Endometrial atrophy is the most common cause of abnormal postmenopausal bleeding.
It is the reason for over half of all cases. The thin atrophic endometrium in postmenopausal women is prone to superficial ulceration that can lead to bleeding. Of course, clinically the most important cause of postmenopausal bleeding is endometrial cancer. Up until recently, women with postmenopausal bleeding always required endometrial sampling. Each of these techniques has drawbacks.