Post  menopausal uterine bleeding is any abnormal bleeding that occurs in women who no longer menstruate. Although only about 10% of cases will be due to endometrial cancer, post-menopausal uterine bleeding must always be thoroughly evaluated.

Common causes of post-menopausal uterine bleed include atrophy of the vaginal mucosa and in fact is the cause of 59% of bleeding. Polyps account for another 12% with endometrial cancer accounting for 10%. Cervical cancer accounts for less than 1%.

Atrophy is caused by the lack of estrogen which explains why post menopausal women often have vaginal dryness. This dryness leads to micro tears that cause spotting. Treatment, depending on severity is by estrogen replacement, either topical or oral.

Endometrial cancer is the leading cause of genital cancer in post-menopausal women and is highly treatable when caught early with 96% of women with localized (non-metastatic) endometrial cancer surviving after 5 years.

UpToDate publishes a great patient handout that I highly recommend: Endometrial Cancer Treatment.