Is Postmenopausal Bleeding a Sign of Cancer?

This page is for anyone who has had vaginal bleeding after menopause and wonders what it means. It explains when to get checked, the usual causes, and what the tests involve.

The National Institute on Aging says menopause is confirmed one year after a woman's final period. It lists bleeding or spotting that starts again after more than a year without a period as a reason to see your doctor.

MedlinePlus says to contact your provider about any bleeding after menopause. The American Cancer Society says it is especially important to report any vaginal bleeding, spotting or abnormal discharge after menopause, and that even discharge without visible blood should be checked.

There is no threshold to reach here. A single episode, a small amount, or spotting is enough to call.

One number gives this its shape.

MedlinePlus says the risk for cancer increases to about 10% in women with postmenopausal bleeding. So this is not a symptom to shrug at, and roughly nine in ten women who report it have another cause.

The NHS puts the same idea plainly: postmenopausal bleeding is not usually serious, but it can be a sign of cancer, and cancer may be easier to treat if it is found early.

The NHS names the most common causes.

• Inflammation and thinning of the vaginal lining, or of the womb (uterus) lining, caused by lower estrogen levels.
• Cervical or womb polyps, which are growths that are usually not cancer.
• A thickened womb lining, which it says can be caused by HRT (hormone replacement therapy), high levels of estrogen or being overweight, and which can lead to womb cancer.

MedlinePlus adds fibroids, infection or inflammation of the cervix or womb, injury, blood thinners, an underactive thyroid, and irregular use of hormone medicines.

Less commonly, the NHS says, the cause is cancer, such as womb cancer or ovarian cancer. The American Cancer Society says abnormal vaginal bleeding is the most common symptom of endometrial cancer, which starts in the lining of the womb. MedlinePlus also lists cancer or pre-cancer of the cervix.

This is where the timing needs to be clear.

For bleeding that is light and comes with no other symptoms, call your doctor or gynecologist and get an appointment soon. The American Cancer Society says it is important to have a doctor check out any irregular bleeding right away. Do not wait to see whether it happens again.

If bleeding becomes very heavy, that changes things. MedlinePlus says to contact your provider right away if bleeding is very heavy, and to keep track of how often a pad is soaked so the amount can be judged.

If heavy bleeding comes with dizziness or lightheadedness, fainting, pale or clammy skin, a racing pulse, confusion or shortness of breath, those can be signs of shock from blood loss. MedlinePlus says to call 911 any time someone has signs of shock.

Knowing the plan makes the wait easier.

MedlinePlus says the visit includes a physical exam with a pelvic exam, and questions about when the bleeding happens, how heavy it is, and what other symptoms there are. Tests that may follow include:

• a pelvic ultrasound. The NHS describes this scan as sometimes done with a small device placed in the vagina.
• an endometrial biopsy, which takes a small sample of the womb lining.
• a hysteroscopy, where a thin camera is passed through the cervix to look inside the womb.
• a Pap test, and blood tests such as a thyroid check.

Bring specifics rather than impressions.

Note the date of your last period, the date the bleeding happened, how much and what color, whether it was linked to sex, and whether there was any pain, discharge or smell. List your medicines, especially HRT, tamoxifen and blood thinners. Add your last cervical screening date.

How Cancer Is Diagnosed explains what each of the tests above is looking for.

Almost all of this is a prompt appointment rather than an emergency. Some things are not.

• Call 911 if bleeding is heavy and you feel faint, dizzy or lightheaded, you pass out, your skin is pale or clammy, your heart is racing, or you are short of breath. MedlinePlus lists these as signs of shock, which it says always need a 911 call.
• Call your doctor or care team today if the bleeding turns very heavy. MedlinePlus says to contact your provider right away when that happens, and to keep track of how often a pad is soaked. Call today too if the bleeding comes with pelvic pain. MedlinePlus lists pelvic pain, tiredness and dizziness as symptoms that, with abnormal bleeding, mean contacting your provider.
• Call your doctor for a prompt appointment if you have any bleeding, spotting or unusual discharge after a year without periods. That includes a single episode, a small amount, and having no other symptoms. If the appointment you are offered feels far away, say that this is bleeding after menopause.

There is no version of this where waiting and watching is the plan.

• MedlinePlus — Vaginal bleeding between periods
• MedlinePlus — Shock
• MedlinePlus — Bleeding
• American Cancer Society — Signs and Symptoms of Endometrial Cancer
• National Institute on Aging — What Is Menopause?
• NHS — Postmenopausal bleeding