There are a lot of changes to your body that come during and post-menopause. Some women may experience vaginal dryness or insomnia during the perimenopause phase while others may suffer from vaginal bleeding. Anyone can have vaginal bleeding during perimenopause (the time leading up to menopause, which usually occurs between ages 40 and 50) due to hormone levels and changing periods. However, if you’re experiencing vaginal bleeding, whether light or heavy, more than a year after your last period, Dr. Tamika Auguste, MD, FACOG and Vice-Chair of Women’s and Infants’ Services at MedStar Washington Hospital Center, suggests visiting your doctor.

“Bleeding after menopause could be due to various number of things,” she tells SheKnows. “It could be something structural or medication. It could be due to varying hormone levels, or it could, unfortunately, be due to something like cancer. That’s why they should always be investigated.” Postmenopausal bleeding occurs in about 10% of women over 55, and most of the time there is no pain associated with the bleeding, but because it’s not considered a normal part of the post-menopause phase, it’s always best to consult with a medical professional. Read more below for everything you need to know about vaginal bleeding during and after menopause.

Why am I bleeding after menopause?

As Dr. Auguste mentioned, there are many reasons someone could be bleeding after menopause. One reason for postmenopausal bleeding could be that the tissue of your vagina and vulva has gotten thinner. This can happen during menopause due to hormone changes. If you experience bleeding after sex, it may be from friction against this thinner, more sensitive skin—but your ob-gyn still should do a full evaluation to be sure.

Cleveland Clinic notes that postmenopausal bleeding can also be due to benign (noncancerous) gynecological conditions such as endometrial polyps. But for about 10% of women, bleeding after menopause is a sign of uterine cancer, which is the most common type of reproductive cancer. So, if you’re experiencing any bleeding after menopause, talk to your healthcare provider sooner rather than later.

What should I do if I’m experiencing bleeding after menopause?

Talk to your healthcare provider who will either perform a pelvic exam. During the exam, your ob-gyn may look at your vagina and cervix and feel the size of your uterus. They may also do a pap smear to check the cervical cells, and an ultrasound, usually using a vaginal approach, which may include the use of saline to make it easier to see any uterine polyps or a biopsy. Some cases call for a more complex procedure called a diagnostic hysteroscopy with dilation and curettage (D&C), Dr. Auguste writes. In this procedure, your ob-gyn will place a camera into the vagina, through the cervix, and into your uterus where cells are removed from the uterine lining. Based on the diagnosis, the next steps will depend on your age, how long it has been since you reached menopause, and how much bleeding you’re experiencing.

What are the potential treatments for post-menopausal bleeding?

Treatment for postmenopausal bleeding depends on its cause, but medications could range from antibiotics to treat infection, estrogen to treat vaginal dryness, or progestin to treat endometrial hyperplasia, a condition in which the lining of the uterus grows too thick. There are also surgeries available, but again, it’s best to talk to your healthcare provider to ensure you’re making the right choice based on your specific condition.

What signs should I watch for during perimenopause that something could be amiss?

Because occasional spotting is common during perimenopause, it can be difficult to determine when exactly something may be amiss. However, Dr. Auguste provided some signs you should watch out for. “If there is bleeding with intercourse, during or afterward, or if there’s any significant pain and abnormal discharge, not just like your normal discharge, but something that’s very different, get it checked out,” she tells SheKnows. “And if you’re seeing any increase in weight, weight loss, an increase in abdominal girth, or if you’re simply not sure, it never hurts to follow up with your gynecological provider for peace of mind.”

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