What are the Causes of Spotting After Menopause & How is it Treated?

What is Menopause?

Menopause happens when a woman has no menstrual periods for at least a year. Menopause most often occurs after the age of 50 years. Experiencing brown spotting or discharge after menopause is not always a cause of concern. However, at times it can signal towards an underlying medical condition. Women should get regular checkups done by a doctor to diagnose any unusual discharge. Listed below are 4 Causes of Spotting After the Menopause and 6 Things to Resolve This.

What are the Causes of Spotting After Menopause?

What are the Causes of Spotting After Menopause?

Women can experience itching, burning, and off-coloured discharge more regularly than what they did before entered menopause. Brown spotting after menopause is specifically a sign of blood mixing into the discharge. While fresh blood is red, it turns brown or black as it gets oxidized and leaves the vagina. The colour can be lighter or mixed with other colours if the woman is suffering from an infection, like yeast infection. Some of the common potential causes of brown spotting after menopause are:

Vaginal or Endometrial Atrophy

The decreasing hormone levels during menopause cause thinning of the vaginal lining or the uterine cells. This thinning is termed as endometrial atrophy or vaginal atrophy. Vaginal atrophy often leads to dryness of the vagina and even makes it more sensitive, less flexible, and more susceptible to infection and inflammation than before menopause. Vaginal atrophy can also lead to itchiness, redness and pain in the vagina, brown spotting, and bleeding after sex. Constant discomfort may be felt in the vagina, and so women with these symptoms should promptly consult a doctor. Hormone replacement therapy and use of water-soluble lubricants during sexual activity, are the most commonly recommended treatments for vaginal atrophy.

Endometrial Hyperplasia

The endometrium can also get thicker after menopause. Like vaginal or endometrial atrophy, this too often occurs due to excess production of estrogen, and deficit production of progesterone in the body. Bleeding and abnormal spotting are some signs of thick endometrial tissue. Endometrial hyperplasia is one of the causes for spotting after the menopause. Hormone replacement therapy (HRT) may be recommended by the doctor for adjusting the levels of the hormones in the body and treating the issue effectively. Sometimes, a surgery may also need to be conducted to remove thickened cells, or a hysterectomy may need to be done to resolve the issue.


Off-coloured discharge which looks like spotting is indicative of infection in the vagina. Vaginal infections also cause an unpleasant odour, irritation, itching, and pain in the area. Certain factors like douching, antibiotics, diabetes and wearing tight undergarments while exercising, increase the risk for vaginal infections which in turn cause spotting after the menopause. The doctor usually recommends antibiotics or antifungal medications for treating vaginal infections which in turn resolves spotting after menopause.

Strenuous Exercise

Regular exercise is important for keeping the body in good shape. But exercises can at times also lead to brown spotting post menopause. Some women regularly experience brown spotting, especially after a strenuous workout. But this is usually nothing to be worried about. However, females who experience brown spotting after exercise for the first time should consult a doctor.

Diagnosis of the Cause of Spotting After Menopause

To accurately diagnose the cause of brown discharge/spotting after menopause, the doctor would enquire about the patient’s medical history and the medications which they are currently taking. The gynaecologist may also physically examine the patient’s pelvis or take a swab to test for infections and other conditions. Other tests which can be recommended to diagnose the cause of spotting after menopause include: pelvic ultrasound, Pap smear, blood test, dilation and curettage (D&C).

What is the Treatment & Management of Spotting after Menopause?

The ways of managing spotting/brown discharge after menopause depend on the underlying cause. Given below are some ways and methods to manage and treat spotting after menopause:

Wear Sanitary Pads & Loose Clothing: Wearing sanitary pads or thin liners prove helpful in dealing with the problem of spotting and discharge. By avoiding synthetic clothing, and wearing more of breathable materials like cotton, a person can feel more comfortable and also avoid contracting vaginal infection. Wearing loose-fitting clothing can help to avoid irritation in the vagina.

Avoid Douching & Harsh Chemical/Cosmetics: and Post-menopause, a woman’s vagina becomes more sensitive due to the thinning of the tissues. So, soaps, lotions and laundry detergent, which contain fragrances or other chemicals can easily irritate the vagina and should not be used. Although hygiene is important, douching is hardly necessary. Douching should be avoided since it can negatively affect the sensitive environment in the vagina and cause spotting after menopause.

Estrogen Therapy to Treat Spotting after Menopause: Atrophic vaginitis or endometrium is commonly treated with estrogen therapy. Estrogen therapy is available in many forms like tablets, creams, gels and skin patches. A soft and flexible vaginal ring, which slowly releases the hormone in the vagina, can also be used to manage spotting after menopause. Certain treatments are available to help deal with the problem of thickening of the endometrium. In mild case of endometrium thickening which is causing spotting after menopause, treatment may not be required all together. The doctors mostly take up a wait-and-watch approach. But since endometrial hyperplasia raises a female’s risk of endometrial cancer, it is very important to monitor their condition. When bleeding or spotting post menopause is caused due to Hormone Replacement Therapy, the treatment may need to be adjusted or stopped altogether.

Surgery for Treating Spotting after Menopause: Other treatment options for spotting after menopause include: hysteroscopy or D & C for removing the thickening endometrium, hormones in the form of oral tablets or intrauterine system implant, and surgery called hysterectomy for removing the cervix, ovaries and uterus.

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Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 5, 2023

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