Red flag · Gynecology
Postmenopausal bleeding: when to worry
Bleeding after 12 months of amenorrhea is never normal. Most cases are due to atrophy or benign polyps, but ~10% represent endometrial hyperplasia or cancer. Prompt evaluation is standard of care.
Common causes
- Endometrial or vaginal atrophy
- Endometrial polyps
- HRT breakthrough bleeding
- Endometrial hyperplasia
- Endometrial cancer (~10%)
Frequently asked questions
Is any postmenopausal bleeding cancer?
No — most is benign atrophy or polyps. But every episode needs workup to exclude cancer.
What is the standard workup?
Transvaginal ultrasound to measure endometrial thickness; biopsy if >4mm or persistent bleeding.
What if I am on HRT?
Some breakthrough bleeding is expected in the first 6 months. Persistent bleeding still requires workup.
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Written and medically reviewed by the Kindr Health Clinical Team · Published 2026-06-19 · Last reviewed 2026-07-01. Compounded medications are prepared by FDA-registered 503A pharmacies and are not FDA-approved drug products.