Post Menopausal bleeding-Benign Hysteroscopy

Absolutely will be asking for another referral on Friday

Hi @rainee2025
I just came upon your original posting. We have a similar situation. I hope you are finding answers though. I'm menopausal but don't have lichen s. and am just average weight for my height. However, like you, I had spotting 2 years ago. Then a benign endometrial biopsy. Two years passed and nothing.... then spotting. Another benign endometrial biopsy. That was back in May. Then nothing and this past week spotting again! ugh!

This time I will be getting a hysterscopy. My uterine lining on the biopsies went from .2 to .8 to 1 cm., so obviously I'm growing what appears to be a thickened lining of cells with no precancerous cells, no atypia. I thought the biopsy was "proof" all is well but now I'm told an endometrial biopsy can "miss" spots.

I will say, every single time I've had spotting I have been in an extroadinary time of stress in my life. And it seems kind of similar for you?

I have some medium size fibroids and a benign polyp, and the dr thinks that's possible these things cause the endometrium to grow or push on it and cause bleeding.

I just feel exhausted, exasperated and like there is an unknown stress (!) adding to my known stresses!

I'm hoping you will find the answers for your experience. Please share here if you wish or have time. I feel like the only way we can gather information is from each other. The more information we have, the better choices we can make for ourselves. Plus the moderator on here seems very helpful!

Best wishes!

Hi Rainey, yes I am experiencing bleeding right now. My circumstances are a bit different than yours but very close. I am 61 years old and weigh 310. Don't know how that happened as I barely feel like eating anything. I started bleeding on 12/21/2025 and still going strong on 12/29. The last time I bled was in January, 2024. The time before that was February 2023. Each time as someone mentioned I had cortisone shots. I know you haven't had any shots but I'm putting it out there that even before the cortisone shots I was only spotting. I had a D&C/hysteroscopy done in November, 2020 and had benign results. I had 3 or 4 endometrial biopsies done between the November 2020 D&C and 2023. Right now I'm thinking the cortisone kicked this off but my lining had to be thick for an amount of blood in producing.
I have had a female hormone panel done and at age 60 my FSH was only 25.0 when it should have been much higher! Estradiol was 36 of and progesterone was 0.2.

I am scheduled to see my gyn again on January 29. Trying to get in earlier to see him but maybe it's for the best if I stop bleeding. Right now I am taking 100 mg micronized progesterone to hopefully stop the bleeding. I had the progesterone from earlier this year when I wanted to try an 25mg estrogen patch. Never did use the patch and I probably won't at all. So basically I'm using the progesterone in a way that he didn't prescribe it hoping it stops this bleeding.

Just wanted you to know that yep I'm still spotting/bleeding at 61 although it's never been this much and hopefully it's the cortisone. BTW I've never had the COVID vaccine either so it's not that in my case either.

I am 55 and began menopause in April of 2021. I have been on continuous HRT since then. In the last 6 months, I have started having bleeding episodes. Usually, it starts with light spotting and some dark tissue strings, then I will have a light “period” for a few days. I had a hysteroscopy with D&C on 1-21-26. A (benign) polyp was removed. I stopped bleeding from the surgery on 2-7-26. Today, the cycle of spotting began, some tissue, & tonight I am having a light bleed again. I had a follow-up appt. with my gyno on 2-12-26. Things were good then, thought bleeding was in my past. I had an early morning HRT appt. with my N.P.. She said as long as I am not bleeding, no need to make any big changes to it. I wasn’t bleeding prior to the appointment, so we didn’t get to discuss it. The only new thing I had introduced over the last 2 weeks is Yuvafem estradiol suppositories. I am supposed to insert one tablet per night for 14 days, then use 2 times per week. I am on night 10. I read that it is not normal for that to cause bleeding. Supposedly, it’s not systemic. Just wondering if anyone has any advice for me please.

Did your D&C show hyperplasia or estrogen stimulated tissue?
It is not unusual for estradiol of any kind when used, especially vaginally, to cause hyperplasia or bleeding from estrogen stimulated tissue or to stimulate polyps with resulting bleeds.
Of course you have had a uterine polyp and uterine polyps are a common cause of abnormal uterine bleeding, An elevated estrogen (estradiol) levels may cause or stimulate their growth. These, often benign, growths on the inner uterine lining frequently cause spotting, heavy periods, or postmenopausal bleeding.

You might be better served with an estriol vaginal cream. Estriol is 10 times less strong than estradiol and not tied to polyps or hyperplasia.
Scientific literature generally suggests that estriol is "endometritically silent." This means that at standard doses for vaginal atrophy, it typically does not cause the uterine lining to thicken.
In contrast, while Yuvafem is also considered very safe, its more potent nature means that in a small percentage of women—particularly those who are highly sensitive or using the product more frequently than prescribed—the estradiol can trigger spotting or localized growth like polyps.
Estriol works in the vaginal area but generally does not significantly thicken the uterine lining (endometrium) because of its short duration of action on receptors. It is a weak estrogen that binds to vaginal receptors long enough to treat dryness and atrophy, but dissociates too quickly from endometrial receptors to cause proliferation.

Also, with a system like yours which is sensitve to estrogen it is safest to use progesterone systemically and maybe vaginally to counteract any estrogen over reaction. Please ask your doctor; there is a ratio of progesterone to estrogen which is considered safe which you doctor should be able to maintain for you.

Your story is one that I hear over and over again. It seems that doctors have grown used to prescribing estradiol for women, women that were for years predominately without a uterus or ovaries.
That is less and less the case nowdays, and doctors are seeing that women with a uterus/ovaries are more senstitive to estrogens and do better on estriol, whereas women without a uterus/ovaries seem to need the stronger estradiol. At this point this is all self reporting and doctors speaking out on line, but hopefully a research or population study will clarify this better in the future.

Now though we are left with our own bodies' speaking to us and us having to listen very carefully.
personal example: I have bled twice in my around 28 years in menopause and both times I was taking estradiol systemically. Seems, I was making my own estradiol and was basically overdosing on estradiol when I used the topical estradiol cream. I found a doctor that uses hormone testing and the tests showed that I made plenty of estradiol naturally. I have not used estradiol again until just recently when at the age of 73 my estradiol levels have begun to fall; we will see how I do on this tiny amount of estradiol skin cream balanced by progesterone which I am now taking, plus upping my estriol vaginally.

@kathleen1314 thanks very much for the reply. Your opening question was, “ Did your D&C show hyperplasia or estrogen stimulated tissue?”. I had some thickening prior to the D & C. My lining was 5mm, which is considered too thick according to my Gyn. She said they like to see 4mm or less. I don’t know how to find out if I have estrogen stimulated tissue. My Gyn didn’t mention that, though she wants me to go lower on my estradiol patches, which I have started doing 2 weeks ago (from .2mg to .1mg). My N.P. for hormones said yesterday that estrogen does not cause polyps. That was surprising to hear and contrary to what you said. I told her the Gyn did not say that.
What you said about switching to localized estriol over estradiol is interesting. My gut is telling me that the Yuvafem is the culprit for the new bleeding. It’s just so hard to convince my providers, since from what I read online, this is not wildly reported. All they say is bleeding after menopause is not normal.
I was on .2mg patches twice a week, for the systemic portion of my estrogen. The reason I was on a higher dose than usual was based on a blood test I had 2 years ago where my estrogen was 30. At that time I was on .1mg patches. My last blood test, in Dec. 2025, estrogen was 134. I have gone down to .1mg patches again, as of 2 weeks ago, though started on the Yuvafem because of vaginal discomfort (thinning, pain, etc). I take 200mg of oral micronized progesterone and my test result was in a normal range last Dec. You mentioned taking it vaginally. I asked my Gyn about it. She said, “I guess you could place the pills up inside of you”. She never heard of it before though. I hesitate to do so because they smell awful. I looked up why that is and, supposedly, the capsules are beef gelatin rather than vegan. Not really something I would like to place up in me. She also offered an IUD. I am terrified of that type of pain though. I have chronic pain and have a low tolerance for acute pain, esp. in that area. My Gyno said it’s no big deal. My friend who works as a PA in women’s health said to stay away from IUD’s. Many women online have reported awful pain, whether during insertion or removal. I also never had kids, so that may play a part in having low pain tolerance for that, according to what I have heard.
As you discussed, I’m thinking I just might be extra sensitive to estradiol. Though, unlike you I don’t think my body produces it on its own. Based on how things were 2 years ago when I got tested and had a low number. I could feel that it was low then. Figuring all this stuff out has been so challenging. I would just like to be at a place where I have enough hormones and no bleeding.
I hope your new system works out well for you.

@kiki21
5mm is the highest they wish to see for women on vaginal or topical estrogens, as per my gyn. They used to say the 4mm but that changed the last time I spoke with her. Also the level of thickness is important, no humps or lumps that might indicate problems.

The estrogen stimulated would be from any biopsy done with a D&C.

You might do your own research on polyps and estrogen stimulation and see what you find.

Well, the vaginal progesterone is a cream, compounded at a pharmacy. I had to laugh when I saw the comment about putting the pill inside you. I get the feeling your doctor does not use compounded medications.?

You might call your local compounding pharmacist and ask for a recommendation of hormone doctors that use compounded estriol etc and hormone tests, especially saliva or dutch. Now that you are on a patch the serum test may not test your estrogen accurately; the saliva test or the dutch test is aimed at testing where the hormones are actually used or may show how the body is processing the hormones.
The Saliva test will check at the cellular level to see what hormones are available for your body to use, and the DUTCH test measures metabolized hormones (both free and used/broken-down) in the urine over a 24-hour period, offering a deeper look into how the body is processing hormones rather than just the circulating levels.

Hormone tests have been less than accurate over the years, but all hormone testing is in a state of flux now. We really need some current and accurate research to help us all with our hormone testing decisions.
Here is an overview of the 3 ways of hormone testing and what the strengths are for each one.
https://www.zrtlab.com/resources/provider-webinars-on-demand/testing-hormones-in-saliva-dbs-urine-serum-following-hormone-administration/
Personally, I have used the serum and saliva; for awhile I did both at about the same time, because I had 2 doctors who preferred different tests.
In my experience, any change to my topical/vaginal BHRT showed up quickly in the saliva test; in the serum test it would need to be repeated at a later date to show any change.
I think this is because the saliva showed what was at the cellular level and the serum showed all the hormones whether being used or ushered out of the body and it took some time for this "ushering" number to rise. But I don't know for sure. I would love some good research.

Thank you for the additional information! My biopsy report from the D & C only says no hyperplasia. There isn’t a mention whether I have estrogen stimulated tissue. I have sent a message to my Gyn to ask about it further. Correct, she does not work with compounded pharmacies. Lol I will research the hormone testing methods. Thank you for providing a link.

@kiki21
Well, hyperplasia and stimulated should go together so without the hyperplasia there is probably no stimulated.
Sounds like it is the polyp...wonder if they can check the polyp for estrogen stimulation?

Hi, checking in to see if you’ve had any luck figuring out your issue.

I’m close to your age, I’ve had four hysteroscopies…3 for fibroids, 1 for overgrown endometrium and spotting this week. Waiting on pathology…

Anyhoo…my doc said the bleeding appeared to be from atrophy, meaning the lining did not have supporting tissue. She said from low estrogen; however, we know from labs I’m estrogen dominant (have been since my 30’s) and had normal estradiol and high total estrogen on labs but almost zero progesterone (on progestin birth control pill). Atrophy can also be from low progesterone, or using birth control pills… they put me on bcp after my first hysteroscopy and I had breakthrough bleeding until they allowed me to take a week off to have a withdrawal period each month.

As a side note my body apparently requires progesterone to convert thyroid t4…I started oral micronized progesterone a little over a month ago and started converting t4 and let’s just say it’s the first the medical world has ever heard of this… I’m rolling my eyes.

Note, I also did not spot at all for a month after stopping bcp and starting progesterone. My uterus seemed to like the natural oral micronized progesterone. I’m now increasing my progesterone to get a proper ratio of progesterone to estrogen for my endometrial health.

So…I’d ask about hormone therapy, but get hormones tested first to see if you are estrogen dominant (this was my mistake…I shouldn’t have listened to the doctor who said bcp would protect my uterus against added estrogen or maybe even estrogen dominance, it doesn’t…not only do I have a thick endometrium I have new fibroids).