Vaginal atrophy: This is the most common cause of vaginal bleeding after hysterectomy, especially in postmenopausal women. The decrease in estrogen levels leads to thinning and drying of the vaginal walls, making them more susceptible to bleeding.

Cervical stump cancer: If the cervix was not removed during the hysterectomy, there is a risk of cervical cancer developing in the remaining cervical stump.
Vaginal cancer: Although rare, vaginal cancer can cause bleeding and should be considered in the differential diagnosis.
Urethral diverticulum or caruncle: These are benign conditions that can cause vaginal bleeding, especially if they become inflamed or infected.
Hormone replacement therapy (HRT) side effects: Women on HRT may experience vaginal bleeding due to the hormonal changes.

Uterine stump sarcoma: A rare but aggressive tumor that can develop in the remaining uterine stump after a hysterectomy.
Metastatic cancer: Cancer from other parts of the body can metastasize to the vagina, causing bleeding.
Invasive mole or choriocarcinoma: Although rare, these conditions can cause vaginal bleeding and are life-threatening if not treated promptly.

Vaginal endometriosis: Endometrial tissue can implant in the vagina, causing bleeding, especially during menstruation (if the woman is still having periods) or at any time if she is on HRT.
Vaginal adenosis: A rare condition where glandular tissue is present in the vagina, which can cause bleeding.
Foreign body: A foreign object in the vagina can cause bleeding and should be considered in the differential diagnosis, especially if the patient has a history of inserting objects into the vagina.