This probably isn’t a newsflash, but your body changes a lot during menopause. It is, after all, getting used to the fact that you won’t get periods or be able to naturally conceive anymore—after literally decades of buying tampons and being on birth control.

The adjustment process can be long; perimenopause (aka, lead-up to menopause) can take years. This is unfortunate considering many of the symptoms women experience during perimenopause are rough, like hot flashes and mood swings.

During perimenopause, you may also have irregular periods—but once menopause hits and you haven't gotten a period for 12 months—your days of monthly bleeding are over. But what do you do if you start bleeding after menopause? Here's what to know if you think you have your period—when you're not supposed to.

So, what if you do start bleeding after menopause?

A number of things can be going on with your body if you've started bleeding after menopause, Julian Peskin, MD, an ob-gyn at Cleveland Clinic, tells Health.

But let’s be clear about one thing: It’s not your period. “If a patient’s postmenopausal, there should be no reason for them to bleed,” says Dr. Peskin. Once you’ve hit menopause, there’s no going back. So don’t try to convince yourself it’s probably just one more period to avoid another doctor’s visit.

In fact, you should definitely get to the doctor as soon as you notice postmenopausal bleeding, says Dr. Peskin. This is because, while some causes of postmenopausal bleeding are relatively harmless, others are more serious. The two that could be more complicated to treat, and potentially fatal, are endometrial cancer and fibroids that have become cancerous. In fact, “one in 10 women who present with postmenopausal bleeding will have endometrial cancer,” says Dr. Peskin. Therefore, you need to immediately get checked out if you’re bleeding down there after you’ve already hit menopause.

That said, the source of postmenopausal bleeding could be something pretty easy to deal with. Examples include benign polyps in the uterus, a vaginal infection, or even certain medications. Dr. Peskin points out that doctors evaluating patients for postmenopausal bleeding should always ask their patients about their medication history because taking hormones can cause irregular bleeding after menopause.

Additionally, the blood you’re seeing could be coming from somewhere other than your vagina. “The assumption is [the uterus is] bleeding—you always have got to think of non-gynecologic” concerns too, says Dr. Peskin. For example, hemorrhoids could be the issue, he explains. He adds that it can be difficult for a woman to know exactly where the blood is coming from if she notices it when she wipes. (FYI: Even if your bleeding is coming from somewhere other than your vagina, seeing a doctor is still necessary to rule out any serious issues like inflammatory bowel disease or colorectal cancer.)

Essentially, the bottom line is simple: Get to your doctor ASAP if you see any postmenopausal bleeding, because it's never normal to bleed out of your vagina once your periods are done. 

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