Postmenopausal Spotting, Bleeding - Causes

Postmenopausal Spotting

Postmenopausal spotting refers to spotting or discharge of tiny specks of blood after menopause.

Menopause refers to that phase in a woman life where she stops having periods or menstrual cycles.  It is not something that happens overnight, it is a gradual process over a period of time.  Though the average age of menopause is 51, it can even in cases when a woman in in her thirties or when she is in her early 60s. But typically, menopause happens between 45 and 55 years of age.

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This initial phase is known as peri-menopausal stage and is marked by irregular periods with light bleeding wherein periods may occasionally not occur for months. After years of such minor menstrual bleeding, the periods completely stop. When a woman has not had any menstrual cycles for one year, then she is said to be in the postmenopausal stage.

Postmenopausal spotting is usually not a common occurrence. It is usually described as discharge of reddish or brownish droplets of blood. It is not similar to the light or heavy flow of blood associated with normal periods.

Postmenopausal spotting may or may not be a cause of serious concern. It is however best to consult a doctor for diagnosis treatment if needed.

Causes of postmenopausal bleeding

Postmenopausal spotting may occur due to a variety of causes, which may be mild or severe. The most common causes are listed below:

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  • After a woman reaches the phase of menopause, the ovaries are unable to produce sufficient levels of the reproductive hormone called estrogen. Reduced levels of estrogen may trigger a condition called endometrial atrophy which is marked by thinning of the endometrium. In other words, the tissues and blood vessels that wall the vaginal lining tend to become weak and thus vulnerable to rupture. This is what causes red, white, or brown discharge or postmenopausal spotting. Affected women may also experience inflammation and itchiness in the region.
  • Any kind of vaginal infection may result in postmenopausal spotting. Infection is usually identified when the discharge is smelly and occurs along with pain in abdomen and fever.
  • An ongoing treatment with hormone replacement therapy post menopause can also cause women to experience spotting. It may be noted that this hormonal therapy involves administration of low estrogen dosages to alleviate the different symptoms of menopause that adversely affect a woman’s body. The subsequent changes in estrogen levels in the body is what triggers the occasional postmenopausal spotting.
  • Uterine or ovarian cancer is another cause of postmenopausal spotting. It is not so common and usually affects women older than 60 years old. It is a serious condition and is often marked by continuous spotting.
  • When the uterine wall develops polyps or fibroids, then it can result in postmenopausal spotting. Polyps may grow on the cervix, uterus, or within the cervical canal and cause spotting or some light bleeding as well as pain. On the other hand, fibroids on uterine lining may occur with spotting or heavy bleeding. These growths typically tend to be non-malignant or benign, but they come with a high risk to becoming cancerous if left untreated. Doctors may carry out varied tests to determine the condition of the non-cancerous uterine wall growths and then remove them via an endoscopy.
  • Patients of leukemia may also suffer from abnormal postmenopausal spotting because the blood disorder disrupts the process of clotting of blood.
  • Postmenopausal spotting may sometimes be triggered by elevated levels of stress. The process by which the body tries to adjust to the physical changes that occur during menopause can result in increased stress. Additional external factors can also contribute towards excess stress.
  • Loss of weight at a rapid pace can sometimes result in postmenopausal spotting. This is because the estrogen occurring in fat also gets lost when women lose fat during weight loss, thereby leading to spotting.

Treatment of postmenopausal spotting

As discussed above, it is clear that postmenopausal spotting can be caused due to mild reasons or serious diseases like cancer. Hence, women need to seek medical attention whenever they experience such spotting after menopause.

The physician will first conduct a Pap smear test to verify the presence or absence of cancer.

  • If Pap smear test yields a positive result, the additional tests like a biopsy are carried out. When malignant cells are found during these additional tests, then surgeons will perform a hysterectomy surgery to remove the cancer.
  • If Pap smear test results are negative, then doctors will examine the medical history of the woman, her lifestyle, etc., to determine other causative factors of postmenopausal spotting.
    • Hormonal imbalances can be treated with prescription topical or oral medications that correct the estrogen levels
    • Vaginal infections can be treated with antibiotics and other drugs
    • Women with ongoing hormone replacement therapy may be recommended a change in dosage, etc.
    • Doctors may suggest lifestyle changes, intake of a healthy and balanced diet, meditation, and exercising for alleviation of stress.


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