a condition called endometrial hyperplasia. This can result from estrogen exposure without adequate progesterone, which can occur in conditions like polycystic ovary syndrome (PCOS) or obesity. Endometrial hyperplasia can increase the risk of developing endometrial cancer, so it requires medical evaluation.
5. Endometrial polyps: These growths develop on the uterine lining, commonly occurring in women during or after menopause. While most are benign growths, these polyps can cause heavy bleeding or lead to other complications, so removal is often recommended.
6. Uterine fibroids: These noncancerous growths can be present in the uterus and may cause bleeding or other symptoms. Although fibroids usually shrink and cause fewer problems after menopause due to a lower oestrogen level, they can still occasionally lead to postmenopausal bleeding.
7. Infections or trauma: Urinary tract infections and infections of the reproductive organs or trauma to the vaginal area can cause bleeding in postmenopausal women. These conditions require prompt medical attention and treatment.
8. Medications or hormone therapy: Certain medications or hormone replacement therapy (HRT) can sometimes cause thickening of the uterus, which can lead to endometrial hyperplasia and postmenopausal bleeding. If you're taking any medications or HRT, discuss this with your healthcare provider.
9. Endometrial Cancer: The most common cancer affecting the female reproductive system is uterine cancer, and postmenopausal bleeding is very a common symptom. There are two forms of this cancer; endometrial cancer and uterine sarcoma, with endometrial cancer being the most common of the two. Only 10% of women experiencing postmenopausal bleeding will be diagnosed with uterine cancer. If you are concerned, speak with your GP about further testing. 
10. Other Gynecological cancers: Although less common, gynecological cancers such as cervical cancer, ovarian cancer, or vaginal cancer could also be a reason for postmenopausal bleeding. It's important to rule out these possibilities through medical evaluation by your GP. 

Remember, postmenopausal bleeding should always be evaluated by a healthcare provider to determine the underlying cause. They may perform a physical exam, review past medical history, order diagnostic tests like an ultrasound, a biopsy, or imaging scans, and recommend appropriate treatment options based on the findings. If you have any concerns or questions about bleeding after menopause, speak to your GP or Fertifa Patient Advisor, who will always be available and happy to help 💜

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