If you have completed menopause — gone without a period for more than one year — you should not experience any menstrual bleeding. Even a little spotting is not normal after menopause. If you have postmenopausal bleeding, make an appointment to see your doctor as soon as possible. It could be caused by a number of health problems, some of which are serious.
Here is an overview of the most common causes of postmenopausal bleeding.

Causes of Postmenopausal Bleeding

Several health conditions can cause postmenopausal bleeding, including:
Polyps: These are growths, usually noncancerous, that can develop in the uterus, on the cervix, or inside the cervical canal, and may cause bleeding.
Endometrial atrophy (thinning of the endometrium): The endometrium, the tissue that lines the uterus, can become very thin after menopause because of diminished estrogen levels, and may cause unexpected bleeding.
Endometrial hyperplasia: In this condition, the lining of the uterus becomes thick, usually as a result of too much estrogen and too little progesterone, and bleeding may occur as a result. Obesity may be the cause of the problem. Some patients with endometrial hyperplasia may have abnormal cells that can lead to endometrial cancer (cancer of the uterine lining).
Endometrial cancer (uterine cancer): Bleeding after menopause can be a sign of endometrial cancer.
Other causes: Hormone therapy, infection of the uterus or cervix, use of certain medications such blood thinners, and other types of cancer can cause postmenopausal bleeding.

Determining the Cause of Postmenopausal Bleeding

Your doctor can determine the cause of your bleeding by taking your medical history, performing a physical exam, and conducting a few tests. Tests may include:
Transvaginal ultrasound: During this test, a special imaging device is inserted inside the vagina so that your doctor can view the pelvic organs and look for abnormalities.
Endometrial biopsy: A thin tube is inserted into your uterus and a tiny sample of the uterine lining is removed so that it can be sent to a lab to look for abnormalities.
Hysteroscopy: During this test, your doctor uses an instrument with a light and small camera to examine the inside of the uterus and look for problems.
D&C (dilation and curettage): This test allows your doctor to remove tissue from the uterus lining so that it can be sent to a lab for analysis.
Ultrasound and biopsy can be performed in your doctor’s office; hysteroscopy and D&C are usually performed in a hospital or outpatient surgical center.

How is Postmenopausal Bleeding Treated?

Treatment depends on what is causing the bleeding. If polyps are to blame, surgery may be needed to remove them. Endometrial atrophy can be treated with medication alone; endometrial hyperplasia may be treated with medication, such as progestin or progesterone therapy, and/or surgery to remove thickened areas of the endometrium. If you have endometrial hyperplasia, you will need to see your doctor on a regular basis for monitoring.