Postmenopausal Bleeding: Why It Matters

Bleeding after menopause can be alarming. Even a small amount of spotting should never be ignored. While many causes are harmless, postmenopausal bleeding can sometimes be a sign of cancer, so timely evaluation is essential.

What is postmenopausal bleeding? Any vaginal bleeding that occurs 12 months or more after periods have stopped is considered postmenopausal bleeding. This includes spotting, light bleeding, or heavier flow.

Common causes:

• Vaginal dryness or thinning (atrophy)
• Polyps
• Hormonal changes
• Side effects of medications
• Endometrial hyperplasia
• Endometrial cancer

When is it concerning? Bleeding after menopause should always be checked, especially if:

• It happens more than once
• It is accompanied by pelvic pain
• You have risk factors such as obesity, diabetes, or family history
• You have used hormone replacement therapy
• You are over 55

What should you do? Visit your doctor as soon as possible. Evaluation usually includes:

• Pelvic examination
• Ultrasound to check endometrial thickness
• Endometrial biopsy (Pipelle)
• Further tests if needed

In Pakistan, these tests are available at gynecology departments in teaching hospitals and private clinics.

Key message: Postmenopausal bleeding is never normal. Most causes are treatable, but early detection is crucial. Do not wait for symptoms to worsen. Seek medical evaluation promptly.