What factors can cause bleeding after menopause?

Patient's question:

Postmenopausal bleeding for four years

Doctor's answer:

Postmenopausal women experiencing vaginal bleeding have two possible causes. For some women who still engage in sexual activity, due to hormonal changes after menopause, vaginal dryness can easily lead to mechanical damage of the vaginal tissues and bleeding if lubricants are not used.
Vaginal bleeding after menopause without a clear reason is often a cause for concern, as the risk of cervical cancer and uterine cancer increases with age.