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General Medical Questions
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Question : I thought I had finished my cycle of change, but I am having a period for the first time in 5 years. Is this normal?
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The Trusted Source
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Howard LeWine, M.D.

Joan Marie Bengtson, M.D., is assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology & Reproduction at Brigham and Women's Hospital.

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April 18, 2014
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Once menopause begins, vaginal bleeding is not normal. You should see your doctor about it. 

Postmenopausal bleeding (PMB) is any bleeding that happens after one year of not having periods. The reason for this definition is that many women skip periods in the year or two leading up to menopause. This transition phase, called the perimenopause, is due to the gradual change in the hormone production from the ovaries. 

There could be several causes of bleeding after menopause. First, an exam is needed to find the source of the bleeding.

If it is from the vaginal walls, the most common cause is thinning and tearing of the tissues due to low estrogen levels. This is called atrophy. It accounts for about half of the cases of PMB. It is not a serious condition and can be treated if bleeding persists or it causes discomfort.

The most worrisome cause of PMB is cancer of the genital organs, especially the uterus or womb.  The further a woman is from menopause, the higher the risk that bleeding is due to cancer. Overall, about 10% of cases of postmenopausal bleeding are due to cancer.

Cancer can usually be ruled out with some simple office tests. This could include a biopsy of the uterus and a pelvic ultrasound. But if cancer or precancer of the uterus is responsible for the bleeding, it’s very important to make the diagnosis as early as possible. 

Other causes of PMB include:

  • Infection
  • Benign growths such as polyps and fibroids
  • Injury
  • Bleeding disorders or use of blood thinners

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