Why does endometrial hyperplasia cause bleeding after menopause?

Endometrial hyperplasia is an overgrowth of the endometrium, the lining inside the womb. It often develops when estrogen stimulates the lining without enough progesterone to balance that effect. After menopause, menstrual periods have stopped, so any vaginal bleeding is unusual and should be assessed.

A thickened lining may contain fragile areas that break down at different times. This can cause spotting, light bleeding, or a heavier episode. The bleeding may stop and return, but its pattern does not reliably show the reason. Examination and tests are needed to distinguish hyperplasia from other causes, including polyps or changes that require treatment.

Arrange an appointment with a gynaecology or primary-care clinician even if the bleeding was brief or happened only once. Note when it started, how long it lasted, whether it was spotting or flow, and whether you had pain or unusual discharge. Tell the clinician about hormone medicines, tamoxifen, bleeding medicines, and any previous womb conditions.

Assessment may include a pelvic examination, an ultrasound to look at the womb lining, and sometimes a sample of the lining called an endometrial biopsy. The result guides care. Treatment can involve progesterone-based medicine or removal of a local growth; the appropriate option depends on the tissue findings and your health history.

Seek urgent medical help if bleeding is heavy or persistent, you feel faint or unusually weak, you have severe or worsening pelvic pain, or you develop fever. If the bleeding is light and you otherwise feel well, contact a clinician promptly for an appointment rather than waiting for another episode.

Ask what may be causing the bleeding, whether an ultrasound or biopsy is appropriate, what the tissue result shows, and how treatment will protect the womb lining. You can also ask which symptoms should prompt an earlier review.