What is the reason for menstruation after three years of menopause?

Patient's question:

Previous laboratory test results: The uterus has small fibroids

Doctor's answer:

Postmenopausal bleeding may be caused by diseases such as those affecting the vulva, vagina, uterus, ovaries, and fallopian tubes. The causative factors could be inflammatory, endocrine (endogenous or iatrogenic), traumatic, foreign body-related, or even systemic bleeding disorders. These conditions can be either benign, malignant, or non-organic. The following are some common conditions that can cause vaginal bleeding:
1. Reproductive organ tumors. Endometrial cancer is the most common, followed by cervical cancer, often presenting as watery or bloody discharge.
2. Organic lesions. Examples include endometritis, submucosal fibroids, endometrial polyps, benign ovarian tumors, cervical erosion, polyps, and various vaginal infections, with atrophic vaginitis being the most prevalent among the elderly. Severe atrophic vaginitis may cause purulent discharge with an odor, along with spotting.
In recent years, the increasing use of estrogen replacement therapy among postmenopausal women has led to a rise in iatrogenic endocrine-related postmenopausal bleeding. Given your age, it is recommended that you undergo a gynecological examination at a hospital in the near future to rule out malignant conditions such as endometrial cancer.