Sources checked October 22, 2026. Directory figures are from September 2026. This guide explains terminology and published research; it does not diagnose bleeding, choose tests or recommend hormone treatment.
Does light spotting after menopause need checking?
The NHS advises contacting a clinician about vaginal bleeding after menopause even when the amount is small or it has happened only once.[3]
In the United States, contact your obstetrician-gynecologist or primary care clinician to arrange evaluation. A directory search should not delay that contact. ACOG specifically asks patients to report bleeding after menopause.[1]
What can cause bleeding after menopause?
ACOG lists polyps, thinning of the uterine lining, endometrial hyperplasia and endometrial cancer among possible causes. It also names hormone therapy, infection and some medications.[1]
Atrophy means thinning; hyperplasia means thickening of the uterine lining. These are different findings, not names for the same process.[1]
The NHS distinguishes thinning of vaginal tissue from thinning of the uterine lining. The location of a finding matters when discussing an examination or pathology report.[3]
Ask which anatomical site the clinician is evaluating and whether the proposed explanation is confirmed or still being investigated. This page does not assign a cause from the color, amount or timing of bleeding.
What do ultrasound, biopsy and hysteroscopy mean?
A pelvic ultrasound uses sound waves to produce images. An endometrial biopsy collects tissue from the uterine lining for examination in a laboratory.[1]
Hysteroscopy uses a thin camera passed through the cervix to view the inside of the uterus. Sonohysterography is an ultrasound examination performed after fluid is introduced into the uterine cavity.[1]
For an appointment, write down the last menstrual period you recall, when bleeding started, whether it returned, and the names of medicines and hormones you use. Bring earlier ultrasound and pathology reports if available.
Ask what each proposed test will examine, where it will take place, what preparation is required, which comfort or anesthesia options are offered, and how the results will reach you. These are appointment questions, not a testing protocol.
What changed in ACOG's 2026 evaluation guidance?
ACOG's 2026 Clinical Practice Update revises its 2018 guidance on transvaginal ultrasound in postmenopausal bleeding. The update describes ultrasound together with endometrial tissue sampling as the initial evaluation for most patients.[2]
It retains an ultrasound-only pathway for selected patients under several conditions. The document considers the bleeding history, visualization of the uterine lining, clinical history and access to follow-up together.[2]
A number copied from an ultrasound report is not the complete guideline. Ask your clinician which version of the guidance they are using and how the history and findings inform the evaluation. This page provides no self-triage cutoff or instruction to omit a biopsy.
What has research measured about recurrent bleeding?
One observational study illustrates the difference between everyone enrolled and the group followed for recurrence. It is not a treatment trial or a personal prediction.
What did the 2024 Netherlands cohort report?
Van Maldegem and colleagues studied women undergoing endometrial sampling at four Dutch hospitals. Their analysis included 437 women presenting with a first episode of postmenopausal bleeding. After exclusions for an initial premalignant or malignant finding or hysterectomy, 360 remained in the recurrence analysis.[4]
Over a median follow-up of 61 months, 95 of those 360 women had recurrent bleeding, reported as 26.4 percent. Recurrence was identified retrospectively from records; patients who did not contact the hospital were classified as having no recurrence. This limits what the recorded proportion can establish. The findings describe this selected hospital cohort, not the chance of recurrence for every reader.[4]
What should I ask if I already use hormone therapy?
Hormone therapy appears among the possible causes discussed in ACOG's patient information, but that list does not determine the explanation for an individual's bleeding.[1]
Tell the prescribing clinician the exact product names and any recent changes. Ask who will coordinate the bleeding evaluation and communicate with the prescriber. Do not use this article to start, stop or adjust a prescription.
Where can I compare hormone therapy clinic listings?
For a separate hormone-care discussion, Regenerated.com's September 2026 export contains 3,761 clinics listing HRT among 9,042 US clinic records, across all 50 states and Washington, DC. This is directory category coverage, not a count of clinicians confirmed to evaluate postmenopausal bleeding. Source: Regenerated.com clinic export, collected September 2026.
The HRT clinic directory provides a national browsing route. Local examples include HRT clinics in Bryant, Arkansas and HRT clinics in Goodyear, Arizona. These links are not a recommendation to use HRT for bleeding or a substitute for gynecologic evaluation.
Before arranging hormone care, ask whether the clinician provides gynecologic assessment, has access to imaging and pathology services, or refers those services elsewhere. A listing is not an endorsement and does not confirm those capabilities.