What Causes Light Pink Spotting After Menopause? 5 Causes

Last updated 04.01.2024 | by Sabrina Johnson | 7 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.


“I am 55, and a week ago, I experienced light pink spotting from my vagina during one of the washroom breaks. It left me perturbed since it’s been two years since my period has stopped.” She was referring to postmenopausal bleeding, which may happen in some women. It is True that when you find yourself bleeding after menopause, it could make you immensely panic, but that isn’t always a cause for worry. In most cases, it’s an outcome of benign conditions. However, in 10% of women, vaginal bleeding might indicate the early onset of uterine cancer.

Are you worried about postmenopausal bleeding and its consequences? This article is a must-read. I have covered important aspects, such as the causes of spotting or bleeding after menopause and the symptoms, diagnosis, and treatment procedures. So, let’s get started.

Is it Normal to Bleed After Menopause?

If you experience vaginal bleeding after a year since you’ve had your last menses, then that isn’t a usual thing to happen. You may have light spotting varying in color from pinkish-gray to light red to brown. Postmenopausal bleeding isn’t common and occurs in around 10% of females over 55.

5 Causes of Postmenopausal Bleeding

Most women are keen on knowing the causes of postmenopausal spotting or bleeding. Here is an elaboration of the same:

1. Vaginal Atrophy

Vaginal atrophy occurs when your vaginal walls become thin, gets inflamed, and dried. Most women during and after menopause face this problem because of low estrogen levels. Estrogen isn’t only a reproductive hormone but also has other functions. One of them is to keep the va+ginal wall thick and lubricated.

A reduction in these hormone levels makes the vagina less moist, leading to inflammation and irritation. Some of the common signs of vaginal atrophy include:

  • Burning and itching sensation (in the vagina)
  • Pain during sex
  • Yellowish vaginal discharge
  • Bleeding or spotting (mostly during and after sexual intercourse)
  • Vulvar itching 

Sometimes vaginal atrophy could result in urine-related infections like:

  • Frequent UTIs
  • Urinary incontinence 
  • Increased and painful urination 
  • Blood in urine
  • Burning sensation while urinating

2. Endometrial Hyperplasia

Endometrial hyperplasia occurs when the uterine lining thickens. This condition mainly occurs in women transitioning into menopause or in those who are already in menopause. It’s rarely seen in women below 35. Endometrial hyperplasia could manifest into endometrial cancer when untreated for long.


If you’ve developed this condition after menopause, you could experience vaginal bleeding. If you are in perimenopause, you may bleed between periods or even bleed heavily. Findings have shown that estrogen therapy may result in abnormal thickening of the uterine lining, leading to endometrial hyperplasia. If you are on HRT or taking any drug to raise your estrogen levels and experience abnormal bleeding, consult your healthcare provider immediately.

3. Uterine Polyp

Polyps are benign growths in the inner uterine lining. They form in areas where the endometrial tissues overgrow. Polyps are most common in women approaching menopause or those who have already experienced menopause. They are rare in women under 20. Obese women, those taking HRT, or those who have high blood pressure are at a greater risk

One common symptom of polyps is pinkish, brownish, or reddish bleeding after menopause. If your menses are on, you may have symptoms like heavy or irregular periods or spotting between menses. Polyps don’t usually cause pain unless they’ve increased in size.

4. Endometrial Cancer

As mentioned above, sometimes endometrial hyperplasia could result in endometrial cancer in the long run. Postmenopausal bleeding is one of the signs of endometrial cancer seen in 90% of women diagnosed with the same. Bleeding isn’t the only symptom of endometrial cancer. It comes with other warning signs also, which include: 

  • Abdominal pain
  • Difficulty in urinating 
  • Unexplained weight loss
  • Vaginal discharge 

Vaginal bleeding may even indicate ovarian or cervical cancer. In the case of ovarian cancer, the associated symptoms alongside bleeding include:

  • Pelvic pain
  • Back or abdominal pain 
  • Bloating
  • Lessened appetite 
  • Urgency to urinate often or constipation 

For cervical cancer, besides bleeding, one may experience pelvic pain, smelly vaginal discharge, pain, and bleeding during and after intercourse.

5. Hormone Replacement Therapy (HRT)

The effectiveness of HRT in managing menopausal symptoms isn’t unknown. However, they come with some banes, particularly a few of them. Some women taking HRT may experience bleeding after menopause. However, the mechanism causing the bleeding isn’t known well.  So, if you are on HRT and experience postmenopausal bleeding, seeking a doctor’s consultation is a mandate.

How is Postmenopausal Bleeding Diagnosed?

When you seek a healthcare provider’s advice regarding postmenopausal bleeding, the following diagnoses are done to get to the root cause: 

  • A pelvic exam to determine any lumps or abnormalities in your cervix and vagina 
  • Transvaginal ultrasound to check the endometrial walls’ thickness
  • Endometrial biopsy to collect the cells from your uterine lining 
  • Pap smear for detecting any irregular cervical cells 
  • Hysteroscopy, where the doctor inserts a tube (thin and lighted) through the vagina to check your uterus and cervix)

The doctor may even ask for details like: 

  • Since when you’ve been experiencing bleeding, and the duration and severity 
  • The time when you had your last period
  • The medicines you take
  • If you have any preexisting health conditions

Treatment and Management Procedure for Postmenopausal Bleeding

The treatment depends on the cause of the bleeding and its severity. In most cases, medicines are needed to manage the cause, while a surgical procedure is sometimes required. 

  • In case of vaginal atrophy, the healthcare provider may prescribe drugs functioning similar to estrogen. You can get them as gels, skin patches, rings, creams, and tablets. 
  • Uterine polyps require surgical removal, though the procedure depends on the polyp’s size. If the polyps are small, the doctor might suggest waiting for them to dissolve. Your medical expert may even prescribe hormonal medications to minimize polyp symptoms. Bigger polyps need hysteroscopy and are sent to the laboratory for examination upon removal. 
  • Insufficient progesterone is often responsible for endometrial hyperplasia. Your doctor may prescribe drugs containing progestin to raise your hormone levels. The medicines are available as pills, creams, and injections. 

If your condition doesn’t improve after taking hormone medications, your doctor could suggest a hysterectomy as a last resort. However, most women respond well to hormonal treatment, and a surgical procedure isn’t always needed. 

  • Cancer treatments depend on the severity and staging. They involve several procedures, such as chemotherapy, surgery, radiation therapy, immunotherapy, and targeted therapy. 
  • If hormone therapy is the reason for postmenopausal bleeding, changing the therapy or stopping it at least for some time may help. 
Who is at a greater risk of postmenopausal bleeding?

Obese women, those who smoke a lot, or individuals with underlying conditions like thyroid, diabetes, or polycystic ovary syndrome are at a greater risk of postmenopausal bleeding. Women who have had menopause later than the estimated age could even bleed in the period that follows.

When should you contact a doctor regarding postmenopausal bleeding?

As I said in the beginning, postmenopausal bleeding isn’t always a cause for concern, though, in a few, it could be a symptom of cancer. So, if you bleed a year after your last menses, talking to the doctor is always a must. You must do the same even if you bled once.

Conclusion

Postmenopausal bleeding could scare you to the core. Right? Irrespective of how you bleed, a light pinkish spot or heavy bleeding, talking to the doctor will always help. Getting yourself checked by your healthcare provider will help you understand the reason, and early intervention is effective in solving the problem.

Author

  • Sabrina Johnson

    Meet Sabrina Johnson, a compassionate author and a seasoned expert in Obstetrics and Gynecology. She is a driving force behind Simply Menopause, where her extensive medical knowledge and empathetic nature come together to empower women in their menopausal journey. Sabrina offers culturally sensitive guidance and support through her approachable writing, making her a trusted friend on the path to menopause wellness.