The main cause of vaginal bleeding again one year after menopause is due to inflammation of the endometrium or localized hyperplasia of the endometrium. Malignant lesions of the endometrium as well as of the cervix need to be excluded. A gynecologic examination is performed to determine whether the vaginal bleeding is from the cervix or from within the cervical canal. Screening for cervical cancer is performed to rule out vaginal bleeding due to cervical lesions. Obstetrical and gynecological ultrasonography is performed to determine the thickness of the endometrium. If the thickness of the endometrium is greater than 5 mm, hysteroscopy is recommended to determine the cause of the bleeding, to rule out endometriosis, and to perform an endometrial biopsy if necessary. If the thickness of the endometrium is less than 5mm, oral hemostatic and anti-inflammatory medications can be taken temporarily and reviewed regularly.