She's Bleeding After Menopause — What to Do Right Now

Post-menopausal bleeding — any vaginal bleeding that occurs 12 or more months after her last period — is never considered normal. That doesn't mean it's automatically cancer, but it always needs investigation. About 90% of the time, the cause is something benign like vaginal atrophy, polyps, or endometrial thinning. But roughly 10% of cases are linked to endometrial cancer or its precursors. The critical fact for you as a partner: endometrial cancer caught early has a 95% survival rate. Caught late, that number drops dramatically. This is why urgency matters. She may downplay it — 'it was just spotting,' 'it's probably nothing' — because she's scared, or because women are socialized to minimize their symptoms. Your job is to gently but firmly insist that she sees her doctor. Not next month. This week.

The most frequent cause is vaginal or endometrial atrophy — thinning of the tissue due to declining estrogen. This can cause spotting, especially after sex. Endometrial polyps are another common cause; these are usually benign growths in the uterine lining. Endometrial hyperplasia — an overgrowth of the uterine lining — is less common but more concerning because some types can progress to cancer. And then there's endometrial cancer itself, which accounts for roughly 10% of post-menopausal bleeding cases. HRT (hormone replacement therapy) can also cause bleeding, particularly in the first months of use or with certain regimens. The point isn't to diagnose from home — it's to understand that a range of things could be happening, and only a doctor can sort it out. An ultrasound and possibly an endometrial biopsy are the standard first steps.

The first step is usually a transvaginal ultrasound, which measures the thickness of the endometrial lining. A thin lining (under 4mm) is generally reassuring. If the lining is thickened or the ultrasound is inconclusive, the next step is typically an endometrial biopsy — a brief office procedure where a small sample of the uterine lining is taken. It's uncomfortable but quick. In some cases, a hysteroscopy may be recommended, where a small camera is inserted to visualize the uterine cavity directly. These tests can feel invasive and anxiety-provoking. Your role: be there. Ask her if she wants you in the room or in the waiting area. Have the car warm. Bring her something comforting afterward. These small gestures communicate that you're in this together.

This is a real concern — you don't want to create panic, but you also can't stay silent. The key is leading with care rather than fear. Start from your own feelings: 'I noticed you mentioned some spotting, and I just want to make sure you're okay. I'd feel a lot better if we got it checked out.' Using 'we' language matters. It signals that this isn't her problem alone — it's something you're facing together. If she pushes back, don't argue. Instead, be honest: 'I know you think it's nothing, and I hope you're right. But I love you and I'm not willing to take that chance.' Most women who delay seeking care for post-menopausal bleeding do so because they're afraid of what they'll find. Your gentle persistence can break through that fear. And if it turns out to be nothing? Then you've both gained peace of mind, and she's learned that you pay attention and care enough to speak up.

If the diagnosis is endometrial hyperplasia or cancer, the road ahead depends on the stage and type. Early-stage endometrial cancer is highly treatable — often with a hysterectomy alone, sometimes with additional therapy. The five-year survival rate for localized endometrial cancer is over 95%. Your partner will need you to be her rock, but that doesn't mean you can't have feelings about it. Find your own support — a friend, a therapist, a support group for partners of cancer patients. You can't pour from an empty cup. During treatment, practical support matters as much as emotional support. Managing appointments, handling logistics, taking over household tasks she normally does — these are acts of love. Let her define what she needs. Some women want to talk about it constantly; others need distraction. Ask her. And keep asking, because what she needs will change.